Providing dialysis to Covid-19 patients is the latest unforeseen challenge taxing hospitals.
Doctors are scrambling to handle an unanticipated crisis as a surge in Covid-19 patients with kidney failure has led to shortages of machines, supplies and staff required for emergency dialysis.
Evidence is mounting that in addition to respiratory complications, the coronavirus is also shutting down some patients’ kidneys, posing yet another series of life-and-death calculations for doctors, who were already dealing with a shortage of ventilators.
It is not yet known whether the kidneys are a major target of the virus, or whether they’re just one of many organs that can fail as the virus overwhelms the body.
Kidney specialists now estimate that 20 percent to 40 percent of patients in intensive care suffered kidney failure and needed emergency dialysis. Outside of New York, the growing demand for kidney treatments is becoming a major burden on hospitals in emerging hot spots like Boston, Chicago, New Orleans and Detroit.
Not only are there few spare machines, fluids and other supplies needed for the dialysis regimen are also running short. The number of trained nurses on hand to provide the treatment has also been limited.
Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand.
As soon as the clock ticked past 5 p.m. on Friday, signaling the reopening of beaches in Jacksonville, Fla., people flocked to the shoreline in droves, evidence of Floridians’ desire for fresh, salty air after more than two weeks under a stay-at-home order.
Photographs showed people walking dogs, carrying flip flops and soaking up the sun at beaches in Duval County, which first ordered people to stay off the sand in March. On Friday and Saturday, people reveled in the opportunity to dive through waves again.
Some people criticized the sudden rush to the shore, saying the crowded beaches risked spreading the virus further. Friday was one of the deadliest days for the coronavirus in Florida, where more than 730 people have died and at least 25,000 have been infected. On Saturday, Gov. Ron DeSantis said Florida’s public schools would remain shut for the remainder of the academic year.
Mayors in the county warned that the beaches were only reopening for activities deemed “essential,” a list that included fishing, surfing and taking care of pets.
“Just to be clear, this is an opportunity for people to come out to the beach and exercise a couple of times a day,” Mayor Charlie Latham of Jacksonville Beach said at a news conference with other local mayors. “It’s not a sunbathing opportunity.”
Organized group activities, such as picnics and team sports, will still be prohibited, and park restrooms will be closed. Beaches will open from 6 a.m. to 11 a.m. and from 5 p.m. to 8 p.m.
“This can be the beginning of the pathway back to normal life,” Mayor Lenny Curry of Jacksonville said in a video address on Thursday, when he announced the reopening. He and other officials pleaded with residents to be careful and patient, and some warned that the privilege could be revoked if proper safety guidelines were not followed.
From the cashier to the emergency room nurse to the drugstore pharmacist to the home health aide taking the bus to check on her older client, the soldier on the front lines of the current national emergency is most likely a woman.
One in three jobs held by women has been designated as essential, according to a New York Times analysis of census data crossed with the federal government’s essential worker guidelines. Nonwhite women are more likely to be doing essential jobs than anyone else.
The work they do has often been underpaid and undervalued — an unseen labor force that keeps the country running and takes care of those most in need, whether or not there is a pandemic.
Women make up nearly nine out of 10 nurses and nursing assistants, most respiratory therapists, the majority of pharmacists and the overwhelming majority of pharmacy aides and technicians. More than two-thirds of the workers at grocery store checkouts and fast food counters are women.
In his first trip from Washington in over a month, Vice President Mike Pence delivered the Air Force Academy’s commencement address in Colorado Springs, Colo., on Saturday.
He and his aides have been pushing the Trump administration to reopen the country, and this trip was seen as an attempt to demonstrate that certain old routines can soon start up again.
“We gather at a time of national crisis, as the coronavirus epidemic impacts our nation and the wider world,” Mr. Pence told the graduating class of senior cadets who will be commissioned as second lieutenants.
The small, somber graduation reflected the moment of crisis the country is in: There were no spectators or family in attendance, and cadets sat eight feet apart from one another as Mr. Pence spoke. They also did not march onstage to receive their diplomas, as they did when President Trump spoke at the ceremony last year.
When Mr. Pence, who did not wear a face mask, arrived on the tarmac in Colorado Springs, he was greeted by Gov. Jared Polis, whose face mask featured a pattern of the Colorado state flag. The two men did not shake hands.
“We will get through this,” Mr. Pence told the cadets in his speech. “You’ll also inspire confidence that we will prevail against the invisible enemy in our time.”
Mr. Pence is expected to resume a semi-regular travel schedule in the coming weeks.
Researchers say testing needs to triple for the U.S. to reopen safely, as Cuomo says testing is critical.
Gov. Andrew M. Cuomo of New York acknowledged on Saturday that hospitalizations in his state had begun to decrease, but added that the state’s economy could not fully reopen without more widespread testing, which would require both supplies and an operational capacity that the health system does not currently have.
“We are barely stabilizing our public health system right now,” Mr. Cuomo said at his daily briefing. “The first priority is life and death and public health. We’re not at a point where we’re going to be reopening anything immediately.”
As Mr. Cuomo and other governors consider easing social distancing restrictions, new estimates by researchers at Harvard University suggest that the United States cannot safely reopen unless it conducts more than three times the number of coronavirus tests it is currently administering over the next month.
An average of 146,000 people per day have been tested for the coronavirus nationally so far this month, according to the Covid Tracking Project. To reopen the United States by mid-May, the number of daily tests performed between now and then should be 500,000 to 700,000, according to the Harvard estimates.
That level of testing would be needed to identify the majority of people who are infected and isolate them from people who are healthy, according to the researchers. About 20 percent of those tested so far have been positive for the virus, a rate that the researchers say is too high.
“If you have a very high positive rate, it means that there are probably a good number of people out there who have the disease who you haven’t tested,” said Ashish Jha, the director of the Harvard Global Health Institute. “You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure you’re identifying as many infected people as possible and isolating them.”
At least 100 people gathered on the statehouse grounds in Austin to call for the reopening of the state and the country, riding a wave of similar protests at statehouses and in city streets this past week.
The urgency of the rally was reduced somewhat by an announcement from Gov. Greg Abbott that he was already acting on plans to reopen the state. Mr. Abbott, a Republican, said he was starting a “phased-in” approach to reopen the state economy, including lifting some restrictions in the coming days on medical procedures unrelated to the virus, retail shopping and public access to state parks.
With more than 22 million unemployment claims nationwide in the past four weeks, some conservatives have begun voicing displeasure with the moribund economy.
As businesses have been shuttered in an attempt to slow the spread of the virus, which has killed more than 34,000 people in the United States, a common theme has emerged uniting the various protests around a shared desire to return to work.
The protests have been encouraged by President Trump, but polls show that most Americans support restrictions meant to combat the virus.
Similar demonstrations were also held in other far-flung corners of the country on Saturday, with groups rallying in Indianapolis, Salt Lake City and Annapolis, Md.
At around noon, protesters in Annapolis, many wearing masks, some waving signs and others in their cars honking their horns, moved through the streets to loudly call on Gov. Larry Hogan to reopen businesses.
In Bloomfield, Wis., many protesters waved flags and held up signs in support of Mr. Trump, openly defying orders by Gov. Tony Evers of Wisconsin to stay home.
The debate over how soon to loosen restrictions on businesses and workers has moved from the hands of health experts to become an increasingly political fight over costs to the economy, which Mr. Trump sees as crucial to his re-election.
Gov. Gretchen Whitmer of Michigan, a potential vice-presidential pick, has stirred Republican fears that her growing popularity will help Democrats carry the battleground state of Michigan in November, whether or not she is on the ticket. Referring to the raucous rally that snarled traffic in Lansing, Mich., on Wednesday, she said, “It felt a lot more like a political rally than a statement about the stay-home order.”
At his daily briefing on Saturday, Gov. Andrew M. Cuomo of New York warned that politicizing people’s frustrations would be costly.
“It is as a tumultuous a time as we have ever seen,” Mr. Cuomo said. “But in the midst of this, there is no time for politics. How does this situation get worse and get worse quickly? If you politicize all that emotion. We cannot go there.”
The border between the United States and Canada will remain closed for another 30 days, Prime Minister Justin Trudeau said on Saturday.
As with a previous agreement that came into effect last month, people whose travel is deemed essential — a group that includes health care workers — will still be allowed to cross. Trucks, airplanes, trains and ships will also continue to carry freight between the two countries.
The extension of the border closing came as the Pentagon announced that it would prolong a national and international travel ban, stopping military units from deploying overseas and returning until June 30. The original ban was set to expire in mid-May.
The Harry S. Truman, a nuclear-powered aircraft carrier with more than 4,000 people aboard, was scheduled to return from the Middle East for weeks, but is stuck off the eastern coast of the United States. Marines from the Seventh Marine Regiment, who were deployed to Kuwait and set to return home at the end of the month, are similarly left waiting for flights to be rescheduled.
Craft stores, which some Americans have turned to for cloth coverings and materials for face masks, are getting approval to reopen in some parts of the country.
Gov. Tony Evers of Wisconsin, a Democrat, said this week that he was extending the state’s stay-at-home orders until May 26, but he eased restrictions on certain businesses, including arts and crafts stores, which can now offer curbside pickup of materials for masks and other forms of personal protective equipment. The stores are required to operate with the minimum number of workers needed to sell the materials.
In Dallas, county commissioners voted on Thursday to allow craft-store chains like Michaels and Hobby Lobby to reopen. Stores that sell fabric are now deemed essential there, and can sell cloth coverings, masks and materials for home schooling. Earlier this month, Dallas County Judge Clay Jenkins asked residents to report craft stores and other businesses that remained opened in violation of state orders.
The decisions come after weeks of heated back-and-forth between local governments and stores such as Sears, Kmart, Guitar Center and Joann Fabric and Craft Stores that have said they offer essential services for customers stuck at home during the pandemic and should be open for business. Earlier this month, the arts-and-crafts chain Hobby Lobby was accused of defying stay-at-home orders in at least four states, prompting officials to send cease-and-desist letters and close stores.
The Centers for Disease Control and Prevention is encouraging people to wear basic cloth masks when they cannot practice social distancing. Because of widespread shortages, Americans have flocked to D.I.Y. solutions, often making their own masks with needle, thread and strips of cotton.
As meat production has waned and meatpackers have fallen sick with the coronavirus at alarming rates, slaughterhouses are emerging as a weak point in the nation’s food supply chain.
The number of cattle slaughtered this past week dropped nearly 22 percent from the same period a year ago, while hog slaughter was down 6 percent, according to the Department of Agriculture. The decline is partly driven by the shutdown of restaurants and hotels, but plant closings have also caused a major disruption, leaving many ranchers with nowhere to send their animals.
As of Thursday, the Smithfield pork factory in Sioux Falls, S.D., had become the nation’s single largest coronavirus “hot spot.” Its employees now make up about 44 percent of the diagnoses in South Dakota.
Despite warnings from executives that the country could be approaching a meat shortage, state and federal regulators have sent mixed signals to the industry about how to deal with the crisis.
In the 1980s and ’90s, major meat producers in the U.S. gradually began buying out competitors and building up massive plants that could slaughter more than a million animals a year, increasingly concentrating the industry in a few states where animal feed is grown, like Iowa and South Dakota.
As the virus has spread quickly in some of these plants, executives fear it may be difficult for factories to remain open and profitable while taking measures to protect workers.
Democrats sent the Trump administration a compromise offer late Friday evening in an effort to break an impasse over replenishing funds for a new loan program, created as a way to help businesses weather the pandemic. The program, known as the Paycheck Protection Program because it provides forgivable loans for small businesses that use most of the funds to maintain their payroll, stopped accepting applications on Thursday as lawmakers remained at odds over how to move forward.
Democrats had blocked an effort to increase the amount of funding because they insisted on additional conditions that would ensure more small businesses had access to the funds and more money for localities and state governments.
The offer, according to a senior Democratic aide, would include $150 billion for states and local governments, prioritizing need and establishing new pots of money for cities, counties and towns. The offer also outlines stipulations to the aid program, more money for testing and hospitals and additional funds for the small business program, which was created as part of the $2 trillion stimulus package that President Trump signed into law last month. Republicans initially resisted those requests, but have begun to acknowledge that such a compromise may be needed. It is unclear how different the offer is from what Democrats initially proposed this month.
Speaking at a news conference on Saturday, Mr. Trump said funding for the program was “fully drained.”
“Lawmakers must stop blocking these funds and replenish the program without delay,” he said.
Steven Mnuchin, the Treasury secretary, has privately conferred with Democrats over ways to break the impasse, leaving some Republicans wary that Mr. Mnuchin may acquiesce too much to Democrats in an effort to replenish the program, which has left millions of small businesses without relief. With Congress not expected to return to Washington until May 4, any legislation would require unanimous agreement from all 100 senators — meaning that any compromise Mr. Mnuchin wrangles with Democrats will have to win the approval of Republicans in both chambers.
Apprehensive about Mr. Mnuchin’s willingness to offer concessions to Democrats in previous stimulus negotiations, Republicans are warily watching the talks over replenishing a small-business loan program.
The Census Bureau is scrambling to figure out how to count Americans.
Slammed by a pandemic, the Census Bureau postponed crucial portions of the count for the third time in a month, pushing final population totals and even reapportionment of Congress far into 2021.
The unprecedented delay buys time for census strategists to try to figure out how a head count built around engaging the public — through advertising, crowd-drawing events and knocking on millions of doors — can succeed in a nation locked down by the coronavirus pandemic.
The obstacles are enormous and the cost of failure would be large. Most critically, the task of counting those who were already hardest to count — chiefly minorities, the poor, children and those who were born elsewhere — keeps getting harder.
Strategists are betting that the virus’s grip will weaken enough by mid-August to safely deploy hundreds of thousands of temporary field workers to track down the millions who still have not sent in forms. Without the success of that exercise — known in census-speak by the acronym NRFU (“ner-foo”), for nonresponse follow-up — the census will be compromised.
Experts say that effort, which is set to run through October, is likely to be the diciest aspect of the entire reboot. The census is supposed to be a snapshot of the nation at the beginning of April; the door-knocking was originally supposed to begin in May. But by autumn, the national mosaic will have reshuffled.
“The farther you get from April 1, the less accurate the data is,” said Jeri Green, a veteran Census Bureau employee who now is the senior adviser on the census for the National Urban League. “In some communities people may be one stimulus check from getting off someone’s couch. Weddings are coming up. People are going to move out of their parents’ homes.”
Even as it scrambles to contain the spread of Covid-19 in the United States, the Trump administration is pushing forward with its immigration enforcement agenda, deporting thousands of people to their home countries, including some who are sick with the virus.
Deportations also have risen sharply for children and teenagers traveling without their parents — long considered so vulnerable that they have almost never faced expedited deportations, until now.
The Trump administration closed the border to all but essential travel last month, warning that migrants could bring the coronavirus into the United States. But Guatemalan officials said this week that the United States has been exporting the virus to their country.
Dozens of Guatemalans who have been deported since late March have tested positive, according to the authorities there. A team of researchers from the Centers for Disease Control traveled to Guatemala this week “to review and validate” the tests.
“When you send kids back without any precautions,” said Michelle Brané, of the Women’s Refugee Commission, an advocacy group, “you create a situation in which traffickers, smugglers and people who want to take advantage of them are literally waiting for them in these border towns.”
Are face masks going to become like condoms — ubiquitous, sometimes fashionable, promoted with public service announcements? They should be, one virus researcher says, if early indications are correct in suggesting that the coronavirus is often spread by people who feel healthy and show no symptoms.
“Face masks are a barrier method that might also need to be worn consistently and correctly to prevent transmission of this virus,” David O’Connor, who studies viral disease at the University of Wisconsin-Madison, wrote in an email.
He said it was time to “normalize face masks, and fast.”
States are now following that guidance, as New Yorkers now walk behind their own personal barriers. A population known for big mouths pulled on a newly essential accessory and ventured into a landscape that changed yet again on Friday when, as of 8 p.m., a new order from the governor mandated the wearing of masks in public.
As part of his latest measures to contain the coronavirus, which has killed more than 12,000 people in the state and infected more than 200,000, Gov. Andrew M. Cuomo rolled out the executive order this week.
Maryland, New Jersey and Pennsylvania are requiring that masks be worn in stores; likewise in Los Angeles and some surrounding California counties. New York’s order is the most expansive, requiring face coverings anywhere in the state where two people might come within two yards of each other, though for now, there is no fine for disobeying.
“Nobody likes it, but we’ve got to do what we’ve got to do,” said Amanda Neville, 43, inside her wine store in Clinton Hill, Brooklyn.
In the United States, President Trump’s mercurial messages have been widely contrasted with the detailed briefings by Gov. Andrew M. Cuomo of New York. Elsewhere in the world, leaders have also taken approaches that run the gamut.
Here are highlights from the five leaders The Times examined.
Prime Minister Boris Johnson
In one of his first news conferences about the virus, Mr. Johnson mentioned a “clear plan” for Britain to contain it but detailed few concrete measures. He also talked about the values of “herd immunity,” suggesting that allowing many people to be exposed to the virus would help build immunity. Days later, he reversed course, putting the nation on lockdown and ordering Britons to stay at home.
Chancellor Angela Merkel
Ms. Merkel shocked some during one of her earliest news briefings on the outbreak when she outlined a stark possibility: In a worst-case situation, she said, up to 70 percent of the German population could become infected. At a time when other leaders were hoping to lessen the blow in their messaging, she stood out. But her frankness preserved the trust of Germans.
President Rodrigo Duterte
In the Philippines, the pandemic is Mr. Duterte’s latest reason to greenlight extrajudicial killings. More than 5,000 people have been killed in his war on drugs. Initially dismissive of the coronavirus, Mr. Duterte later introduced stringent measures, including a lockdown. Critics have accused him of pursuing his often-stated ambition of imposing martial law. He threatened those who considered breaking the lockdown, instructing the police and military to “shoot them dead.”
Stocks in the United States rallied on Friday, with efforts to reopen the economy taking center stage and Boeing — one of the nation’s largest manufacturers — announcing that it planned to bring about 27,000 employees back to work in Washington State to resume aircraft production.
The announcement is the first attempt at large-scale resumption of business activity by a U.S. corporation since the coronavirus outbreak forced companies and government officials to shut down most nonessential work. Boeing’s shares rose more than 14 percent on Friday.
Some European automakers — including Volkswagen, Volvo and Daimler — are planning to restart assembly lines next week, staffed by workers in masks and protective clothing, sometimes separated from one another by plastic screens.
Carmakers have been among the hardest-hit by the global pandemic. New car registrations in the European Union fell 55 percent last month compared with a year earlier, the European Automobile Manufacturers Association said, as dealers closed their doors and buyers were stuck in their homes. Sales all but evaporated in Italy, the European country that went into lockdown the earliest, falling 85 percent. Spain and France also suffered declines of around 70 percent.
The how, when, what and why on masks.
Starting at 8 p.m. on Friday, people in New York must wear masks or other coverings when social distancing is not possible, including on mass transit, to prevent the spread of the virus. But everyone should be wearing masks when out in public, according to the Centers for Disease Control and Prevention. Here’s everything you need to know.
Reporting was contributed by Reed Abelson, Ian Austen, Karen Barrow, Nicholas Bogel-Burroughs, Emily Cochrane, Michael Corkery, Caitlin Dickerson, Manny Fernandez, Sheri Fink, Trip Gabriel, Robert Gebeloff, James Gorman, Annie Karni, Nicholas Kulish, Sarah Lyall, Jonathan Martin, Zach Montague, Thomas Gibbons-Neff, Kwame Opam, Keith Collins, Rick Rojas, Campbell Robertson, Giovanni Russonello, Kirk Semple, Katie Thomas, Michael D. Shear, Michael Wilson, Michael Wines, Patricia Mazzei and David Yaffe-Bellany.
Source : Nytimes
