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Two Doctors Who Treated SARS: Beware These Behavioral Changes That Could Make The Coronavirus Pandemic Worse

Coronavirus Frontlines is a special series where we are sharing the perspective of experts at the forefront of combating the COVID-19 pandemic.

The impact of the COVID-19 pandemic on the health and wealth of the human race is unprecedented for almost every person on the planet.  The last incidence of an event of this magnitude was the Spanish Flu in 1918. There have been other pandemics caused by infectious agents in the last century — polio in the 1950s, influenza in 1957 and 1968, and more recently H1N1 in 2009 — but none of these wreaked as much havoc as COVID-19.

Human beings have tremendous difficulty in responding to unprecedented bad news – however, research has shown that our behavioral responses to it are predictable.  There are three behaviors we are observing and will continue to observe in the next few months. You should watch for these in both yourself and your loved ones to avoid falling into some mental health traps. That goes double if you’re responsible for advising decision makers, or if you are one yourself.

The first of these predictable behaviors is denial.  When we physicians break bad news to our patients, such as telling them they have a terminal illness, they often will not even hear us at first.  They use words like ‘growth’ instead of ‘cancer.’ They appear cheery in the face of awful predictions. Denial is an extremely powerful defense mechanism that allows individuals to protect themselves from completely breaking down. But the downside of denial is that it can lead to avoiding taking the essential next steps needed to avoid disaster.

In the case of COVID-19, it is clear many individuals were in denial when the images from Wuhan first emerged.  The natural reaction was, “That is far away and really can’t happen where I live.” Even when it spread through Asia, people had this same reaction. When it got to Iran, it remained easy to ignore the news, as there is little open communication with Iran. Even when it hit a Seattle nursing home, people continued to dismiss it as being far away and impacting an isolated vulnerable population.

Countries like Taiwan, which experienced SARS in 2003, avoided denial, and so were much better able to defend themselves by recognizing the threat early and proactively setting up control measures.  While denial can be useful on an individual level, it was a dire behavior for countries that were then ill prepared for this pandemic despite the clear warning signs.

The second behavior people invoke in crisis is attempting to control their immediate environment. When we treat patients in the terminal phases of their lives, it is not uncommon for troubled family members to ask us “What is his potassium level today?” This despite the detail being irrelevant to the patient’s overall health state. They can’t control the really bad thing that is happening, but it gives them comfort to focus on something they think they can control.

When COVID-19 approached, people responded by hoarding items they feared would be in short supply; both reasonable items like hand sanitizer and unreasonable items like toilet paper and over the counter cold remedies that don’t help with COVID-19. Trying to maintain control helps soothe the fear, but it is only temporary and false security. It becomes further detrimental when hoarding leads to panic.

The third behavior is the thirst for good news. Having one young patient with COVID-19 come off of a ventilator and recover can have a tremendous impact on the morale of the healthcare providers. The relief of hearing that infected friends have recovered can feel like a major victory. But the intense desire to find good news is also a trap.

During the SARS outbreak in Toronto, one of us chaired a daily conference call of clinicians in all hospitals in Ontario.  In early May 2003, it appeared the outbreak was finally contained. But on those calls one clinician voiced concern about a cluster of patients in her hospital that didn’t have clear SARS infections but warranted further investigation. The rest of us wanted it to be over so badly that our bias led us to dismiss this information and declare the outbreak controlled.  One week later, those patients created a new cluster of SARS, and we had to do it all over again.

We fully expect that in addition to the tremendous pressure to get the economy going again, that the ‘thirst for good news bias’ will rear its head with tremendous force. The same countries that used denial to cope with the start of this pandemic will fall into this trap — with dire consequences.  When we start to see reduction in the number of new cases of COVID-19, the job is far from over. This is when it gets challenging, because it is vital to continue physical distancing measures until there is a sustained reduction in cases. Despite the personal, economic and socio-political damage this causes, it is only then that public health authorities should start to lift these restrictions.

Recognizing these three behaviors, which are the natural result of normal human cognitive psychology, will be crucial in determining how this all ends (or at least how it plays out until we have an effective vaccine). And this is why we believe that while heads of governments should be accountable for what happens in their countries, they should leave the decision making to public health scientists.  Those scientists in turn would do well to consult with behavioral psychologists to weed out destructive biases, so they can devise the right strategies to save lives and get us back to normal again.

Dr. Allan S. Detsky is a Professor, Institute of Health Policy, Management and Evaluation, and Department of  Medicine at the University of Toronto; former

Dr. Isaac Bogoch is an Associate Professor at the University of Toronto in the Department of Medicine, and is an Infectious Diseases specialist and General Internist at the Toronto General Hospital with a focus on tropical diseases, HIV, and general infectious diseases. He completed medical school and Internal Medicine residency training at the University of Toronto, and then specialized in Infectious Diseases at Harvard University. He holds a Masters Degree in Clinical Epidemiology from the Harvard School of Public Health, and has completed fellowships in both Tropical Infectious Diseases and HIV care. Dr. Bogoch divides his clinical and research time between Toronto and several countries in Africa and Asia and he collaborates with a team that models the spread of emerging infectious diseases

Source: Two Doctors Who Treated SARS: Beware These Behavioral Changes That Could Make The Coronavirus Pandemic Worse

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What to Know About Coronavirus Immunity and Chances of Reinfection

Troubling headlines have been cropping up across Asia: Some patients in China, Japan and South Korea who were diagnosed with COVID-19 and seemingly recovered have been readmitted to the hospital after testing positive for the virus again.

Because SARS-CoV-2, the novel coronavirus that causes COVID-19, was only discovered a few months ago, scientists are still trying to answer many big questions related to the virus and the disease it causes. Among them is whether patients can be reinfected by the virus after they seem to recover from the symptoms.

With other coronavirus strains, experts say the antibodies that patients produce during infection give them immunity to the specific virus for months or even years, but researchers are still figuring out if and how that works with COVID-19.

The answer has huge implications for the spread of the disease, since researchers believe it will continue to crash across the world in waves, hitting the same country multiple times.

Can you get re-infected after recovering from COVID-19?

There remains a lot of uncertainty, but experts TIME spoke with say that it’s likely the reports of patients who seemed to have recovered but then tested positive again were not examples of re-infection, but were cases where lingering infection was not detected by tests for a period of time.

Experts say the body’s antibody response, triggered by the onset of a virus, means it is unlikely that patients who have recovered from COVID-19 can get re-infected so soon after contracting the virus. Antibodies are normally produced in a patient’s body around seven to 10 days after the initial onset of a virus, says Vineet Menachery, a virologist at the University of Texas Medical Branch.

Instead, testing positive after recovery could just mean the tests resulted in a false negative and that the patient is still infected. “It may be because of the quality of the specimen that they took and may be because the test was not so sensitive,” explains David Hui, a respiratory medicine expert at the Chinese University of Hong Kong who also studied the 2002-2003 outbreak of severe acute respiratory syndrome (SARS), which is caused by a coronavirus in the same family as SARS-CoV-2.

A positive test after recovery could also be detecting the residual viral RNA that has remained in the body, but not in high enough amounts to cause disease, says Menachery. “Viral RNA can last a long time even after the actual virus has been stopped.”

Keep up to date on the growing threat to global health by signing up for our daily coronavirus newsletter.

Where have patients tested positive for COVID-19 after seeming to have recovered?

A study on recovered COVID-19 patients in the southern Chinese city of Shenzhen found that 38 out of 262, or almost 15% of the patients, tested positive after they were discharged. They were confirmed via PCR (polymerase chain reaction) tests, currently the gold standard for coronavirus testing. The study has yet to be peer reviewed, but offers some early insight into the potential for re-infection. The 38 patients were mostly young (below the age of 14) and displayed mild symptoms during their period of infection. The patients generally were not symptomatic at the time of their second positive test.

In Wuhan, China, where the pandemic began, researchers looked at a case study of four medical workers who had three consecutive positive PCR tests after having seemingly recovered. Similar to the study in Shenzhen, the patients were asymptomatic and their family members were not infected.

Outside of China, at least two such cases have also been reported in Japan (including one Diamond Princess cruise passenger) and one case was reported in South Korea. All three of them reportedly showed symptoms of infection after an initial recovery, and then re-tested as positive.

Does recovering from COVID-19 make you immune?

There hasn’t been enough time to research COVID-19 in order to determine whether patients who recover from COVID-19 are immune to the disease—and if so, how long the immunity will last. However, preliminary studies provide some clues. For example, one study conducted by Chinese researchers (which has not yet been peer-reviewed) found that antibodies in rhesus monkeys kept primates that had recovered from COVID-19 from becoming infected again upon exposure to the virus.

In the absence of more information, researchers have been looking at what is known about other members of the coronavirus family. “We are only three and a half months into the pandemic,” Hsu Li Yang, an associate professor and infectious disease expert at the National University of Singapore, says. “The comments we’re making are based on previous knowledge of other human coronavirus and SARS. But whether they extrapolate across COVID-19, we’re not so sure at present.”

One study conducted by Taiwanese researchers found that survivors of the SARS outbreak in 2003 had antibodies that lasted for up to three years—suggesting immunity. Hui notes that survivors of Middle East respiratory syndrome (MERS, which is also caused by a virus related to the one that causes COVID-19) were found to last just around a year.

Menachery estimates that COVID-19 antibodies will remain in a patient’s system for “two to three years,” based on what’s known about other coronaviruses, but he says it’s too early to know for certain. The degree of immunity could also differ from person to person depending on the strength of the patient’s antibody response. Younger, healthier people will likely generate a more robust antibody response, giving them more protection against the virus in future.

“We would expect that if you have antibodies that neutralize the virus, you will have immunity,” Menachery says. “How long the antibodies last is still in question.”

By Hillary Leung April 3, 2020

Source: What to Know About Coronavirus Immunity and Chances of Reinfection

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In Singapore, Standing Too Close Can Now Get You 6 Months in Jail

In Singapore, one of the most densely populated places in with world, sitting or standing too close to another person is now a crime, punishable by up to six months in jail or a $7,000 fine.

The new laws came into effect on Friday as the city-state takes drastic measures to try to curb the spread of COVID-19 amid a surge in new cases linked to travelers who have come from other parts of the world.

Anyone who intentionally sits less than one meter (a little more than three feet) away from another person in a public place or who stands less than a meter away from another person in a line will be guilty of an offense, according to rules published by the country’s health ministry. The new restrictions also ban people from sitting on fixed seats that have been marked to indicate they should not be occupied. The measures, which are expected to be in place until April 30, apply to business and individuals.

The Singaporean government also closed bars and nightclubs and placed limitations on gatherings of more than 10 people and banned large events.

Singapore confirmed its first case of COVID-19 on Jan. 23, but officials there were able to stave off a major outbreak from spreading from mainland China thanks to aggressive testing, contact tracing and strict quarantine measures. But now Singapore, like several other cities in Asia, is facing a second wave of infections.

Will Coronavirus Ever Go Away? Here’s What One of World Health Organization’s Top Experts Thinks

Dr. Bruce Aylward was part of the WHO’s team that went to China after the coronavirus outbreak there in January. He has urged all nations to use times bought during lockdowns to do more testing and respond aggressively.

On Thursday, officials in Singapore confirmed 52 new cases of the virus. Twenty-eight of those were imported cases, many with a travel history to Europe, North America, the Middle East, and other parts of Asia.

Other governments in the region, which largely avoided large-scale lockdowns that are now taking place across the U.S. and Europe, are introducing increasingly strict measures in the fight against the coronavirus, in the hopes of stopping a resurgence of the illness. The Hong Kong government this week announced that it was considering a ban on serving alcohol at bars and restaurants. Chinese authorities said that they will ban the arrival of most foreigners into the mainland from March 28, in an attempt to stop the virus from coming in from overseas.

The number of people infected with the coronavirus in Singapore rose to 683 on Friday. More than 500,000 people in over 175 countries and territories are now infected by COVID-19.

By Amy Gunia March 27, 2020

Source: In Singapore, Standing Too Close Can Now Get You 6 Months in Jail

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Critics: USCIS Policies Make Immigration Difficult And Dangerous

In the age of coronavirus, policies imposed by U.S. Citizenship and Immigration Services (USCIS) are making it difficult for businesses, high-skilled professionals and others to file applications and meet deadlines. Attorneys say that although USCIS has made one positive accommodation their clients deserve policies that better take into account the new health and safety realities of doing business under social distancing, remote work and USCIS office closures.

In general, USCIS policies are years behind and have not adapted to the modern work environment, which has become more evident in the face of worldwide concerns about coronavirus. A glaring example, attorneys say, is USCIS still does not permit electronic filing for the most commonly used employment-based forms.

While USCIS service centers continue to operate, many businesses are following the recommendations of health experts and have moved to remote work. Paper-based applications and hard copy checks to pay filing fees are still required for most employment-based petitions. Vic Goel, managing partner of Goel & Anderson, said USCIS has not indicated it will relax or grant leniency on required filing dates and Requests for Evidence (RFE) response dates.

“Employers and law firms are straining to maintain paper-based processes while working remotely,” said Goel in an interview. “Particularly in areas where people have been told to temporarily close, as in California, New York, Illinois and Pennsylvania, it has become difficult to comply with USCIS requirements and meet filing deadlines.”

On March 20, 2020, USCIS made an accommodation welcomed by attorneys and employers by relaxing the requirement to obtain “wet” signatures on forms. “For forms that require an original ‘wet’ signature, per form instructions, USCIS will accept electronically reproduced original signatures for the duration of the National Emergency,” USCIS said in a statement. “This temporary change only applies to signatures. All other form instructions should be followed when completing a form.”

“The relaxation of the signature requirement helps but USCIS has not addressed the fact that applications are still paper-based or that the agency requires hard copy checks,” said Goel.

A practical solution would be for USCIS to allow filing fees to be charged on a credit card for all form types using Form G-1450, which is now permitted only for applications processed at a USCIS lockbox and, therefore, excludes the major employment-based applications filed at USCIS service centers. Goel notes USCIS also could issue an interim final rule to allow ACH payments direct from a bank using Form G-1450. Applications (or petitions) filed at service centers include H-1B, H-2A, H-2B, H-3, L-1, O-1, TN and a few others.

While the annual H-1B lottery garners most of the media attention, USCIS adjudicates more than twice as many H-1B petitions each year for continuing employment. (These are extensions for existing H-1B visa holders.) In addition, employers often need to file amendments for H-1B employees, including when they must work in a new metropolitan statistical area (MSA). There are also many applications for L-1 visa holders and employment-based immigrants that need processing.

Goel and other attorneys note current USCIS practices go against Centers for Disease Control and Prevention (CDC) guidelines for controlling coronavirus. The process of gathering documents, forms and checks means Goel’s law firm has been forced to circulate employees in and out of the firm’s offices rather than permit everyone to work from home.

USCIS is not the only government agency whose policies have been questioned. Immigration and Customs Enforcement (ICE) has been criticized for requiring attorneys to provide their own protective gear to visit clients in detention. “ICE/ERO [Enforcement and Removal Operations] now requires all legal visitors, CODELs, and STAFFDELs to provide and wear personal protective equipment (PPE) (disposable vinyl gloves, N-95 or surgical masks, and eye protection) while visiting any detention facility,” according to ICE guidelines. Attorneys point out there is currently a shortage of such equipment.

Many foreign nationals are facing crucial deadlines and, unlike in a number of other countries, USCIS has not relaxed immigration deadlines. France has extended all expiring residence permits for 90 days, according to the Fragomen law firm, while Ireland has provided a “blanket two-month automatic renewal of immigration status for all foreign nationals whose status is due to expire March 29 to May 20, 2020.”

USCIS offices are closed at least until April 1, 2020. However, a new government directive discourages people gathering in federal offices. Combined with other concerns, the directive could delay reopening USCIS offices to the public.

The problem, Jeffrey Gorsky, a senior counsel with Berry Appleman & Leiden, said in an interview is many applications require in-person interviews or access to a USCIS office. For example, USCIS requires interviews as part of the process to obtain family-based and employment-based adjustment of status (to obtain a green card inside the United States). The same is true for naturalization. For several other immigration applications, biometrics collection (photos and fingerprints) must be done at USCIS offices.

The spouses of H-1B visa holders and individuals with Deferred Action for Childhood Arrivals (DACA), among others, are likely to miss deadlines to renew Employment Authorization Documents (EADs) if USCIS office closures continue, note attorneys. Without an EAD many individuals cannot work legally in the United States. “USCIS remote work agreements, office closures and staff reductions portend more and more interview cancellations, appointment reschedulings, adjudication delays and backlog buildups that will likely become worse over time,” according to  the Seyfarth law firm.

“If the effects of the virus severely disrupt USCIS’s operations, the agency will likely not be able to decide requests to extend or renew work visa status or temporary employment authorization (for persons in the employment-based green card queue filing for adjustment of status) within an acceptable turnaround time,” writes Seyfarth. “Current regulations allowing interim employment authorization while an extension or renewal request is pending – up to 240 days to extend status for most work-visa holders and 180 days for adjustment of status applicants under current regulations – could thus prove to be insufficient.”

Seyfarth concludes: “Unless USCIS takes action to prolong and expand interim grants of employment authorization for pending immigration benefits requests, or otherwise excuse status violations, the situation for employers and their noncitizen temporary workers (and families) will become dire.”

In a March 16, 2020, statement, the Alliance of Business Immigration Lawyers (ABIL) urged U.S. Citizenship and Immigration Services, the State Department and other federal agencies to “announce the immediate suspension of all immigration compliance deadlines in order to help minimize harms to public safety and business continuity caused by the COVID-19 pandemic.”

In sum, critics say USCIS can adapt its policies to the new realities of coronavirus – or it can continue its old ways that have made life more difficult and dangerous for attorneys, employers and immigrants.

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I am the executive director of the National Foundation for American Policy, a non-partisan public policy research organization focusing on trade, immigration and related issues based in Arlington, Virginia. From August 2001 to January 2003, I served as Executive Associate Commissioner for Policy and Planning and Counselor to the Commissioner at the Immigration and Naturalization Service. Before that I spent four and a half years on Capitol Hill on the Senate Immigration Subcommittee, first for Senator Spencer Abraham and then as Staff Director of the subcommittee for Senator Sam Brownback. I have published articles in the Wall Street Journal, New York Times, and other publications. I am the author of a non-fiction book called Immigration.

Source: Critics: USCIS Policies Make Immigration Difficult And Dangerous

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They leave their communities and loved ones behind for a better life in the United States. The journey is perilous and survival is not guaranteed. Illegal immigration. Which side of the fence are you on? Walk in the footsteps of these Migrants. Watch Borderland, Sundays only on Al Jazeera America. http://alj.am/borderland

Mapping the Spread of the Coronavirus Outbreak Around the U.S. and the World

ince the first case of COVID-19 was identified in central China in December, the illness has spread across the world, leading to an outbreak that the World Health Organization has called a pandemic. The maps and charts below show the extent of the spread, and will be updated daily with data gathered from over a dozen sources by the Johns Hopkins University Center for Systems Science and Engineering.

Where COVID-19 has spread in the U.S.

Testing for the novel coronavirus that causes COVID-19 was slow to roll out in the U.S., but as more and more Americans get tested, it’s becoming clear that the illness is already spreading in the U.S. It has now been confirmed in some three dozen states, with the largest clusters in Washington state, California and New York.

Where COVID-19 has spread around the world

Over 110 countries and territories, representing every corner of the globe, have now reported at least one case of the novel coronavirus. In total, there are now over 125,000 cases and over 4,600 related deaths.

Which countries have the most COVID-19 cases?

China remains the country with the most coronavirus cases and related deaths, by a significant margin. However, in recent weeks, China has seen fewer and fewer new cases per day, while the count in places like Italy, Iran, Germany, France and the U.S. have risen.

Keep up to date with our daily coronavirus newsletter by clicking here.

Here’s what you need to know about coronavirus:

By Elijah Wolfson

Source: Mapping the Spread of the Coronavirus Outbreak Around the U.S. and the World

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The video shows the timelapse of the coronavirus by map worldwide since January 20, 2020. It first started in Wuhan, Hubei, China, then spread to more than 80 countries by March 5, 2020. Twitter: https://twitter.com/wawamustats Facebook: https://fb.me/wawamustats Source: World Health Organization & CDC Special Thanks to Our Patron: C&MHansen Subscribe here: https://www.youtube.com/wawamustats?s…

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