NY governor begs for help amid ‘staggering’ death toll at outbreak’s epicenter

New York’s governor issued an urgent appeal for medical volunteers Monday amid a “staggering” number of deaths from the coronavirus, as he and health officials warned that the crisis unfolding in New York City is just a preview of what other communities across the US could soon face.

“Please come help us in New York now,” Gov. Andrew Cuomo said as the state’s death toll climbed by more than 250 in a single day for a total of more than 1,200 victims, most of them in the city. He said an additional 1 million health care workers are needed to tackle the crisis.

“We’ve lost over 1,000 New Yorkers,” Cuomo said. “To me, we’re beyond staggering already. We’ve reached staggering.”

Even before the governor’s appeal went out, close to 80,000 former nurses, doctors and other professionals in New York were stepping up to volunteer, and a Navy hospital ship, also sent to the city after 9/11, had arrived with 1,000 beds to relieve pressure on the city’s overwhelmed hospitals.

“Whatever it is that they need, I’m willing to do,” said Jerry Kops, a musician and former nurse whose tour with the show Blue Man Group was abruptly halted by the outbreak. He returned to his Long Island home, where he volunteered to be a nurse again.

Kops has been waiting to be reinstated since mid-March and said Monday that the state has sent him an email survey or questionnaire several times, without acting on it. In the meantime, he has been helping at an assisted living home near his residence in Shirley, NY, and is considering sending his resume himself to various hospitals.

In Europe, meanwhile, hard-hit Italy and Spain saw their death tolls climb by more than 800 each, but the World Health Organization’s emergency chief said cases there were “potentially stabilizing.” At the same time, he warned against letting up on tough containment measures.

“We have to now push the virus down, and that will not happen by itself,” Dr. Michael Ryan said.

Three-quarters of a million people around the world have become infected and more than 37,000 have died, according to a count by Johns Hopkins University.

The US reported nearly 160,000 infections and over 2,900 deaths, with New York City the nation’s worst hot spot, but with New Orleans, Detroit and other cities also seeing alarming clusters.

“Anyone who says this situation is a New York City-only situation is in a state of denial,” Cuomo said. “You see this virus move across the state. You see this virus move across the nation. There is no American who is immune to this virus.”

Dr. Anthony Fauci, the US government’s top infectious-disease expert, similarly warned that smaller cities are likely about to see cases “take off” the way they have in New York City.

“What we’ve learned from painful experience with this outbreak is that it goes along almost on a straight line, then a little acceleration, acceleration, then it goes way up,” he said on ABC’s “Good Morning America.”

In other developments around the world:

Bells tolled in Madrid’s deserted central square and flags were lowered in a day of mourning as Spain raced to build field hospitals to treat an onslaught of patients. The death toll topped 7,300.

In Japan, officials announced a new date for the 2020 Tokyo Olympics — summer of 2021 — as a spike in reported infections fueled suspicions that the government had been understating the extent of the country’s outbreak in recent weeks while it was still hoping to salvage the Summer Games.

Moscow locked down its 12 million people as Russia braced for sweeping nationwide restrictions.

Israel said 70-year-old Prime Minister Benjamin Netanyahu is quarantining himself after an aide tested positive for the virus. And in Britain, Prince Charles, the heir to the throne who tested positive for the virus, ended his period of isolation and is in good health, his office said.

Italy’s death toll climbed to nearly 11,600.

But in a bit of positive news, newly released numbers showed a continued slowdown in the rate of new confirmed cases and a record number of people recovered.

“We are saving lives by staying at home, by maintaining social distance, by traveling less and by closing schools,” said Dr. Luca Richeldi, a lung specialist.

At least six of Spain’s 17 regions were at their limit of intensive care unit beds, and three more were close to it, authorities said. Crews of workers were frantically building more field hospitals.

Nearly 15% of all those infected in Spain, almost 13,000 people, are health care workers, hurting hospitals’ efforts to help the tsunami of people gasping for breath.

In a sign of the mounting economic toll exacted by the virus in the United States, Macy’s said it would stop paying tens of thousands of employees thrown out of work when the chain closed its more than 500 department stores earlier this month.

The majority of its 130,000 workers will still collect health benefits, but the company said it is switching to the “absolute minimum workforce” needed to maintain basic operations.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with existing health problems, the virus can cause severe symptoms like pneumonia. More than 160,000 people have recovered, according to Johns Hopkins.

The crisis in China, where the outbreak began in late December, continued to ease. China on Monday reported 31 new COVID-19 cases, among them just one domestic infection, and the city at the center of the disaster, Wuhan, began reopening for business as authorities lifted more of the controls that locked down tens of millions of people for two months.

“I want to revenge-shop,” one excited customer declared.

Japanese automaker Toyota halted production at its auto plants in Europe, but all of its factories in China resumed work Monday.

How would overwhelmed hospitals decide who to treat first?

A nurse with asthma, a grandfather with cancer and a homeless man with no known family are wracked with coronavirus-induced fevers. They are struggling to breathe, and a ventilator could save their lives. But who gets one when there aren’t enough to go around?

Health care workers are dreading the prospect of such dire scenarios as US hospitals brace for a looming surge in patients who need breathing machines and other resources that could soon be in critically short supply.

That has meant dusting off playbooks they’ve never before had to implement on how to fairly ration limited resources during an emergency.

“I pray for their good judgment and their capacity as they make very difficult choices,” said Erik Curren, whose 77-year-old father died this month from respiratory complications related to the virus after becoming infected at an assisted living home in Florida.

Harrowing scenarios already are unfolding in country after country hard-hit by the COVID-19 pandemic, including Spain, where one nursing home official said sick residents are dying after being unable to get into overflowing hospitals.

Like much of the rest of the world, ventilators that help people breathe are in particular demand across the US, given the respiratory problems common among people severely ill with COVID-19.

As many as 900,000 coronavirus patients in the US could need the machines during the outbreak, according to the Society for Critical Care Medicine. Yet the group estimates the country has only 200,000, many of which already are being used by other patients.

In New York, the US epicenter of the outbreak, one city hospital has already logged 13 coronavirus deaths in a single day and officials are setting up hundreds of hospital beds in a sprawling convention center as cases climbed past 30,000 in the city.

In preparation, health officials across the country are reviewing guidelines from sources including state governments and medical groups on how to ration limited resources in emergencies.

The general principle spanning those plans: Bring the most benefit to the greatest number of people and prioritize those with the best chance of recovery. But exactly how that’s determined is fraught.

Automatically excluding certain groups from receiving ventilators, such as those with severe lung disease, invokes ethical issues, said Dr. Douglas White at the University of Pittsburgh. Many hospitals seeking guidance on COVID-19 in recent weeks have adopted a policy he devised without such exclusions, he said.

Guidelines previously developed by New York state’s health department exclude some seriously ill people from receiving limited ventilators in major emergencies, but note that making old age an automatic disqualifier would be discriminatory.

The plans go on to add, however, that given the “strong societal preference for saving children,” age could be considered in a tie-breaker when a child’s life is at stake.

Recommendations published this week by German medical associations in response to COVID-19 also say age alone shouldn’t be a deciding factor. Among the situations where they said intensive care should not be provided if availability is in short supply: if the patient would need permanent intensive care to survive.

The crushing emotional burden of carrying out potentially life-and-death decisions is why the guidelines typically designate separate triage teams to make the call, rather than leaving it to the doctors and nurses providing bedside care.

“This is a really terrifying decision — you don’t want any doctor or nurse to be alone with this decision,” said Nancy Berlinger of the Hastings Center, a bioethics research institute.

Having separate teams make decisions also is intended to ensure patients get a fair shot at care regardless of their race, social status or other personal factors.

Berlinger noted that underlying social inequities can still persist — for example, poorer people tend to be sicker — but that those are deeper injustices that can’t be remedied in the throes of a pandemic.

Another grim calculation that experts say hospitals could make is how long a patient might need a hospital bed or ventilator and how many more lives the machine might otherwise save. That would help forestall an even more wrenching decision many doctors in the US likely have never faced — whether to take a patient off a machine to free it up for others.

The norms don’t apply in the current crisis and taking precious resources away from one patient to save others in a pandemic “is not an act of killing and does not require the patient’s consent,” said a paper addressing the COVID-19 emergency published last week in the New England Journal of Medicine.

The authors noted that patients and their families should not be shielded from the realities and should be warned in advance of the possibility their loved one could be taken off a machine.

Hospitals should also prepare alternatives for those who don’t make it to the top of the list for limited resources, such as stocking up on morphine, said Philip Rosoff of Duke University’s Trent Center for bioethics.

It’s not yet known how dire the crisis in the US will get. Last week, Dr. Deborah Birx, the White House coordinator for the coronavirus response, sought to calm fears, noting there’s no evidence yet that a hospital bed or ventilator won’t be available for Americans when they need it. Even in New York, she said, beds are still available in intensive care units and a significant number of ventilators aren’t being used.

But what’s happening overseas has health care workers around the world preparing for worst-case scenarios.

In France and Spain, hospital and nursing officials say nursing home residents who come down with symptoms of coronavirus are not necessarily admitted to intensive care.

In hard-hit regions, “they are hospitalized only when there is a chance to save them,” said Marc Bourquin of the French Hospital Federation.

Jesús Cubero, general secretary of AESTE, an association of nursing homes, said some residents end up dying after being unable to get into full hospitals.

In northern Italy, Dr. Luca Lorini at the Pope John XXIII hospital in hard-hit Bergamo, compared how patients are being triaged to people waiting for an organ transplant.

”One heart and 10 people who are waiting for a heart transplant. Who gets the heart? The one who has the greatest chance of living better and longer with that heart,” he said.

In the US, the rapidly multiplying cases is creating fear that hospitals could soon be overwhelmed.

“The fact that we’re in a situation that one day we may not have enough ventilators is terrible and unacceptable,” said Zachary Shemtob, whose husband has been sedated and on one of the machines at NYU Langone hospital since testing positive for the virus.

Curren, the Virginia man whose father died of COVID-19 last week, said he wouldn’t fault health-care workers for any of the agonizing decisions they may have to make in coming weeks — and trusts that they have the training to do so.

“These people are doing a fantastic job under war-time conditions,” he said.

Header: Medical staff carry a patient infected with coronavirus on a stretcher, during a stopover of the medicalized TGV train from Strasbourg, in Angers, western France, on March 26, 2020 (JEAN-FRANCOIS MONIER / AFP)


700 IDF troops, mostly unarmed, to join police in enforcing partial lockdown

Some 700 troops, most of them unarmed, are set to be deployed across the country to help police officers enforce the government’s partial lockdown, the government said Monday.

The extraordinary measure was approved by the cabinet Monday evening, as officials said thousands more soldiers could be called into service in the future, if the lockdown tightens.

Police officers at a synagogue in the ultra orthodox Jewish neighborhood of Meah Shearim as they close shops and disperse public gatherings following the government’s decisions, in an effort to contain the spread of the coronavirus. March 30, 2020. Photo by Olivier Fitoussi/Flash90

The troops will conduct patrols alongside police officers, who will run the operation, according to a statement from Public Security Minister Gilad Erdan’s office.

The contingent had originally been slated to join enforcement efforts on Sunday.

Following a number of deliberations on the matter, the government decided that the soldiers will not carry weapons, except for commanding officers and those serving in West Bank settlements.

Erdan’s office said it had been agreed that additional soldiers may be deployed if the lockdown became more strict. According to the Israel Defense Forces, a total of eight battalions — each of which contains a few hundred soldiers — have been designated for this purpose, with the possibility of doubling that if necessary.

The deployment of the IDF inside Israel proper is an exceedingly rare occurrence and a complicated, sensitive mission for the military, which is more used to serving in the West Bank and on the country’s borders to fight terrorism and repel foreign attacks, respectively.

As such law enforcement operations within Israeli cities are not in the military’s normal playbook, the troops involved have undergone rapid specialty training on the matter, according to the IDF.

The 700 soldiers — eight companies’ worth — will come from the military’s various training bases and will assist police by performing patrols, ensuring people remain in quarantine, blocking roads, and protecting the officers, according to the military.

One company would be deployed to each of the Israel Police’s eight districts across the country and the West Bank.

“The soldiers will undergo training for the mission and preparation for operating in the civilian space,” the IDF said last week.

Since Wednesday, March 25, at 5 p.m., Israelis have been ordered to remain in their homes, unless they are taking part in a small number of specially designated approved activities, including purchasing food and medicine.

Those found violating those regulations are subject to large fines of upwards of NIS 500 ($140) and even imprisonment.

The government was also considering ordering a yet more dramatic full national lockdown, in which nearly no one would be allowed to leave their homes under any circumstances, in a bid to curb the spread of the coronavirus to prevent a collapse of the country’s healthcare system.

Israeli troops pack boxes of food as part of the military’s preparations to support the country’s supply lines in light of the coronavirus pandemic in March 2020. (Israel Defense Forces)

The IDF has been gradually getting more and more involved in the national response to the coronavirus pandemic, assisting the country’s other emergency response services and working with local governments to prepare for the crisis.

The Shin Bet security service has also played a critical and controversial role in the government’s efforts with a contentious mass surveillance program to retrace the movements of confirmed coronavirus carriers in order to identify people they may have infected. The Mossad spy agency has also been working to help bring test kits to Israel from abroad.

According to the Health Ministry, as of Monday night, there have been at least 4,695 confirmed cases in Israel. Sixteen people have died, 79 people are in serious condition and 90 in moderate condition. The vast majority — 4,349 — displayed only light symptoms, and 161 people have fully recovered from the disease.

Header: Police officers at a synagogue in the ultra-Orthodox Jewish neighborhood of Mea Shearim, as they close shops and disperse public gatherings following the government’s decisions, in an effort to contain the spread of the coronavirus. March 30, 2020. (Yonatan Sindel/Flash90)

US expert: Israeli response to coronavirus crisis is ‘right on target’

When American medical expert Dr. Martin Zand visited Israel recently, the first coronavirus cases in the country were diagnosed and publicized. He got on a plane back to the United States shortly afterwards, but he’s kept thinking about the COVID-19 pandemic, and the responses to it in both the US and Israel.

Zand is tackling the pandemic from many angles at the University of Rochester Medical Center in Rochester, New York. A practicing physician, he is the medical center’s senior associate dean for clinical research, as well as the co-director of its Clinical and Translational Science Institute. He coordinates the center’s research response to the COVID-19 pandemic.

He described his role in a phone interview with The Times of Israel as “a combination between an air-traffic controller and a matchmaker,” adding, “I match needs with resources, trying to harmonize these efforts.”

Asked how he keeps himself calm, Zand said that “you have to remain calm in order to be effective and get things done. Pray for the best possible response in bringing cutting-edge therapies to our community and national efforts. Panic is not going to help.”

Zand stayed with family during his visit and he’s been able to continue monitoring the COVID-19 responses in both the US and Israel.

“From what I can see from the news, the response in Israel has actually been right on target,” Zand said. “Social distancing, travel restrictions, the testing and the hospital preparedness, the national response has all been very good.”

He’s a little more critical when it comes to the US. He says there is a “national shortage of a whole variety of supplies for COVID-19 testing.”

Dramatically, in a press conference on March 25, New York Gov. Andrew Cuomo pleaded with the Trump Administration to send badly-needed ventilators to help his state, which he called “the canary in the coal mine.”

“We have the highest and the fastest rate of infection,” Cuomo said. “Deal with the issue here. Deploy the resources. Deploy the ventilators here in New York for our apex. And then, after the apex passes here, once we’re [past] that critical point, deploy the ventilators to the other parts of the country where they are needed.”

Asked about such a system of sequential sharing, Zand said that its concept “is to make sure we shift resources to places that have the most need,” and that his labs have shifted to provide reagents for tests.

He said there is “a national shifting in the US of resources,” and although he has “not been involved in these discussions,” he said, “I know there is coordination in the Rochester health care system to make sure that everyone has adequate resource bases to take care of patients, and at this point there were some discussions about shifting resources to other parts of the country.”

Pros and cons of centralized or decentralized health care

Zand feels that the decentralized American system of state and county government sometimes works to the nation’s disadvantage. He notes that states and counties all have their own departments of public health, “and at a national level, you don’t have an overruling coordinator of those state efforts in the same way that Israel does.”

According to Zand, “I think the most important contrast between Israel and the US health care system with respect to the COVID-19 pandemic is that Israel has a centralized health care system as well as a central public health care system. That has really helped coordinate the response across the country.”

He said that there are also efforts being coordinated in the US, “but it’s easier to achieve synchrony when you have an integrated national public health system.”

One way Zand sees this reflected in the two countries is in terms of social distancing. He explained that “in the US, because there’s no centralized public health system, social distancing measures are being adapted or defined differently by states.”

He cited “nuances of social distancing in different areas, attempts to deal with hardships of social distancing, especially for people who are involved in critical industries or health care during the crisis and need to work.” And, he asked, “what do you do for single parents who have children at home? How do you work from home when taking care of your elderly family members? … I think we’re all struggling with it.”

Yet, he said, social distancing is one of the “essential pieces” in fighting the virus, a practice that is “really widely accepted and recognized,” along with sheltering in place, maintaining a distance of two meters from people who are outside, hand-washing, only going out for groceries, medical care or medications, and closing all nonessential businesses in high-risk areas.

“That’s certainly what Israel did early,” Zand said. “Those are a good thing.”

That doesn’t necessarily mean that everyone will follow social distancing even in Israel’s centralized system, he notes.

“It’s going to depend on what the local character of social distancing is,” Zand said, “how often people take that guidance. Social distancing is only as good as the individuals who adhere to it. These kinds of local, regional differences make a difference in how effective it is, how the virus spreads in different regions in Israel.”

Whether it’s a centralized or decentralized system, whether in Israel or the US, Zand recommends following basic guidelines.

“If I had one message to leave to you,” he said, it’s that there is “hope for vaccines and treatments for COVID-19, but it’s going to take a while. We really need to focus on slowing this epidemic” through “public health measures like washing your hands, social distancing, staying home except for very, very essential things, shopping for food and medical concerns. Give the system a chance to come up with this treatment.”

Original: Times of Israel

World Bank warns pandemic is causing ‘unprecedented global shock’

The pandemic is causing “an unprecedented global shock, which could bring growth to a halt and could increase poverty across the region,” said Aaditya Mattoo, World Bank chief economist for East Asia and the Pacific.

This photo taken on 30 March, 2020 shows employees working on a battery production line at a factory in Huaibei in China’s eastern Anhui province. Photograph: AFP via Getty Images

Even in the best-case scenario, the region will see a sharp drop in growth, with China’s expansion slowing to 2.3% from 6.1% in 2019, according to a report on the pandemic’s impact on the region.

Just two months ago, the World Bank’s economists forecast China would grow by 5.9% this year, which would have been its worst performance since 1990.

Now the world’s second-largest economy faces a more dire outlook, reflected in the record contraction in manufacturing activity in February and industrial production that fell for the first time in 30 years.

Researchers: 1,000 patients in serious condition by end of Passover

Researchers from the Racah Institute of Physics at the Hebrew University presented on Monday an analysis predicting the number of serious cases of coronavirus in Israel.

According to the data, on April 9, there will be about 500 patients in serious condition with high certainty. At the current rate, on April 14 – after Passover – there will be 1,000 patients in serious condition.

The researchers argue that reaching the point of 1,000 patients on respirators can be delayed through protective measures, such as those taken in the past week, as well as isolation and strict protection of at-risk populations, especially those aged 65 and over.

Israel mulls imposing quarantine on haredi population centers defying lockdown

The government is considering placing the ultra-Orthodox city of Bnei Brak under quarantine, over its residents’ defying of the nationwide curfew orders and the fear that the coronavirus outbreak could spiral out of control in the densely populated locality, where the infection rate is higher than the national average.

Finance Ministry Director Shai Babad told the Knesset on Sunday that “we are having more than a few problems with ultra-Orthodox society in areas like Bnei Brak.”

Babad made the comment hours after hundreds of residents gathered for the burial of Rabbi Tzvi Shenkar, with thousands reportedly attending a funeral procession just before. Videos show hundreds gathering in close proximity to one another, breaking social-distancing directives.

Several clashes between residents and police attempting to enforce the lockdown have taken place in ultra-Orthodox neighborhoods in recent weeks.

The images sparked criticism of the police, who were accused of not enforcing the directives as vigorously as they do in secular cities.

Public Security Minister Gilad Erdan said he “would not stand for it,” and demanded the police exercise “determined and equal enforcement of Health Ministry orders throughout Israel, with no exceptions.”

Prime Minister Benjamin Netanyahu has instructed Interior Minister Aryeh Deri to devise a solution that would enable the ultra-Orthodox population, as well as the Arab sector, to observe Health Ministry directives while considering their specific needs.

Last week, Health Ministry data showed that 24% of infections have occurred in synagogues, with the next most common places of infection being hotels (15%), restaurants (12%), supermarkets (7%), yeshivahs (5%) and medical clinics (5%). Educational institutions, senior facilities, daycares, mikvahs, election ballot stations, shopping malls, event halls, and gyms all fell under 5%.

The data further showed that in Bnei Brak, cases of infection are increasing eightfold every three days, compared to the twofold national average. In Jerusalem, which also has a high ultra-Orthodox population, the cases are quadrupling in the same time period.

The Knesset discussion of a potential full lockdown, said Babad, is centered on “how we could put a closure in place and isolate those areas,” referring to the ultra-Orthodox areas with high infection rates and non-compliance with government orders intended to decrease the spread of the outbreak.

Israeli police have used a drone, helicopter and stun grenades in recent days to prevent people gathering in an ultra-Orthodox Jewish neighborhood of Jerusalem in defiance of Health Ministry measures aimed at slowing the spread of the coronavirus.

Israeli security forces arrest an Ultra Orthodox Jewish man as they close a synagogue in the Mea Shearim Ultra-Orthodox neighbourhood in Jerusalem (Photo: AFP)

On Monday, police, some in riot gear and surgical masks, encountered occasional resistance and verbal abuse while enforcing the measures in a part of the city whose residents have long chafed against the state.

“Nazis!” shouted a group of boys, as police pulled men off the narrow streets of Mea Shearim.

As well as broadcasting the message “Stay Home” from the helicopter and drone, police have issued offenders with fines.

Israeli officials describe the ultra-Orthodox as especially prone to contagion because their districts tend to be poor and congested, and in normal times they are accustomed to holding thrice-daily prayers with often large congregations.

Some of their rabbis have also cast doubt on the degree of coronavirus risk.
Many ultra-Orthodox reject the authority of the Israeli state, whose Jewish majority is mostly secular.

The Mea Shearim patrols represented an escalation in security enforcement.

‘Irresponsible to remove key players Bennett & Erdan at this time of crisis’

Yossi Yehoshua, military correspondent for Yediot Aharonot, appealed to Prime Minister Binyamin Netanyahu on Monday not to replace Defense Minister Naftali Bennett (Yamina) and Public Security Minister Gilad Erdan (Likud) at the height of the coronavirus crisis.

“With all due respect for your attempts to resolve the political crisis and establish an emergency government, the removal of Naftali Bennett from the Ministry of Defense and Gilad Erdan from the Ministry of Public Security at the height of the biggest crisis that we’ve ever had here is irresponsible,” he wrote.

“[This is the worst time for] the government to lose one of its key players, Naftali Bennett, and replace him with [a political appointee]. The price we’ll pay for this until the new appointee learns the ropes will be a big one, and the public should refuse to pay it.”

Yehoshua added that due to his handling of the coronavirus crisis, Bennett has made a name for himself even among his political opponents as a mature and responsible politician and one of the most serious and professional members of the government. He works around the clock and plans a few steps ahead, and he gives almost daily briefings at which he accepts questions from the public.

On Sunday, he presented his own plan for the future management of the crisis, in which he argues that decisions should not be based solely on the recommendations of experts from the field of medicine and that the current economic restrictions should not be made any harsher. Yehoshua noted that Bennett’s proposal includes a gradual easing of restrictions immediately after Passover, with schools reopening and the economy starting up again.

Israel offers foreign airlines Ramon Airport to store planes

The Israeli government has offered foreign airports the use of the Ramon International Airport to park aircraft which have been grounded due to the coronavirus pandemic, Reuters reported.

“The site offers a good climate for preserving the planes, as well as security,” Israel Airports Authority spokesman Ofer Lefler said. One airline from eastern Europe has expressed interest in Israel’s offer.

The number of planes being kept in storage around the world has doubled to about 5,000 due to the pandemic.

The Ramon International Airport was inaugurated last year The airport was constructed to boost tourism to the nearby Red Sea and serve as an emergency alternative to Tel Aviv’s Ben-Gurion airport.