On Monday, Italy placed its 60 million residents under lockdown, as the number of cases of the COVID-19 virus throughout the country continues to rise.
In less than a month, Italy has gone from having only three cases of the coronavirus to having the highest number of cases and deaths outside of China, with 463 deaths and at least 9, 172 of people infected throughout all 20 regions of the country. The number of cases rose by 50% on March 8 alone. Italy also faces an above average mortality rate of 4%.
“We all must give something up for the good of Italy,” Italian Prime Minister Giuseppe Conte said in a televised address on Monday while announcing the nationwide lockdown. “There is no more time.”
The nationwide lockdown is expected to have major economic repercussions on the country, where growth was already stagnating. While the government has not specified exactly how long the ban will last, it says it will remain in place until April 3.
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Here is how the virus spread across the country — and why it is so much worse in Italy than any other European country:
How did coronavirus start spreading in Italy?
Officially it began in Feb. 20, when a 38-year-old man checked himself into a local hospital in the town of Codogno in Lombardy. He tested positive with the virus, becoming the first recorded patient with the COVID-19 virus in Italy.
Yet some health officials believe that the virus arrived in Italy long before the first case was discovered. “The virus had probably been circulating for quite some time,” Flavia Riccardo, a researcher in the Department of Infectious Diseases at the Italian National Institute of Health tells TIME. “This happened right when we were having our peak of influenza and people were presenting with influenza symptoms.”
Before the first case was reported, there was an unusually high number of pneumonia cases recorded at a hospital in Codogno in northern Italy, the head of the emergency ward Stefano Paglia told the newspaper La Repubblica, suggesting it is possible patients with the virus were treated as if they had a seasonal flu. Health facilities hosting these patients could have become sites for infection, helping proliferate the spread of the virus.
The northern regions of Lombardy, Veneto and Emilia-Romagna, have been most affected by the outbreak. 85% of infected patients are in the region which is home to 92% of deaths so far. But the virus has been confirmed in all 20 regions of the country.
Why does Italy have such a high number of cases and deaths?
Because the virus spread undetected, some officials believe this is the reason for such a high number of cases in the country. “This started unnoticed which means by the time we realized it, there were a lot of transmission chains happening,” Riccardo says, noting that this may be why Italy has seen such a high number of cases.
Some officials also believe Italy, which has already tested over 42, 000 people, may have a higher number of cases as a result of performing more rigorous tests than their European counterparts.
Italy, however, is also reporting an above average mortality rate at 4%. The average age of coronavirus patients who have died because of the virus in Italy is 81, according to the National Health Institute. Italy, which has one the world’s oldest populations, could be facing a higher mortality rate as a result of its above-average elderly population. “Italy is the oldest country in the oldest continent in the world,” says Lorenzo Casani, the health director of a clinic for elderly people in Lombardy told TIME. “We have a lot of people over 65.”
Casani also suggests the mortality rate might be higher than average because Italy is testing only the critical cases. “We are not doing enough,” he said.
Casani says that pollution in northern Italy could be a factor in higher death rates. According to a report by the Swiss air monitoring platform IQAir, 24 of Europe’s 100 most polluted cities are in Italy. “Studies have shown a high correlation between mortality rates from viral respiratory conditions and pollution,” Casani says. “This could be a factor.”
Was the Italian government prepared for the outbreak?
The outbreak in Italy has come as a surprise to some, given the stringent measures Italy imposed to protect itself from the virus. A month before the first case was reported, the Italian Health Ministry created a task force to manage coronavirus. Italy was the first European Union country to ban flights to and from China.
The travel ban, however, may have encouraged travellers to come in on connecting flights without disclosing their country of departure. Some experts also believe the virus could have entered the country before the government took action, spreading undetected throughout the country.
How is the government responding now?
The Italian government has taken the biggest steps outside of China to curb the spread of the disease.
Under the new lockdown legislation, people can be issued fines for traveling within or outside the country without a permit, though foreigners still can travel to Italy. All public events are banned and schools have been cancelled throughout the country. Public spaces, such as gyms, theatres and cinemas, have also been closed by the government. Individuals who defy the lockdown could face up to three months in jail or a fine of $234. The new rules prohibit inmates from having visitors or day releases, which set off protests at 27 prisons throughout the country.
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Many have applauded Italy’s actions. In a tweet, the Director-General of the World Health Organization commended Italy for its “bold, courageous steps” and for “making genuine sacrifices.”
The government & the people of 🇮🇹 are taking bold, courageous steps aimed at slowing the spread of the #coronavirus & protecting their country & 🌍. They are making genuine sacrifices. @WHO stands in solidarity with 🇮🇹 & is here to continue supporting you.https://t.co/Y2rkgUihtA
— Tedros Adhanom Ghebreyesus (@DrTedros) March 8, 2020
Some infectious disease and public health experts, however, have concerns about the effectiveness of the lockdown.
“These measures will probably have a short-term impact,” John Edmunds, a professor at the London School of Hygiene & Tropical Medicine told Reuters, noting that the measures were “almost certainly unsustainable.” He added, “if they can’t be sustained for the long term, all they are likely to do is delay the epidemic for a while.”
How is the Italian healthcare system handling it?
Italy’s current national health service, known as Servizio Sanitario Nazionale (SSN), provides free universal care to patients yet remains under-funded. Investments in public healthcare make up only 6.8% of the country’s gross domestic product (GDP), which is lower than other countries in the European Union including France and Germany.
“The continuous cuts—to care and to research—are obviously a problem right now,” Casani says. “We were not prepared. We do not have enough doctors for the people. We do not have an organized plan for pandemics.”
With the number of coronavirus cases on the rise, the Italian health ministry has doubled the number of hospital beds in infectious disease wards. The Governor of Lombardy Attilio Fontana has requested that universities grant degrees earlier this school year in order to increase the number of nurses in Italy. Yet some health officials fear these efforts will not be enough.
“Right now in Lombardy, we do not have free beds in intensive care units,” Casani says. He added that doctors “have to make this horrible choice and decide who is going to survive and who is not going to survive…who is going to get a monitor, a respirator and the attention they need.”
What impact will the lockdown have on the Italian economy?
The lockdown could push Italy into a recession. Berenberg bank, which before the outbreak estimated that Italy’s GDP would contract by 0.3%, now forecasts it will fall by 1.2% this year.
Lombardy, the region most affected by the outbreak, account for one-fifth of Italy’s GDP. The Italian tourism sector, which makes up 13% of the country’s GDP, is projected to lose $8.1 billion, according to the Associated Press, as a result of 32 million fewer foreign travelers.
Conte said on March 9 that the government would deploy a “massive shock therapy” in order to protect the economy. Italy’s Deputy Economy Minister, Laura Castelli said in an interview with Rai Radio 1 today that “mortgages, taxes, everything is suspended” as a result of the lockdown. The government has also created a support package of $8.5 billion for families and businesses affected by virus.
Italy’s Deputy Economy Minister, Laura Castelli @LaCastelliM5s from the Five Star Movement saying decree tomorrow will suspend mortgages and taxes:
“ Mortgages suspended? Mortgages, taxes, everything is suspended.
But we need to look at the situation of the municipalities” https://t.co/fR6vwMl9T0
Some experts are concerned about the long-term implications of this spending.
Before the coronavirus outbreak, Italy was already struggling with a public debt that is at 134% of the country’s GDP. In the Europe Union, countries are not supposed to have debt that is higher than 60% of their country’s GDP. “With the increased spending that comes with having to support people and businesses, the deficit might explode,” says Pepijn Bergsen, a Europe Research Fellow at Chatham House.
An economic slowdown in Italy, a country in the Eurozone, will have impacts on the rest of the continent.
“It is likely there will be a Eurozone wide recession this year,” Bergsen says, citing both an Italian recession and potential future lockdowns in other European Union countries as contributing factors. “It will be difficult for authorities to come up with any measures that would avoid a recession.”
Please send any tips, leads, and stories to virus@time.com.
A stretcher is moved from an AMR ambulance to the Life Care Center of Kirkland where one associate and one resident were diagnosed with the novel coronavirus (COVID-19) according to a statement released by the facility in Kirkland, Washington on February 29, 2020. – The first fatality from the novel coronavirus has been confirmed on US soil, as President Donald Trump on Saturday urged Americans not to panic. (Photo by Jason Redmond / AFP) (Photo by JASON REDMOND/AFP via Getty Images)
Eleven people have now died in the United States after contracting the novel coronavirus. Ten of the U.S. deaths have been in Washington state and one has been in California, with the latest two fatalities confirmed on Wednesday.
At least 159 people have been diagnosed with the coronavirus—known as COVID-19—in the U.S. so far, according to a virus tracker from researchers at Johns Hopkins University. The infections are scattered across at least 16 U.S. states.
Pence said that all travel coming from Iran has been suspended and “even foreign nationals who visit either [China or Iran] are barred from coming into this country for 14 days.”
Pence also said that the Center for Medicaid and Medicare Services has issued new guidelines for nursing homes nationwide aiming to improve infectious disease control and ensure those operating these facilities are complying with federal standards. Many of the cases in Washington State have been linked with a nursing home.
At a press conference on Tuesday, Pence had said the U.S. is now “screening 100% of all travelers taking direct flights from all airports in Italy and South Korea” to the U.S and that Medicaid and Medicare would cover the cost for Americans who can’t afford COVID-19 testing. He added that new guidance would quickly be issued “to make it clear that, subject to a doctor’s orders, anyone can be tested.”
Federal officials noted that the American public should prepare for “more cases in the community” as the country improves its ability to track and diagnose the disease.
Outside Washington and New York, at least 14 other states have recorded confirmed COVID-19 cases. A number of these cases are Americans evacuated from the virus-stricken Diamond Princess cruise ship in Japan, where over 620 passengers and crew were diagnosed with the virus.
Globally, more than 94,000 cases of COVID-19 have been diagnosed or clinically confirmed as of March 4 and more than 3,200 people have died, according to Johns Hopkins University researchers. The vast majority of cases are in China, but diagnoses in the U.S. are expected to increase over the coming days and weeks, according to the CDC.
U.S. Citizens Document A Day In The Life On Lockdown In Wuhan
On early Wednesday morning, a U.S. plane evacuated around 240 Americans from Wuhan. Justin Steece and Priscilla Dickey were not on that plane with their families.
Here’s what to know about COVID-19 cases in the U.S.
California
California announced the state’s first COVID-19 death and State Gov. Gavin Newsom declared a state of emergency on Wednesday.
Local and federal health officials are now working to contact other cruise passengers as they “may also have been exposed,” according to Placer County health officials. Newsom said about 2,500 passengers traveled on the same voyage as the Placer Country victim.
As of Wednesday, 53 people had tested positive for COVID-19 in California. Of these, 24 were cases related to repatriation flights and 29 cases were not related to these flights; 12 were travel-related. 10 more involved person-to-person spread, four involved community transmission and three were “currently under investigation.”
Officials in Washington State confirmed a tenth coronavirus death on Wednesday and the state currently has 39 COVID-19 cases.
Nine of the deaths are in King County, and an additional death is in Snohomish County. The most recently reported deaths in King County include a woman in her eighties who was never hospitalized and died at her family home, and a man in his 50s who was hospitalized at Harborview Medical Center. Both of them died on Feb. 26 and were residents of Life Care Center in Kirkland, a long-term residential facility where more than 50 people have reported symptoms of possible COVID-19 infection.
On Tuesday, Acting U.S. Department of Homeland Security Secretary Chad Wolf said that he had ordered the facility to close “out of an abundance of caution” and “directed those employees to telework, if possible, in order to reduce the threat of community spread of the coronavirus.”
The center said in a statement Wednesday that there are several confirmed COVID-19 cases connected to the facility. It added that current residents and associates continue to be monitored closely” and that it is following the infection control recommendations from the CDC. The center had previously said all visits from family and volunteers are suspended for the time being, and new residents are currently not being admitted to the center.
King County announced an additional seven new COVID-19 cases on Tuesday. Thirty-one cases in the state, including those who died, are in King County. At least another nine are in Snohomish County, according to Washington State’s Department of Health. About 230 people at risk of having been exposed to the coronavirus are under medical supervision.
King County signed an emergency declaration on Sunday allowing it to take extra steps to respond to the COVID-19 outbreak. “Among the first actions: purchasing a motel and setting up modular housing units on publicly-owned parking lots and other available land,” the county said in a statement.
Health officials say the first patient who succumbed to the virus had no known history, travel or contact with a known COVID-19 case, suggesting he was infected by human-to-human transmission (often referred to as community transmission).
The results of a study published by Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center in Seattle, suggests that the true number of infections in the state is “a few hundred.”
The study “strongly suggests that there has been cryptic transmission in Washington State for the past six weeks,” Bedford tweeted.
Washington Governor Jay Inslee declared a state of emergency on Saturday in response to the new cases, and directed state agencies to use “all resources necessary to prepare for and respond to the outbreak.”
The first case of COVID-19 in the U.S. appeared in Washington on Jan. 21. A 35-year-old man presented himself to an urgent care clinic in Snohomish County, Wash., after four days of cough and fever, according to the New England Journal of Medicine, which reported that he had recently been visiting family in Wuhan.
The man was released from a Washington hospital on Feb. 4, according to the Associated Press.
Cruise ship evacuees
On Feb. 17, the U.S. State Department evacuated more than 300 American citizens from a quarantined cruise ship in Japan. The Diamond Princess has the largest outbreak of the novel coronavirus outside China, with at least 621 confirmed cases so far.
During the evacuation process, American officials learned that 14 of the Americans being repatriated were infected with COVID-19, according to a joint statement from the U.S. State Department and U.S. Department of Health and Human Services.
After consulting with HHS, officials with the State Department decided to allow the 14 individuals, “who were in isolation, separated from other passengers, and continued to be asymptomatic, to remain on the aircraft to complete the evacuation process,” the statement said.
CDC spokesperson Richard Quartarone told TIME hospitalized patients are at facilities in Sacramento and San Antonio, Texas, or at the Nebraska Medical Center.
Evacuees who were not hospitalized were held in quarantine for 14 days after departing planes at Travis Air Force Base in Sacramento, Calif. and Joint Base San Antonio-Fort Sam Houston in San Antonio, Texas, officials said.
Most, if not all, of these evacuees have since been released from federal quarantine.
More than 100 American citizens who had been on the Diamond Princess remained in Japan, including in hospitals, the CDC said on Feb. 18. The CDC specified that these citizens will only be allowed to fly back to the U.S. if they test negative for and don’t show any symptoms of the virus during the 14-day period.
“If an individual from this cruise arrives in the United States before the 14-day period ends, they will still be subject to a mandatory quarantine until they have completed the 14-day period with no symptoms or positive coronavirus test results,” the CDC said.
The CDC also highlighted concerns with the quarantine process on board the ship, saying that it may have slowed the spread of the disease but that it “may not have been sufficient to prevent transmission among individuals on the ship.”
New York
On Thursday, New York Gov. Andrew M. Cuomo confirmed 11 additional cases of COVID-19, bringing the total in the state to 22. Of the new cases, eight are in Westchester, two are in New York City and one is in Nassau County. “We are trying to contain as much as possible the spread of each case we find – but we expect more cases,” Cuomo said.
Thursday’s cases in New York City include a man in his 40s and a woman in her 80s; neither had traveled to areas with known outbreaks or are connected to other individuals already diagnosed with the disease, according to New York City Mayor Bill de Blasio.
On Wednesday afternoon, Cuomo confirmed five new cases, all in a single family from New Rochelle: a wife and husband in their 40s and three of their children. The entire family is under self-quarantine, Cuomo said.
On Wednesday morning, Cuomo had confirmed an additional four cases of coronavirus. All four are tied to the state’s second case of COVID-19, announced Tuesday — a man in his 50s who lives in Westchester County and works in Manhattan. Those four cases included his wife, two of his children and a neighbor who drove him to the hospital, Cuomo said.
The female child attends SAR Academy and High School in the Bronx and the male child attends Yeshiva University in Manhattan and has not been on campus since Feb. 27, according de Blasio. The children and their mother remain isolated at their home in Westchester, de Blasio said.
Cuomo noted on Tuesday that the man in his fifties had not traveled to regions with increasing COVID-19 cases, but had recently been to Miami. However he noted “that is not a place we have known there is any cluster of coronavirus.”
On Sunday, Cuomo confirmed New York’s first case of the coronavirus. He said on Twitter that a woman in her late 30s contracted the virus while traveling in Iran. She has mild respiratory symptoms but is not in serious condition, and is currently isolated in her home.
Cuomo said there is “no reason for anxiety” as the “general risk remains low in New York.” Still, residents rushed to purchase masks and hand sanitizers at pharmacies, which saw long lines out the door, according to the New York Times. Many said they were out of stock.
Nebraska
Doctors in Nebraska have treated 13 COVID-19 patients — all of whom were on the Diamond Princess cruise ship in Japan, according to the New York Times.
Texas
Texas has 12 confirmed cases of COVID-19 as of Wednesday, according to the Texas Tribune.
Eleven involve evacuees who were infected overseas before arriving at the San Antonio Lackland Air Force Base for quarantine. The only case identified outside of the site is a man in his 70s who lives in the Houston area. He recently returned from travel abroad and is currently isolated in the hospital, according to Texas Health and Human Services.
The City of San Antonio Metropolitan Health District and the CDC announced Feb. 13 that the first person testing positive for COVID-19 in Texas was one of the Americans evacuated from Wuhan and transported to the military base on Feb. 7, after leaving Wuhan the previous day.
On the morning of Feb. 11, the patient exhibited signs of a fever, Jennifer McQuiston, a CDC division deputy director, said. The person was transported to a hospital that morning, where samples were gathered and sent to the CDC overnight. Officials received the positive diagnosis the following day.
“[That patient is] receiving excellent medical care,” McQuiston said at a Feb. 13 press conference. “They were, of course, not happy to learn of their diagnosis last night, and they do have loved ones in the United States that they are in contact with by phone, and we wish this individual well.”
Dr. Anita Kurian, assistant director at the San Antonio Metropolitan Health District, also said at the press conference that “the risk for us at this time to the community here is still considered low.”
Illinois
Illinois officials said it has four “presumed positive” cases on Tuesday. The third and fourth cases are a married man and woman in their seventies.
The first case in Illinois was a woman in her 60s who had returned to the U.S. from Wuhan on Jan. 13, health officials said at a press briefing on Jan. 30. Her husband then contracted the virus, becoming the first confirmed case of person-to-person transfer of the virus in the U.S.
The Illinois Department of Public Health announced Feb. 12 that it became the first state in the U.S. to begin in-state testing for the virus.
Oregon
Oregon has confirmed three “presumptive positive” cases of COVID-19 in the state. One of those cases was confirmed by the CDC on Wednesday.
State officials confirmed a third case on Tuesday: an adult Umatilla County resident who is hospitalized in Walla Walla, Wash. Initial reports suggest that the resident recently went to a youth basketball game at a middle school. Athena-Weston School District officials closed the gym in question and would “conduct a deep cleaning out of an abundance of caution,” health officials said in a statement.
The state’s first and second COVID-19 cases are adults in Washington County who live together. Neither person has “ a history of travel to a country where the virus was circulating, nor is believed to have had a close contact with another confirmed case,” health officials said in a statement. “As such, public health officials are considering it a likely community-transmitted case, meaning that the origin of the infection is unknown.”
Florida
The CDC confirmed two cases of COVID-19 in Florida, the Florida Department of Health said on Monday. Officials said on Tuesday that a third person in the state had tested positive; she is the sister of a person already confirmed to have the virus.
The agency had said in a previous statement on Sunday that the first patient is an adult resident of Manatee County who has not traveled to countries identified for restricted travel by the CDC; the second patient is an adult Hillsborough County resident who had traveled to Italy. Both individuals would continue to “remain isolated until cleared by public health officials,” the Florida Department of Health said.
Georgia
Georgia Gov. Brian Kemp confirmed the state’s first two cases of COVID-19 on Monday evening.
Both individuals are residents of Fulton County who live in the same household; one recently returned from Italy and both are isolated at home with mild symptoms, according to a statement from the governor’s office.
“We knew that Georgia would likely have confirmed cases of COVID-19, and we planned for it. The immediate risk of COVID-19 to the general public, however, remains low at this time,” said Dr. Kathleen E. Toomey, Commissioner of the Georgia Department of Public Health.
Rhode Island
Rhode Island announced its first COVID-19 “presumptive positive” case on Sunday: a person in their 40s who had traveled to Italy in mid-February.
Dr. Nicole Alexander-Scott, Director of the Rhode Island Department of Health, said in a statement that the agency has been “preparing for weeks” and “fully anticipated having a first case of COVID-19.”
“We are not seeing widespread community transmission in Rhode Island, and the general level of risk for Rhode Islanders is still low,” Alexander-Scott said.
The agency announced a second COVID-19 “presumptive positive case” later the same day: a teenager who is “at home with mild symptoms.” She had been on the “same trip to Europe in mid-February as the male in his 40s,” according to the Rhode Island Department of Health.
“All 38 of the people who went on this trip will be self-monitoring for symptoms at home for 14 days with public health supervision, the department said in a statement. “They have been instructed to not go to school or work and to remain at home for these 14 days.”
Arizona
Arizona confirmed on Tuesday its second “presumed positive” case of COVID-19, in a man in his twenties.
“This individual is a known contact of a presumed positive case outside of Arizona who had traveled to an area with community spread of COVID-19,” the Arizona Department of Health Services news release.
The first case of COVID-19 was confirmed in Arizona by the CDC on Jan. 26. The person had also recently returned to the U.S. after visiting Wuhan. The Arizona Department of Health Services said in a public statement that the person is “a member of the Arizona State University community who does not live in university housing,” and added that they were not severely ill but would be kept in isolation.
The infected man was subsequently released from isolation 26 days after testing positive for COVID-19, according to the Associated Press.
New Hampshire
The state’s first case was announced Monday in a hospital employee who had recently traveled to Italy. Health officials later learned this person broke quarantine to attend a social event on Feb. 28 and said they would contact attendees who “had close contact with the person.”
New Hampshire announced its second “presumed positive” case of COVID-19 on Tuesday. State officials said the person, an adult male from Grafton County, had close contact with the first case and is currently isolated at home.
At this time, there is no evidence of more widespread community transmission in New Hampshire,” said state Epidemiologist Dr. Benjamin Chan in a statement after the first case was announced.
New Jersey
On Wednesday, New Jersey announced its first “presumptive positive case” of COVID-19 — a man in his 30s who has been hospitalized in Bergen County.
Health officials maintained that “most New Jersey residents” are still at low-risk.
Massachusetts
On Monday, state health officials announced a presumptive case: a woman who had recently traveled to Italy.
On Feb. 1, the CDC announced that a man in his 20s who lives in Boston was diagnosed with COVID-19; he had recently traveled to Wuhan.
The Massachusetts Department of Public Health said the man sought medical care soon after his return to Boston. He has since been in isolation, and those who came in contact with him have been identified and are being monitored for symptoms, the agency said in a public statement.
“We are grateful that this young man is recovering and sought medical attention immediately,” said Monica Bharel, Massachusetts Public Health Commissioner, in the statement. “Massachusetts has been preparing for a possible case of this new coronavirus, and we were fortunate that astute clinicians took appropriate action quickly. Again, the risk to the public from the 2019 novel coronavirus remains low in Massachusetts.”
Wisconsin
The Wisconsin Department of Health Services and the CDC announced the first case of COVID-19 in the state on Feb. 5. The person was only identified as “an adult with a history of travel to Beijing, China prior to becoming ill and was exposed to known cases while in China.”
Wisconsin health officials said in a public statement that the person is isolated at home, and is doing well.
North Carolina
North Carolina announced its first “presumed positive” case of COVID-19 on Tuesday. According to state officials, the person traveled to Washington state and was exposed at a long-term care facility where there is currently a COVID-19 outbreak.
Telling people that you are a “zero” may not get much attention. Telling people that you are a “patient zero”? That’s a different story.
Apple co-founder Steve Wozniak, who also goes by the nickname Woz, momentarily caused a stir with the following tweet:
Yeah, that’s not going to get zero reaction with the ongoing COVID-19 causing coronavirus (SARS-CoV2) outbreak occurring. The possible suggestion that he and his wife, Janet, may have been the “patient zeros” who brought the new coronavirus to the U.S. got all kinds of responses, ranging from people tweeting that Macs don’t get viruses to those wondering angrily why the Wozniaks took so long to see doctors.
A patient zero is the first human to get infected by a pathogen like a virus and then subsequently spread it to others. There can be a patient zero for the overall SARS-CoV2 outbreak, that is the first human to have contracted the virus from a non-human source such as another animal. There can also be patient zeros for outbreaks in different locations, such as the persons who first introduced the virus to each country. It can be very, very difficult to identify who really was the patient zero in each of these cases because that person may have had very non-specific symptoms or even no symptoms at all.
It turns out that all of this patient zero talk Woz probably a false alarm. As Carlie Porterfield reported for Forbes, Janet Wozniak sent USA Today an email indicating that she actually had a sinus infection, presumably a run-of-the-mill sinus infection that was not caused by the SARS-CoV2. So perhaps there is zero concern, or rather zero zero concern about the Wozniaks.
All of this shows how easy it is to mistake something else for a SARS-CoV2 infection, and vice versa. According to the Centers for Disease Control and Prevention (CDC) website, the potential symptoms of “coronavirus disease 2019” include fever, cough, and shortness of breath. That’s pretty darn non-specific.
The World Health Organization (WHO) website does add “breathing difficulties” to the list of potential symptoms. It also says that “infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.”
OK, so death is always pretty serious and would certainly merit attention. But the other symptoms may not be quite as clear. After all, lots of things can cause a fever, cough, and shortness of breath, including many different types of bacterial and viral infections and a BTS appearance. Just because you have these symptoms, does not mean that you should automatically suspect SARS-CoV2. Instead, ask yourself the following questions:
Are your symptoms severe? If so, contact a doctor as soon as possible. This includes having a temperature of over 102.5° F (39.2° C) or a cough that significantly interferes with your daily life. The prescription for a fever that high is not just more cowbell. It is medical attention. Very frequent or very severe coughing should raise concerns as well. The words “coughed up a lung,” typically shouldn’t be followed by “but everything is cool.” Similarly, distinguish between the love-is-in-the-air type of shortness of breath and real difficulty breathing. The latter calls for a call to the doctor.
Do you have any symptoms of pneumonia, severe acute respiratory syndrome, or kidney failure? Chest pain could be a sign of a pneumonia or other type of severe respiratory disease. So could night sweats, assuming that you aren’t actively doing burpees in your bed, or coughing up blood. Be concerned about any significant decrease in urination or change in the color of your urine when you didn’t just eat a bucket of beets, as these could be signs of kidney damage. Keep in mind though that you can have pneumonia, severe acute respiratory syndrome, or kidney failure without having obvious symptoms.
How long have you had these symptoms? No symptoms should last for more than week without medical attention. Not a fever. Not coughing. Not shortness of breath. In fact, anything that isn’t love and lasts for more than a week should give you pause. Also, track the course of your symptoms. If you find yourself getting better and then suddenly getting worse, contact your doctor.
Do you have any risk factors for a SARS-CoV2 infection? No, seeing someone of East Asian-descent and eating Asian food are not risk factors. We’re talking about real risk factors. Of course, the biggest one is coming into close contact with someone known to have COVID-19. So if your roommate made the news for having COVID-19, take any possible COVID-19 symptoms very seriously. In fact, if you were that close to someone who definitely had COVID-19, it’s good idea to notify your doctor even if you don’t have symptoms. Similarly, if you’ve been in a location where there’s active transmission of the virus such as Wuhan, China, contact your doctor as soon as you develop any kind of fever or respiratory symptoms. Symptoms typically begin anywhere from two to 14 days after being exposed to the virus.
You can see how recognizing COVID-19 can be very difficult without formal medical testing. You can also see how identifying a patient zero before he or she has spread the new coronavirus can be very challenging. The person could even have zero symptoms, so to speak. In the end, we may never find out who the zeros were. Nevertheless, always let your doctor know if you are worried in any way about having a new type of infection. For example, if you hear of a new infectious disease in a place that you have just visited, have a low threshold for seeking medical advice. After all, you want to make sure that you have as close to zero chances as possible of spreading that infection to others.
I am a writer, journalist, professor, systems modeler, computational and digital health expert, avocado-eater, and entrepreneur, not always in that order. Currently, I am a Professor of Health Policy and Management at the City University of New York (CUNY), Executive Director of PHICOR (@PHICORteam), Associate Professor at the Johns Hopkins Carey Business School, and founder and CEO of Symsilico. My previous positions include serving as Executive Director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Associate Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, and Senior Manager at Quintiles Transnational, working in biotechnology equity research at Montgomery Securities, and co-founding a biotechnology/bioinformatics company. My work involves developing computational approaches, models, and tools to help health and healthcare decision makers in all continents (except for Antarctica) and has been supported by a wide variety of sponsors such as the Bill and Melinda Gates Foundation, the NIH, AHRQ, CDC, UNICEF, USAID and the Global Fund. I have authored over 200 scientific publications and three books. Follow me on Twitter (@bruce_y_lee) but don’t ask me if I know martial arts.
What is COVID-19 (Coronavirus Disease 19)? The coronaviruses that circulate among humans are typically benign, and they cause about a quarter of all common cold illnesses. But occasionally, coronaviruses, like COVID-19, circulate in an animal reservoir and mutate just enough to where they’re able to start infecting and causing disease in humans. Find our complete video library only on Osmosis Prime: http://osms.it/more. Hundreds of thousands of current & future clinicians learn by Osmosis. We have unparalleled tools and materials to prepare you to succeed in school, on board exams, and as a future clinician. Sign up for a free trial at http://osms.it/more. Subscribe to our Youtube channel at http://osms.it/subscribe. Get early access to our upcoming video releases, practice questions, giveaways, and more when you follow us on social media: Facebook: http://osms.it/facebook Twitter: http://osms.it/twitter Instagram: http://osms.it/instagram Our Vision: Everyone who cares for someone will learn by Osmosis. Our Mission: To empower the world’s clinicians and caregivers with the best learning experience possible. Learn more here: http://osms.it/mission Medical disclaimer: Knowledge Diffusion Inc (DBA Osmosis) does not provide medical advice. Osmosis and the content available on Osmosis’s properties (Osmosis.org, YouTube, and other channels) do not provide a diagnosis or other recommendation for treatment and are not a substitute for the professional judgment of a healthcare professional in diagnosis and treatment of any person or animal. The determination of the need for medical services and the types of healthcare to be provided to a patient are decisions that should be made only by a physician or other licensed health care provider. Always seek the advice of a physician or other qualified healthcare provider with any questions you have regarding a medical condition.
The patient, a woman in her 30’s, is isolated in her home in Manhattan, according to a New York state official, and had recently been to Iran, according to the Times.
The patient’s test was conducted and confirmed by New York state, according to a state official, after the FDA approved the state on Saturday to run its own tests.
1.5 million masks have been distributed to healthcare workers, with New York City mayor Bill de Blasio saying 300,000 more masks are needed from the federal government, among other protective gear.
Also in New York City: 1,200 hospital beds are available for coronavirus patients, while plans for possible quarantines at hotels, hospitals and homes are being made.
New York City’s subway and bus system could limit or stagger service, according to the New York Times, and transit workers have posted thousands of signs throughout the system encouraging riders to wash hands and avoid close contact with sick people.
San Francisco preemptively declared a state of emergency Tuesday, which will free up funding from state and federal governments that will reimburse its preparedness efforts, and allows it to direct city employees to focus on coronavirus response, including public health nurses, social workers and case managers.
Crucial quote: “The patient has respiratory symptoms, but is not in serious condition and has been in a controlled situation since arriving to New York,” said New York governor Andrew Cuomo in a Sunday evening statement. “There is no reason for undue anxiety—the general risk remains low in New York.”
Big number: $40 million. That’s how much money New York state has set aside for coronavirus efforts. New York governor Andrew Cuomo said the funds will be used to hire additional staff, procure equipment and other resources to combat coronavirus, according to NBC’s New York affiliate.
Chief critic: U.S. surgeon general Jerome M. Adams. “Seriously people,” he tweeted from his official account Saturday, “STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”
What to watch for: “We encourage everyone to take the standard precautions they would during any flu season,” said Patrick Warren, chief safety officer of the New York City’s mass transit system, which means covering one’s face when they sneeze or cough and washing hands frequently. New York City health commissioner Oxiris Barbot said anyone feeling coronavirus symptoms should contact their healthcare provider.
Key background: Up until Sunday, New York City had zero confirmed cases of coronavirus, and 32 people have been tested for the disease, according to a New York state official. Only the Manhattan patient’s test results came back positive, but there are 76 total cases nationwide. New York officials have already asked 700 recent visitors from China to self quarantine. In California, 33 people have been infected, while over 8,400 more are being monitored. And the federal government is enforcing a mandatory 14 day quarantine for any citizens returning from China’s Hubei province, where the coronavirus is thought to have originated. U.S. citizens returning from other parts of mainland China will be asked to self-quarantine and be monitored by their local health departments for symptoms.
Tangent: San Francisco officials urged the public to separate the disease from ethnicity. Both SF and New York City’s Chinatowns have seen a drastic decrease in business over fears of the disease, when the virus’ transmission is mainly based on travel, according to San Francisco city health director Grant Colfax. Carmen Chu, a city assessor, said it was important “to share a message of making sure that we don’t let this disease turn us into racists…this is about contracting a virus because someone traveled.”
I’m a New York-based journalist covering breaking news at Forbes. I hold a master’s degree from Columbia University’s Graduate School of Journalism. Previous bylines: Gotham Gazette, Bklyner, Thrillist, Task & Purpose and xoJane.
Americans evacuated from China receive a health screening every 12 hours; although they have tested negative for the virus, it can incubate up to 14 days.
This photo taken on February 18, 2020 shows a worker sorting face masks being produced to satisfy increased demand during China’s COVID-19 coronavirus outbreak, at a factory in Nanjing, in China’s Jiangsu province. – The medical equipment factory switched surgical instruments and dental equipment production lines to a mask production line to meet the increased demand. (Photo by STR / AFP) / China OUT (Photo by STR/AFP via Getty Images)
f you’re worried about the coronavirus and are having trouble getting hold of medical masks, these numbers will explain why: China is the world’s largest producer of them, with a reported daily capacity of 20 million pieces, but by the estimate of its manufacturers domestic demand alone is around 50 to 60 million per day.
No wonder you can’t find medical masks at your local pharmacy.
Some experts doubt the effectiveness of such masks for stopping transmission of the virus, officially named COVID-19. U.S. health officials say the bug spreads mostly between people who are in close contact with each other, and from respiratory droplets when an infected person sneezes or coughs.
“A surgical mask might provide some protection, but it’s going to be very modest,” William Shaffner, a professor of preventative medicine at Vanderbilt University says.
But that hasn’t put a damper on demand. The scale of the epidemic in China—where the virus originated and where almost 78,500 people are now infected—and the continued spread of the coronavirus globally has driven shortages across the globe.
Retailers on multiple continents are running out of masks, and prices for a box of masks on online retailers like Amazon have surged to hundreds of dollars. On Monday, aerial footage captured a line hundreds of people long in the city of Daegu, South Korea, where an outbreak is growing, waiting to buy them. On the same day, an industrial equipment store in Italy, where more than 370 people are confirmed to be infected, sold more than 500 masks—of the kind used in factories and on building sites—in the first 30 minutes it was open.
Chinese demand is outpacing supply
Chinese mask makers were only operating at 76 per cent capacity in mid-Feb. according to Chinese officials, which puts daily production at around five million pieces fewer than the 20 million maximum. The country’s output of N95 respirators, which are often worn by medical workers for additional protection, is even lower, at 200,000 a day, given the more complex technology and materials required to make them.
Demand in China could even be higher that what its mask makers estimate. Chaun Powell, vice president of strategic supplier engagement at North Carolina-based healthcare company Premier Inc., tells TIME that China’s need might exceed 400 million medical masks every day, if each workplace provides multiple masks per employee per shift.
To meet the shortfall, some Chinese companies in unrelated industries have started making masks. Foxconn, which manufactures Apple’s iPhones in China, has switched some of its production to masks; the company aims to produce two million units a day by the end of the month. Others, like an auto-maker in south China’s Guangxi Zhuang Autonomous Region, are making masks too.
Unable to produce enough of the protective gear to meet its own demand, Beijing has also been sourcing medical masks from overseas. Indonesian officials said at the beginning of February that China had placed “large orders” for Indonesian-made masks, equating to as much as three months of production, and Vietnam has exported huge quantities of masks to China. There are reports that Chinese traders have started sourcing supplies in markets as far away as Kenya and Tanzania.
Shortages are being felt across the world
Meanwhile, pharmacies from Germany to Canada to Italy and the U.K. are all low on medical mask supplies, according to posts circulating on social media.In a post on Twitter, a journalist for Agence France-Presse said that the only pharmacy in central London she could find stocking face masks was selling them for approximately $3.25 a piece.
Stores in the U.S., from Knoxville, Tennessee to New York City are also facing a dearth of the product. One medical supply company in Dublin, Ireland said it was struggling to find a supply of masks at a reasonable cost. And dentists in the U.K. and Australia say that with so much of their supply originally sourced from China, they now are facing a desperate shortage.
Withers Dental in Toowoomba, a city of 137,000 in Australia’s Queensland state, about 80 miles outside of Brisbane, tells TIME that they are among those affected.
“It’s extremely difficult, a lot of our regular suppliers have now put limits on the number of boxes we can buy,” says Anna Yarrow, the practice manager. “We’re limited to about two to three boxes a week, which is nowhere near enough to get us through our normal day of patients.”
Yarrow says that the practice has a back up supply of masks, which they’re relying on now.
“We’re trying every day single day with our suppliers and new suppliers to see what we can manage to get,” she says. “We’re just really hoping everything settles down and gets back to normal.”
Mike Bowen, an executive vice president and partner at the Texas-based mask maker Prestige Ameritech, says that he’s now receiving calls from people across the world who want to buy medical masks from his company, even though American-made masks tend to be more expensive than those produced elsewhere.
“I’m getting hundreds of calls every single day from people wanting to buy products from me because they can’t get them anywhere else,” he says. “You name a country, I’ve heard from them.”
Bowen, who is also the spokesman of the Secure Mask Supply Association, an organization that aims to ensure a sufficient supply of masks in a health crisis, tells TIME that he’s been trying to raise awareness of China’s global dominance in the supply chain for years.
“I’ve been very public about a prediction that one day China is going to have a pandemic and we’re not going to have masks over here,” he says. “And now it’s kind of happening.”
He says that about half of the U.S. supply of face masks comes from China, with Mexico another big supplier, but he’s seen less product available from China in recent weeks as the country grapples with the outbreak at home.
Powell, of Premier Inc., says that although China has not formally announced any embargoes on exports of personal protective equipment, he believes that no such gear has shipped out of China since mid-January. Other places, like Thailand, Taiwan and India have also restricted exports of masks to protect their domestic supply.
In Hong Kong, some have taken matters into their own hands. One film director imported a machine from India with which he hopes to begin manufacturing masks to sell online, and a Hong Kong property developer has announced plans to set up a factory capable of producing 200,000 masks a day.
Medical workers are facing supply shortages
Most seriously, the shortages are hitting medical workers—even those directly treating coronavirus patients.
In early February, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization (WHO) warned that the fight against coronavirus was being hampered by “widespread inappropriate use” of protective gear by those who are not front line medical staff, and he cautioned against stockpiling masks.
“Demand is up to 100 times higher than normal, and prices are up to 20 times higher,” he said. “Global stocks of masks and respirators are now insufficient to meet the needs of WHO and our partners.”
U.S. hospitals are closely watching their mask supplies. According to the initial findings of a survey of more than 4,000 hospitals Premier Inc. ran in conjunction with the U.S. CDC and FDA, most hospitals have more than a week of inventory, but are managing and rationing mask usage to prevent shortages. Powell says that the demand for N95 masks by the U.S. healthcare system is estimated to be somewhere between 25 million and 40 million each year.
“I’m getting calls from large hospitals that used to not even answer my phone calls,” Prestige Ameritech’s Bowen says.
On Tuesday, U.S. health officials said that Americans should prepare for the the coronavirus to begin spreading locally. Health and Human Services Secretary Alex Azar reportedly told Congress Tuesday that the U.S. has far fewer medical masks than it would need in the case of a major outbreak in the country. The country has a stockpile of about 30 million N95 masks, but might need as many as 300 million during the outbreak, he said.
Bowen says that he hopes the crisis is a wake up call for U.S. hospitals who have been purchasing masks from overseas suppliers.
“What’s the difference between a Chinese mask and an American-made mask?” he asks. “Well, the main difference is [American-made masks are] here, and they’ll be available when China has a pandemic.”
