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In a Crisis, We Can Learn From Trauma Therapy

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This article is the first in a series on resilience in troubled times — what we can learn about it from history and personal experiences.

Two years ago, my notions of resilience, how it works and what it means, were remade.

I’d been struggling with the mental-health fallout from a series of car accidents — when I drove, I experienced sporadic flashbacks, feelings of panic and persistent visions of my own seemingly certain doom. I felt certain that I would crash again, and that this time I would die. Sometimes on the highway I had to pull over to hyperventilate and sob. The situation was unnerving, and dangerous.

That was my first experience with lingering trauma, and the power of those memories frightened me. Lately, as I contemplate the potential mental-health fallout from living through a pandemic, I’ve been thinking back on that time: how my visions of those accidents, my memory of my own terror as they’d occurred, seemed to reach out from the past to the present and grab me by the throat. I wonder, and I worry, about how our memories of this time will grab us in years to come.

In an attempt to relieve my trauma, I signed up for a therapy called E.M.D.R., eye movement desensitization and reprocessing.

E.M.D.R. was developed in the late 1980s and greeted with much skepticism at first. “It sounded like yet another of the crazes that have always plagued psychiatry,” Bessel van der Kolk, a trauma expert, wrote in “The Body Keeps The Score.” But clinical trials and peer-reviewed studies that spoke to its efficacy piled up over the three decades since its invention, and Dr. van der Kolk and many others eventually adopted it as part of their therapeutic practice.

It works like this: A therapist prompts the patient to move their eyes back and forth, rhythmically, behind their eyelids. (Devices that beep or buzz help to encourage and regulate the eye movements.) At the same time, the therapist talks the patient through the traumatic event or events at issue, leading them through a series of questions about how their body is reacting to the discussion. It is a strange, and strangely physical, experience. The precise mechanisms at play are not fully understood, but the theory is that something about the eye motion, combined with the focused discussion, can lay the intrusive memories to rest.

E.M.D.R. taught me an important lesson: that internal resilience can be deliberately cultivated. I suppose, if I had thought of it at all, I had thought of my emotional resilience as a kind of reservoir, there to be drawn on as needed, at least until it was drained. I had never before thought of resilience as a muscle I could train and strengthen. The idea felt empowering.

I experienced that cultivation in a kind of prequel to the main event, a process known by the dystopian-novel-worthy term “resource installation.” My therapist explained that she would have me focus on some of the sources of strength and support in my life, and in a reversal of the main therapy, we would use the eye movements to cement the good memories in my mind rather than to sweep away the bad ones. “We all have resources within us, such as memories of comfort and safety, experiences of being powerful and courageous,” writes Laurel Parnell, a clinician who is a leading proponent of the method, in her book “Tapping In.” “These memories, qualities, and images are stored in our body-mind network and can be accessed, activated, and strengthened.”

On the day of my “resourcing” session, my therapist had me select four resources from my memories: a place where I had felt my safest and happiest, a nurturing figure, a protector, and a source of wisdom.

As I held a vibrating pod in each hand, and as my eyes rolled back and forth behind my eyelids in time to their pulsing, following the vibrations from left to right and back again, I thought about my grandmother — my nurturing figure, who had died when I was 18. I pictured her at the open kitchen window of her suburban bungalow, leaning toward the window screen to exhale cigarette smoke; the deep wrinkles around her mouth and eyes and the clear plastic of her glasses; the smell of Vicks VapoRub and feel of her bony frame when we hugged. The pods pulsed. My eyes moved from side to side. I felt loved and safe. To my surprise, I felt stronger, too. In the time since, I have sometimes called up those sensory memories of my grandmother when I’m upset, or when I feel in need of support. It always helps.

Resource installation is one way to cultivate resilience, but there are plenty of other methods and approaches too, many of which do not involve paying a therapist. “It’s not a trait that’s hard-wired, and you have it or you don’t,” said Karen Reivich, the author of “The Resilience Factor” and the director of resilience and positive psychology training programs at the University of Pennsylvania. Nor is it that reservoir I had imagined, with a fixed, finite capacity. “I define resilience as the ability to navigate adversity and to grow and thrive from challenges,” Dr. Reivich added. And, she emphasized, it is an ability that can be learned.

So how do we learn? It is about small shifts in action and outlook. One critical step: Take meaningful action. “Ask yourself, what’s something I can do today, even if it’s small,” she said, “that reminds me that I am not helpless?” During a lockdown, that could mean something as mundane as doing the dishes, imposing some order on your environment. Step two: Connect to others. Our social relationships can be a critical factor in building our resilience — which, of course, is part of what makes the restrictions in place to weather the coronavirus pandemic so hard. But, Dr. Reivich added, “even if you’re not physically present with them, knowing that there are people somewhere on this globe that are cheering for you, and that you can reach out to, is a driver of resilience.”

Unlike the trauma from my car accidents, which took place entirely inside my head, the pandemic is both an external and an internal crisis. It is a disaster happening outside of us, all around us. Lucy Hone, the author of “Resilient Grieving,” is an expert on both the macro- and micro-level crisis. She has used her research into resilience to help her home city, Christchurch, New Zealand, through the aftermath of the devastating 2011 earthquake, but she has also been forced to apply that training in her own life, after the death of her young daughter in a car crash.

Dr. Hone notes that, while there is much that individuals can do to strengthen their own resilience, we are also products of the systems that surround us. “Our capacity for resilience is nested within the environment and the systems within which we live,” she said. Those systems can encompass access to health care and mental health supports during a crisis, paid time off, child care or the simple acts of support from our friends and loved ones (a meal dropped off, a joke told during a phone call). It can be tempting, she said, to emphasize the actions of the individual — but it is much easier to be resilient when you are not struggling alone with the challenges you face.

At the individual level, she invokes the Stockdale Paradox. Named for Vice Adm. James B. Stockdale, a long-term prisoner of war in Vietnam, it holds that surviving adversity means combining both optimism, or faith, that you will prevail over adversity with a bald, even brutal view of your current reality. So we hope for an improved future, while being honest about where we find ourselves; one without the other only leads to disappointment or despair.

Dr. Hone also suggests that we ask ourselves a question with each decision we make: “Is this helping me or harming me?” That third glass of wine: Does it help or harm? How about continuing to scroll through the news and social media? Going for a walk? The question is a simple framework within which to take better care of ourselves.

Small changes in our mind-sets and our choices can add up to increased resilience. “There’s nothing magical about this work,” Dr. Reivich said. “It’s hard work.”

The good news: Some of that work is instinctual. After the worst of my car accidents, when a U-Haul truck veered across the yellow line and into my lane, I found myself alone in a rural motel room. I had narrowly avoided a catastrophic head-on collision, veering onto the shoulder just in time for my Jeep to receive a full sideswipe instead. Still shaky, and covered with a fine dusting of windshield glass and small cuts, I called first one of my parents, then the other, from the room’s old landline phone. As soon as I did, I felt better.

Years before I had thought about how to cultivate my resilience, I already knew, on some deeper level, how to feel safe again. We all contain the potential to take care of ourselves and the people around us. In all the uncertainty of this frightening time, that is something to hold on to.

Eva Holland is the author of “Nerve: Adventures in the Science of Fear.”

Source: https://www.nytimes.com/2020/06/15/health/resilience-trauma-emdr-treatment.html

New York Times

Live Global Coronavirus News: U.S. Sets a Daily Record for New Cases

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Credit…Wilfredo Lee/Associated Press

Four states, including Florida and Texas, report highest single-day totals as the U.S. reopens.

More than two months after the United States recorded its worst day of new infections since the start of the coronavirus pandemic, the nation set a record on Wednesday as it reported 36,880 new cases.

The number of infections indicated that the country was not only failing to contain the virus, but also that the caseload was worsening — a path at odds with many other nations that have seen steady declines after an earlier peak. Cases in the United States had been on a downward trajectory after the previous high of 36,739 cases on April 24, but they have roared back in recent weeks.

The resurgence is concentrated largely in the South and West. Florida, Oklahoma, South Carolina and Texas reported their highest single-day totals on Wednesday, but case numbers have been rising in more than 20 states.

The tally of new cases, based on a New York Times database, showed that the outbreak was stronger than ever. The elevated numbers are a result of worsening conditions across much of the country, as well as increased testing — but testing alone does not explain the surge. The percentage of people in Florida who have tested positive for the virus has risen sharply. Increases in hospitalizations also signal the virus’s spread.

Some states, including New York, which at one point had the most daily virus cases, have brought their numbers under control. Hoping to keep it that way, New York — along with Connecticut and New Jersey — said it would institute a quarantine for some out-of-state travelers.

As of Wednesday, more than 2.3 million Americans have been infected and about 122,000 have died.

Gov. Gavin Newsom of California said that his state had recorded more than 7,000 new cases over the previous day.

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‘We Are Not Out of the First Wave,’ Newsom Warns as Virus Cases Rise

Gov. Gavin Newsom of California said the state recorded more than 7,000 new coronavirus cases in the past day and urged caution as social interactions increase.

Just a few days ago on Monday, I released our new case numbers: 4,230 new cases of people that were identified as positive for Covid-19 on Monday. You’ll see from this chart, just in the last few days those numbers have increased some 69 percent to 7,149 individuals, over 7,000 individuals, a record number here in the state of California, that have tested positive for Covid-19. We cannot continue to do what we have done over the last number of weeks. Many of us, understandably, developed a little cabin fever. Some, I would argue, have developed a little amnesia. Others have just frankly taken down their guard. We give an enormous amount of power, control and authority to local government. But what we’re now looking for is accountability at the local level. I just did a budget deal with the California Legislature, $2.5 billion in that budget, two and a half billion dollars, is conditioned on counties meeting their criteria under the emergency declaration related to Covid-19. We are not out of the first wave. This virus is virulent. This virus knows no boundaries and it knows no age cohort. It is a deadly virus and your increased likelihood of getting it as we reopen the economy, as you cohort with strangers and in mixed crowds, increases, not decreases.

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Gov. Gavin Newsom of California said the state recorded more than 7,000 new coronavirus cases in the past day and urged caution as social interactions increase.CreditCredit…Brian L. Frank for The New York Times

In Florida, Gov. Ron DeSantis gave no indication that the state would roll back its economic opening, but he urged residents to avoid closed spaces with poor ventilation, crowds and close contact with others.

Mr. DeSantis, a Republican, continued to attribute the rising infections, especially in cities, to younger people who have started to socialize in bars and homes, in spite of rules in many municipalities prohibiting group gatherings. He pressed older people to keep staying home as much as possible, and pleaded with young people to be responsible.

“You need to do your part and make sure that you’re not spreading it to people who are going to be more at risk for this,” he said.

Gov. Roy Cooper of North Carolina announced that the state would pause reopening for three weeks and require face masks. In Texas, more than 4,300 people with the virus are hospitalized, more than double the number at the beginning of June.

The World Health Organization warned on Wednesday that if the Americas were not able to stop the spread of the virus, there may be a need to impose — or reimpose — general lockdowns.

“It is very difficult to take the sting out of this pandemic unless we are able to successfully isolate cases and quarantine contacts,” said Dr. Michael Ryan, the executive director of the W.H.O. health emergencies program. “In the absence of a capacity to do that, then the specter of further lockdowns cannot be excluded.”

He said that the growing number of coronavirus cases in the Americas had not peaked and that the region was likely to see sustained numbers of cases and deaths in the coming weeks.

How the virus stayed a step ahead of the American authorities.

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Credit…Stephanie Keith for The New York Times

By mid-February, there were only 15 known coronavirus cases in the United States, all with direct links to China.

The patients were isolated. Their contacts were monitored. Travel from China was restricted.

But none of that worked, as some 2,000 hidden infections were already spreading through major cities.

At every crucial moment, American officials were weeks or months behind the reality of the outbreak. Those delays likely cost tens of thousands of lives.

The Times has analyzed travel patterns, hidden infections and genetic data to show how the epidemic spun out of control in the United States.

In other news from around the country:

  • The cliffhanger elections on Tuesday in Kentucky and New York were what election officials called a preview of what could happen after the polls close in November: no clear and immediate winner in the presidential race.

    The record number of mailed-in ballots during the pandemic has made vote-counting more unwieldy, and election administrators are straining to deliver timely results.

  • The Democratic National Convention will move out of Milwaukee’s professional basketball arena, and state delegations are being urged not to travel to the city because of concerns about the pandemic, party officials said on Wednesday.

  • With no major outbreaks among its workers, the U.S. auto industry is nearly back to pre-pandemic production levels, and vehicle sales have perked up more than many industry executives had expected.

  • The Walt Disney Company on Wednesday abandoned a plan to reopen its California theme parks on July 17, citing a slower-than-anticipated approval process by state regulators. The announcement came after some employees had criticized the reopening timetable as too fast.

  • Travelers to Hawaii can avoid the state’s 14-day quarantine by showing a negative result from a valid coronavirus test, Gov. David Ige of Hawaii announced. The program begins Aug. 1.

A C.D.C. study overlooks an important factor as it measures the effects of pregnancy on Covid-19 patients.

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Credit…John Moore/Getty Images

Pregnant women infected with the coronavirus are more likely to be hospitalized, admitted to an intensive care unit and put on a ventilator than are infected women who are not pregnant, according to a new government analysis presented to a federal immunization committee on Wednesday.

Pregnant women are known to be particularly susceptible to other respiratory infections, but the Centers for Disease Control and Prevention has maintained from the start of the pandemic that the virus does not seem to “affect pregnant people differently than others.”

The increased risk for intensive care and mechanical ventilation worried experts. But the new study, by C.D.C. researchers, did not include one pivotal detail: whether pregnant women were hospitalized because of labor and delivery. That may have significantly inflated the numbers, so it is unclear whether the analysis reflects a true increase in the risk of hospitalization.

Admission for delivery represents 25 percent of all hospitalizations in the United States, said Dr. Neel Shah, an assistant professor of obstetrics and gynecology at Harvard University. Even at earlier stages of pregnancy, doctors err on the side of being overly cautious when treating pregnant women — whether they have the coronavirus or not.

The analysis, the largest of its type so far, is based on data from women with confirmed infections of the coronavirus as reported to the C.D.C. by 50 states, as well as New York City and Washington, from Jan. 22 to June 7.

Despite the ambiguities, some experts said that the new data suggested at the very least that pregnant women with the coronavirus should be carefully monitored.

“I think the bottom line is this: These findings suggest that compared to nonpregnant women, pregnant women are more likely to have severe Covid,” said Dr. Denise Jamieson, head of the Covid-19 task force for the American College of Obstetricians and Gynecologists.

Global roundup

In Guatemala and Honduras, the virus has riddled the corridors of power.

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Credit…Orlando Sierra/Agence France-Presse — Getty Images

Coronavirus contagions have struck at the heart of two Central American governments that are struggling to contain outbreaks in their countries. In one, Guatemala, scores of presidential staff members have fallen ill; in another, Honduras, the pathogen has sickened the president himself.

The condition of President Juan Orlando Hernández of Honduras, who was hospitalized last week and who has pneumonia after testing positive for the coronavirus, was improving after adjustments were made to his treatment this week, according to a statement issued on Wednesday by his office.

Doctors detected a worsening of the pneumonia on Monday, with falling oxygen levels and increasing inflammation, the statement said, but exams on Wednesday showed “a good general condition, without fever, without respiratory difficulty” and with a decrease in inflammation.

In neighboring Guatemala, the number of members of the presidential staff who have tested positive for the virus has climbed to 158, President Alejandro Giammattei said on Wednesday.

The employees work in Mr. Giammattei’s official residential compound in Guatemala City’s historic center, and they include members of his security detail and workers on the compound’s cleaning and kitchen staffs.

Officials first announced the outbreak in early June, when there were a few dozen cases.

Mr. Giammattei said on Wednesday that one of the infected employees, a member of the presidential security service, had died.

The president, however, said that he had been tested three times and that the results had been negative.

In other news from around the world:

  • The top U.N. relief official warned on Wednesday of a drastic worsening in the outbreak in war-ravaged Yemen, the Arab world’s poorest country, where he said that 25 percent of those infected die — about five times the global average.

    Many deaths are most likely going unreported, said the official, Mark Lowcock, the under secretary general for humanitarian affairs. But there is one unmistakable measure of the virus’s toll: “Burial prices in some areas have increased by seven times compared to a few months ago,” he said.

  • About 4,000 members of a South Korean church who recovered from Covid-19 have agreed to donate their blood plasma for medical research, the church said.

  • The Australian airline Qantas will cut roughly a fifth of its work force as it joins other carriers grappling with the near halt in global travel. In addition to the reductions of at least 6,000 jobs, the company will also keep another 15,000 workers on furlough until flying resumes. It will also retire its six Boeing 747 jumbo jets six months ahead of schedule.

  • The pilots of a Pakistani airliner that crashed last month in Karachi were busy talking about the coronavirus and repeatedly ignored directions from air traffic controllers before their plane went down, killing 98 people, Pakistan’s aviation minister said on Wednesday.

  • The Eiffel Tower in Paris, one of the most visited monuments in the world, reopened on Thursday after a three-month shutdown. Visitors will be allowed only as far as the second floor, and anyone over the age of 11 must wear a face mask.

Demand soars for a steroid that showed promise in treating severe cases, an analysis shows.

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Credit…Yves Herman/Reuters

Scientists around the world last week cautiously hailed a report that an inexpensive and commonly available steroid had reduced deaths in patients with severe Covid-19. The drug, dexamethasone, is now in high demand, with orders among some U.S. hospitals rising by more than 600 percent in the week after the report, according to an analysis released on Thursday.

In a news conference on Monday, Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said interest in the drug had “surged” after announcements of its “clear benefit.” Dr. Tedros called for a sharp increase in production, while urging continued vigilance about recommended public health measures such as increased testing, contact tracing, physical distancing and hygiene.

The analysis by Vizient, an American health care services company, highlighted dexamethasone’s spike in popularity. Vizient serves more than 5,000 nonprofit health care system members and their affiliates.

Dexamethasone is frequently administered to patients with various conditions that involve excess inflammation, including arthritis, allergic reactions and certain gastrointestinal disorders. The drug, prized for its ability to tamp down certain aspects of the immune system, appears to ease the severity of some of the worst cases of Covid-19. For many infected by the coronavirus, the most severe consequences arise when immune cells and molecules, roused to fight the virus, cannot be kept in check.

Experts caution that dexamethasone is not a cure-all. Patients with milder cases of Covid-19, particularly those not on respiratory support, did not benefit from the drug, the trial’s results showed. And if the steroid is administered too early in an infection, it might even quell the immune system to a degree that compromises a person’s ability to vanquish the virus.

Economists expect 1.3 million new state unemployment claims in the U.S.

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Credit…Lynne Sladky/Associated Press

With businesses reopening in fits and starts and anxiety increasing over new coronavirus hot spots, the latest unemployment reading on Thursday is likely to offer scant comfort.

Economists surveyed by Bloomberg expect the Labor Department to report that 1.3 million new claims for state unemployment insurance were filed last week, with 20 million people continuing to collect state benefits. If the experts are correct, it would be the 14th week in a row that new claims have topped one million.

The latest data will be published amid conflicting signals for the economy. New York and some other badly affected places are starting to get back to business. But a surge in cases in states that reopened earlier has raised fears of setbacks.

On Tuesday, Gov. Greg Abbott of Texas urged residents to stay home and warned that the state might have to impose new restrictions if the virus could not be contained. And California and Florida have each posted record numbers of new cases in recent days.

Apple shut stores it had reopened in four states — Arizona, Florida, North Carolina and South Carolina — and on Wednesday, the company closed seven stores in Houston.

“The renewed outbreak will hinder the recovery,” said Carl Tannenbaum, chief economist at Northern Trust in Chicago. “I can’t help but think that the willingness of consumers to be in crowded places has diminished. It’s going to be a long haul to get back to where we were before the pandemic.”

The challenges of maintaining a distance.

With eased lockdowns in many places, keeping the recommended distance from others this summer has become more complicated. Here are ideas for handling conflicts over differing ideas of what is safe.

Reporting was contributed by Brooks Barnes, Weiyi Cai, Benedict Carey, Choe Sang-Hun, Reid J. Epstein, Rick Gladstone, James Glanz, Shane Goldmacher, Josh Holder, Apoorva Mandavilli, Salman Masood, Nelson D. Schwartz, Kirk Semple, Mitch Smith, Chris Stanford, Carlos Tejada, Daniel Victor, Derek Watkins, Jeremy Whit, Nic Wirtz and Katherine J. Wu.

Source: https://www.nytimes.com/2020/06/25/world/coronavirus-updates.html

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New York Times

Arizona ‘Overwhelmed’ With Demand for Tests as U.S. System Shows Strain

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Credit…Matt York/Associated Press

People seeking drive-up coronavirus tests in Phoenix faced a three-mile-long car line last weekend. On Friday, Arizona’s largest laboratory received twice as many samples as it could process. The phone line for testing appointments at a large site on the state fairgrounds now opens at 7 a.m. with 800 callers already in the queue.

By 7:07 a.m., all 1,000 appointments for the day are typically taken.

“We are literally overwhelmed with the numbers requested,” said Dr. Marjorie Bessel, chief clinical officer at Banner Health, the hospital system that runs the fairground site. “The testing is very popular, and very needed, but we don’t have enough of it.”

The United States’ coronavirus testing capacity has begun to strain as the pandemic continues to spread, with over 35,000 cases recorded Tuesday. Across the country, more than a dozen public laboratories say they are now “challenged” to meet the demand.

The problem has become especially acute in Arizona, where rapid spread of the virus has left health care providers and medical labs no longer able to meet testing demands.

Inadequate testing capacity has hampered the American coronavirus response since the start of the pandemic. When the federal government distributed faulty test kits in February, states were unable to monitor the disease’s early spread.

Since then, no national testing strategy has emerged. Local governments and health providers largely decide where to offer testing. And the bottlenecks today are strikingly similar to those in the pandemic’s early weeks: laboratories unable to obtain the machines they need to run more tests, scrambling to hire enough workers to staff them, and a fragmented laboratory system that makes it hard for hospitals and doctor’s offices to coordinate with facilities that could handle excess volume.

American labs continue to compete with one another as well as those abroad for testing supplies like swabs used to collect samples and the machines that process the material.

“The global supply for high-volume instruments has not been able to keep up with global demand, and that is a critical factor to increase testing capacity,” said Julie Khani, president of the American Clinical Laboratory Association. “I don’t think there is any laboratory that has an abundance, or stockpile, of any type of supplies right now.”

The surges in cases happen so quickly — some labs have seen their demand double or triple in a matter of days — that health providers have little time to broker relationships with new testing partners.

“I’m continuously frustrated that this is still a problem,” said Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories. “We should be at a place where getting a test isn’t as challenging as it used to be.”

National testing capacity has expanded significantly since the start of the pandemic, recently reaching half a million daily tests. Federal health officials testified at a congressional hearing this week that the country has the capacity to do 15 million coronavirus tests per month; they expect that number to reach 40 million to 50 million by the fall. Experts have estimated that at least 500,000 coronavirus tests daily are what the country needs to safely reopen.

But that target is a nationwide figure, and it does not account for extra testing that states and cities need to manage large outbreaks. No coordinating entity exists to help overwhelmed labs find extra capacity elsewhere.

Testing demands have grown with each day as states reopen, with employers looking to check workers who are back on the job. Some states now require certain health facilities, such as nursing homes, to regularly test their employees. Local governments are setting up new contact-tracing units that will also require ready access to tests.

Federal officials have offered mixed messages about what testing capacity is needed. The Trump administration recently phased out support for some federally funded testing sites, transferring control to the states. At a rally last week in Tulsa, Okla., President Trump said he had asked to “slow the testing down” because it was increasing the number of confirmed cases. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, testified before Congress on Tuesday that he had not received any instructions to reduce testing. Instead, he told legislators that “we need to do much, much more surveillance testing.”

Ms. Wroblewski’s organization has run regular surveys of its members to measure their testing capacity. Of the 88 laboratories that responded last week, 13 said they faced challenges meeting demand.

Those struggling to keep up, Ms. Wroblewski said, tended to be labs serving areas facing a new and large outbreak. “The nature of public lab testing is that they tend to look into outbreaks,” she said. “There are cases of increased demand, and it can take a week to adjust, to pull the staff and change the work flow.”

Testing has also become more challenging as temperatures rise. Many health providers run outdoor drive-up sites to lower the risk of disease transmission. That becomes less feasible in the heat, and some testing sites have had to close.

All of these challenges have become acute in Arizona, which has gone from reporting several hundred daily cases last month to 3,000-plus some days this week. The state recorded its highest number of coronavirus hospitalizations on Monday.

Sonora Quest, the state’s largest medical laboratory, received more than 12,000 coronavirus samples last Friday — twice as many as it can process in a day. “This is not a position we want to be in,” said Sonya Engle, the laboratory’s chief operating officer.

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


For the past two months, Sonora Quest operated with ample capacity: It could run about 5,000 tests daily, but typically the demand was for only 2,400. Testing demand grew quickly this month as the disease spread.

The lab increased capacity to 6,000 daily tests by running machines all day, every day. It would like to go even higher, but the new testing machine it ordered in May won’t arrive until July at the earliest.

“The suppliers are doing as much as they can,” Ms. Engle said. “But demand is exceeding their ability to deliver at this time.”

Many of Sonora Quest’s tests come from large drive-through sites that have not met patient demand. Equality Health, a network of medical clinics in Phoenix, had overwhelming demand at its drive-through testing event last Saturday. The clinic planned to test about 500 people but 1,000 showed up. Some had to be turned away when the site ran out of test kits.

“This is something that is usually done by health departments, not small health clinics,” said Dr. Edmond Baker, Equality Health’s medical director.

Equality Health will host another drive-up testing event this weekend. It closed registration Monday evening — five days before the event — after receiving 1,142 sign-ups.

Banner Health, the state’s largest hospital system, used to run five drive-through testing sites. In the last few weeks, as temperatures surpassed 100 degrees, it has closed all but one; it became untenable to have workers collect samples all day outdoors. Banner Health has closed four sites and moved all testing operations to the state fairgrounds, where workers in fan-cooled tents see 1,000 people a day.

The hospital system has space on the fairgrounds to see more patients but is limited by the availability of test kits. The Banner Health testing site takes about a week to return results. Dr. Bessel, the chief clinical officer, worries that those lags contribute to further spread of the disease.

“One of the downsides of long turnaround times is that some patients may start feeling better, and assume they’re negative,” she said. “They might make the run to the grocery store or get a coffee with a friend, when they really should not be doing that.”

Results for hospitalized patients, which are prioritized, have also slowed and can take more than a day to come back. That interferes with treatment and can cause health workers to use more of their scarce protective equipment.

“We can’t start convalescent plasma or remdesivir if your test is still pending,” Dr. Bessel said. “I don’t want to paint a picture of nothing being done, but having a test result helps move care along.”

Source: https://www.nytimes.com/2020/06/25/upshot/virus-testing-shortfall-arizona.html

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New York Times

Virus Cases Are Soaring in Texas. But Closing Down Again Is a ‘Last Option.’

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HOUSTON — The coronavirus has been testing America’s governors. Few are being squeezed harder than Gov. Greg Abbott of Texas.

Mr. Abbott, the governor of the country’s largest Republican-controlled state, reopened Texas in May, eager to be part of President Trump’s push to restart the economy sooner rather than later. But the reopening has backfired, creating the makings of a political and public health disaster that is putting the lives of Texans at risk, adding ammunition to Mr. Abbott’s long-running war with the Democrats who run the state’s biggest cities and drawing unusually sharp criticism from fellow Republicans.

As millions of Texans have emerged from weeks of isolation and headed to shopping malls, movie theaters and beaches, the governor, faced with an alarming number of new cases, did an abrupt about-face this week and urged people to go back home.

He imposed restrictions on outdoor gatherings of more than 100 people and has cleared the way for local authorities to require face masks in businesses — after earlier opposing attempts by local officials to require everyone in their cities to wear masks in public.

These were the latest in a series of contradictory moves by the governor that have proved confusing and frustrating to many Texans.

For weeks, Mr. Abbott had reassured Texans that the virus was largely under control. “Covid-19, while dangerous, while still growing in the state of Texas, is not as severe as it is in some other states,” he told reporters in April.

But as the state began to rapidly reopen, and people returned to restaurants, bars, malls, hair salons and gyms, the numbers — and the governor’s tone and policy responses — have changed.

New cases, hospitalizations and the percentage of positive tests have been on the rise for weeks, indicators that the coronavirus is spreading rapidly. Since late May, the average number of newly reported cases each day has more than doubled to about 3,500, up from 1,500. That is not just the result of more testing: The percentage of tests coming back positive has soared from 4.5 percent to about 9 percent. Hospitalizations are also on the rise.

Texas has surpassed more than 100,000 cases, joining a small club of only six other states to do so — New York, California, New Jersey, Illinois, Massachusetts and Florida. On Wednesday, Texas hit another milestone, recording more new cases in a single day than it has since the start of the pandemic — more than 6,200 new infections.

Wednesday brought another turnabout. Texas had previously ordered all air travelers arriving from New York, with its then-booming number of cases, to quarantine for 14 days. But on Wednesday, Gov. Andrew M. Cuomo of New York turned the tables and announced that travelers from Texas and eight other hard-hit states would have to quarantine there.

The sudden reversal has left Mr. Abbott with few good options and an array of critics from both parties — some of them the leaders of the state’s largely Democratic major cities, who have complained that the state reopened too quickly and tied their hands when they wanted to impose virus-control measures of their own.

“The governor opens up our economy and says, ‘OK, you guys go back to work,’ and we expect nothing to happen?” said Ruben Becerra, a Democrat and the county executive in Hays County, southwest of Austin, where total confirmed cases have surged from 353 on June 1 to more than 2,100 on Wednesday.

Mr. Abbott is by no means alone. Other states led by Republican governors have struggled to balance their reopenings with the spread of the virus, while navigating the politics of mask-wearing and issues of state versus local control.

In Arizona, the handling of the pandemic by Gov. Doug Ducey, a Republican, has come under intense criticism by Democratic leaders in Arizona’s largest cities. Mr. Ducey had resisted allowing mayors to make mask-wearing mandatory in their cities. But under pressure over a surge in cases, Mr. Ducey allowed mayors to implement their own measures.

On Wednesday, Florida saw a record number of new coronavirus cases, but Gov. Ron DeSantis, a Republican, gave no indication that the state would roll back its reopening, urging people instead to avoid crowds and closed spaces with poor ventilation.

Texas, though, is facing a challenge of both politics and numbers. If local trends persist, Houston could become the hardest-hit city in the country, rivaling the situation in Brazil, Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, warned this week on Twitter.

Dr. Hotez, one of the state’s leading experts on contagious diseases and vaccine development, said in an interview on Wednesday that the Houston, San Antonio, Austin and Dallas-Fort Worth metropolitan regions “are facing a dire public health emergency.”

The governor should require face masks and tougher social distancing measures in those four regions immediately, he said. “We have to take action before the end of this week,” he said. “If we don’t do something, there’s nothing to stop this thing going up the ceiling.”

Image
Credit…Mark Felix for The New York Times

Dr. Hotez and other public health experts, along with several local elected officials, have blamed the uptick in the virus on Mr. Abbott’s decision to speedily reopen the state. They said businesses were allowed to resume operations before the state had enough testing, contact tracing and other resources in place.

The results surfaced immediately in cities around the state.

San Antonio’s Bexar County had 93 patients in county hospitals on June 1, 20 of them on ventilators; by Tuesday, those numbers had jumped to 518 hospitalized, with 79 on ventilators.

“As we opened up Texas, everybody became very complacent and were not wearing face masks,” said Nelson W. Wolff, a Democrat who serves as the top elected official in Bexar County. “Then you have the president running around and not wearing one, and the governor only recommending it, not enforcing it, and so I think people got mixed signals, and we have seen it spread exponentially.”

Mr. Abbott, a former Texas attorney general now in his second term, has been praised for his calm and swift handling of Hurricane Harvey, mass shootings and other large-scale disasters. But he has also been criticized, even by some in his own party, for too often following the lead of the state’s second-in-command, Lt. Gov. Dan Patrick, an outspoken arch-conservative who made national headlines for saying he and other grandparents were willing accept the threat to their own lives if that is what it took to reopen the country.

Mr. Abbott, his aides and his supporters defended his response to Covid-19 and said Texas can both reopen its economy and maintain public health.

“People must know the facts,” Mr. Abbott told KTVT in Fort Worth on Tuesday. “The facts are that Covid-19 is expanding far faster and far wider than at any time during the pandemic in Texas. That is why we are having to take additional measures.”

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


But the governor has had to carefully navigate the state’s complicated politics in trying to control the virus.

The phased opening-up has fueled a backlash among some conservatives, who resist wearing masks in public and say the state needs to go even further. (Bars now operate at 50 percent capacity, while restaurants operate at 75 percent capacity.)

In just one example of the politics at play, the Texas Democratic Party held an online-only convention recently, while the Republican Party is planning an in-person convention in Houston in July.

Image

Credit…Ilana Panich-Linsman for The New York Times

Mr. Abbott has leaned on conservative, pro-business, small-government themes, but has also sent conflicting messages.

The governor initially resisted calls to issue a stay-at-home order, as other states had done, before issuing an executive order in early April. But even that led to a flurry of confusion, when he said at a news conference that it did not amount to a stay-at-home order. The next day, he released a video message clarifying that it did.

The order lasted 28 days, one of the shortest stay-at-home orders in the country.

Since businesses began reopening in early May, Mr. Abbott has gone head-to-head with the mostly Democratic mayors in the state’s largest cities, who have begged for more power to impose tougher restrictions. At first, Mr. Abbott’s approach was to let local officials handle the response. Then he shifted course, issuing an executive order that made it clear the state’s coronavirus rules nullified local ones. His stance shifted again in recent days when he allowed cities and counties to require businesses to have customers and employees wear masks and to fine business owners who did not comply.

Democratic critics who had been fighting for more local control said the governor’s turnabout came too late. Some Republicans saw Mr. Abbott’s move as throwing business owners under the bus.

“Business owners will become a de facto law enforcement arm, but the only tool they will have to enforce the mask requirement is to refuse to sell to their customers and to kick them out of their store,” State Senator Bob Hall, a Republican from East Texas, wrote in a posting online. “Who knew the flame of Texas Liberty would be extinguished, by the stroke of a pen, without a shot fired?”

In Galveston, a beach city southeast of Houston, Mayor James D. Yarbrough ordered mandatory face masks for all businesses starting on Tuesday. The number of people who tested positive rose to more than 300 this week from about 50 at the end of May.

The city has seen packed beaches and crowds in restaurants, bars and souvenir shops.

“There is no social distance — there are minimal masks,” said Mr. Yarbrough, a Democrat. “We are seeing a lot more younger people, what we call day trippers,” he said. “They come to spend the day and leave their trash and Covid and go on back.”

Manny Fernandez reported from Houston, Neil MacFarquhar from New York and Sarah Mervosh from Pittsburgh. Contributing reporting were David Montgomery from Austin, Simon Romero from Albuquerque and Patricia Mazzei from Miami.

Source: https://www.nytimes.com/2020/06/24/us/coronavirus-texas-abbott-masks.html

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