Indian Country faces higher risks, lack of resources in COVID-19 fight

As the death toll from coronavirus rises in Navajo nation, experts closest to the crisis are tragically finding themselves the least surprised.

More and more conversations have circled back to warnings laid out nearly a decade ago, when the Centers for Disease Control and Prevention looked into the reasons the H1N1 flu killed four times the number of Native Americans compared to the rest of the population.

The 2009 study, commissioned by 12 states, found that the astronomically high death rate among Native Americans from H1N1 was largely because of health disparities like diabetes, heart disease and asthma that were — and still very much are — prevalent in Native American communities.

Laura Hammitt, director of Infectious Disease Programs for the Johns Hopkins Center for American Indian Health, has followed those trends back to 1918, when the Spanish flu nearly demolished Native American communities.

“If you think about the 1918 flu or the 2009 H1N1 influenza, during those respiratory viral pandemics we saw that Native American children and adults had markedly higher rates of both death and disease — sometimes in some cases four to five times higher than the general U.S. population,” Hammitt said.

Why? A combination of high-risk health conditions, Hammitt said, as well as the impacts of poverty and the challenges of social distancing posed by crowded living situations.

The stark reality, however, is that despite the 100 years separating the Spanish flu and H1N1 — and the decade between H1N1 and coronavirus — those risks are still just as prevalent for Native American and communities across the country facing similar challenges.

Hammitt said the Navajo Nation and Indian Health Service are doing a great job responding to the crisis with the resources they have but there is still concern knowing how much of the population is high risk.

“I think what is happening on Navajo Nation is not unlike what will happen in other communities that are really significantly impacted by poverty,” Hammitt told ABC.

Stacy Bohlen, the head of the National Indian Health Board, put it plainly. “We know that we have that vulnerability because of our health disparities,” she told ABC News.Despite the risk, health centers shutter when Indian Country needs them most
While the additional risks facing Native Americans are well-documented, tribes still say their requests for federal help to deal with the coronavirus are being ignored — resulting in the same shortages of personal protective equipment and health care staff as hospitals around the country.

Meredith Raimondi, a spokesperson for the National Council of Urban Indian Health Centers, said she knows of two clinics that have closed because they didn’t have enough staff and protective equipment to stay open.

She said the biggest concern across the board is a lack of supplies for hospitals and medical centers and that with the shortage of resources across the country tribes have seen little to no help.

“It really seems like Indian Country is going to continue to be last on the list and it’s really concerning at this point,” she told ABC News.

Urban Indian Health Centers are part of the Indian Health Service, a network that provides basic health care to tribal members at no cost. They exist as part of the federal government’s promise and legal obligation to provide health care to tribes, based on the constitution, treaties, and orders going as far back as 1787.

Raimondi said the centers have built up trust to provide “culturally competent” care in Native American communities where there is a lot of mistrust of the federal government.

“There’s grave concern from our programs that there will be a lack of community trust going forward because if more clinics are forced to close their doors and shut down and people are going to have to be referred elsewhere, that they won’t come back,” she said.
A virus keying in on Indian Country
Native Americans have three times the rate of diabetes as non-hispanic white people, and in some places that rate is even higher, according to Bohlen, the head of the National Indian Health Bureau. They also face higher rates of asthma and cardiovascular disease — and each of those conditions put people at high risk for severe illness from coronavirus, according to the CDC.

Tribes also face separate challenges in following the basic guidelines set out by the CDC to protect against coronavirus — social distancing and washing your hands constantly.

For example, it’s common for as many as 12-15 people to live in a four-person house on a reservation, from grandparents to babies.

“It makes it very difficult to achieve social distancing in a scenario like that, and that’s cultural — the caring for each other on a multi-generational basis,” Bohlen said.

Plus, not all homes have running water — a problem particularly affecting tribes in Montana, Alaska and in Navajo Nation, Bohlen said.

“When the CDC is putting out guidance that you have to wash your hands, several times a day — you know that makes it very difficult to wash your hands several times a day when you don’t even have running water,” she said.

Hammitt said it’s important for tribes to be able to adapt CDC guidance to the language or culture of the community. Johns Hopkins has been working with the Indian Health Service to adapt public service announcements that can be shared by tribes.

Some also fear for large elderly populations, who are particularly high risk and in many tribes serve as the protectors of a lifestyle that has been slowly chipped away at.

“That’s where the impact will be felt the most — the greatest risk to our elder population is the greatest risk to to losing our language and our traditions and culture,” Dr. Gayle Diné Chacon, who held the role of chief medical director for Navajo nation for two years, told ABC News in a phone interview.
Native American communities across the country say they are feeling the impact of those challenges during the COVID19 emergency.

Oj Semans, a member of the Rosebud Sioux Tribe that lies along the South Dakota and Nebraska border, said coronavirus seemed like it was “keying in” on Indian Country.

Both Semans and his wife, who run a voting rights advocacy group called Four Directors, have type 2 diabetes and asthma, putting them in the high-risk category.

“I mean, if you’re looking for a point to be nervous at where it could really go wrong, it’s here, in Indian Country,” Semans said.

“It’s just upping the danger for our people by multiplying the risks we already have,” he said.

Semans, who lives on the reservation, described housing projects built close to one another and multiple families living in most homes.

“The apartment complexes are basically wall-to-wall, where you don’t have that real social distancing,” Semans said. “We’re not built with the thought of a pandemic happening.”The threat is clear. Where is the help?
As the death toll in Navajo nation reaches eight and confirmed cases there make up more than two-thirds of the total in Indian Country, Chacon said it feels like the window for prevention has closed.

She feels she’s gotten the message out to her family because of her career as a doctor, but she knows that not every family has access to resources like hers does, nevermind the daily, constant reminders of the risks or how to stay safe that she harps on in phone calls to her relatives.

“It is so difficult because we keep saying we’re at war with something we can’t see,” Chacon said.
The spread, which Chacon called “stunning,” has led New Mexico Democratic Gov. Michelle Lujan Grisham to warn Trump that the Navajo nation is at risk of being wiped out.

But despite those warnings, Navajo President Jonathan Nez warned that the tribe is not getting the supplies they need.

“There’s frustration from leadership ― not just here on Navajo but all of Indian Country,” Nez said in a town hall over Facebook on Wednesday. “We feel that the United States government once again has ignored or even left out the first residents, the first people, the first citizens of this country: Indigenous people.”

Bohlen, of the National Indian Health Bureau, backed up Nez’s frustration.

“We have an opportunity here to get it right,” she urged.

She described a telephone listening session on Tuesday with the CDC and around 700 tribal leaders to discuss how the tribes want to use the $125 million allocated to them from the CDC for coronavirus response.

The Indian Health Service says they have started distributing some money for tribes in coronavirus response and the CARES Act passed by Congress included more than $3.5 billion for response in Indian Country, including for the health service, resources for tribes, and the Bureau of Indian Affairs.

The Navajo Nation now has roadblocks set-up in the hardest-hit areas, where strict curfews are being enforced. Crews are delivering food, firewood and coal to homes, taking care not to interact directly with occupants as they make deliveries. Medical facilities, like many around the country, are struggling to maintain supplies of protective equipment.

But the Navajo Nation and other tribes say they haven’t seen any money from multiple packages passed to aid COVID19 response in recent weeks, even though states have already received funding.

One issue that came up over and over again was personal protective equipment. Even as equipment and ventilators are sent across the nation from the federal stockpile to hot spots like New York, Louisiana and Michigan, states are under no obligation to dole it out to tribes. That must come from the federal government, which is under a “trust and treaty” obligation to tribes to provide health care.

“I don’t know how much more we can beat that drum, I mean, we need the personal protective equipment,” Bohlen said.

“I did not hear one tribal representative say [on the call with the CDC], ‘thank you for the personal protective equipment, we have it’,” she said. “But I heard repeatedly that they need it.”

COVID19: Tamil Nadu notifies separate jails for newcomers

Director-General of Police (Prisons) Sunil Kumar Singh said that the move was to prevent the spread of COVID-19 from any newcomer to the existing prisoners

In a bid to ensure that prisoners already lodged in prisons across the State do not contract COVID-19 from fresh inmates, the Tamil Nadu Prison Department has notified District Jails, Sub-Jails and Borstal schools at 37 cities/districts to accommodate newcomers.Director-General of Police (Prisons) Sunil Kumar Singh said that the move was to prevent the spread of COVID-19 from any newcomer to the existing prisoners.The newly-earmarked prisons were cleaned and disinfected to house the newcomers. Adequate staff strength was provided in the jails notified for fresh inmates remanded in judicial custody by courts.“As a precautionary step, the newcomers will subjected to medical screening and anybody having symptoms of cough, cold, sneezing, breathlessness, sore throat and fever will be referred to the nearest Government Hospital for further check up,” Mr Singh said in a release.Though the Standard Operating Procedure in prisons is that all newcomers are mandatorily isolated for a period of 14 days in Quarantine Blocks, irrespective of whether they have any ailments or not, the decision to notify separate jails was to prevent the possibility of asymptomatic infected persons mingling with a larger crowd, sources in the prison department said.The occupancy of the 135 prisons in the State is 11,985, which is 51.23 per cent of the total capacity. About 4,000 inmates involved in petty offences were released on bail, including personal bond, in the last ten days, the sources added.


Coronapod: Ramping up responses

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

In this episode:01:33 Testing in the UKThis week, the UK health secretary announced plans to further ramp up testing for COVID-19, with the aim of preforming 100,000 tests a day in England by the end of April. We discuss these plans and why testing remains a key weapon in the fight against the virus.11:37 Pandemic preparation in poorer countriesCOVID-19 cases have started to be reported in many low- and middle-income countries. We hear how a few of these nations are preparing and what might happen if these efforts fail.News article: How poorer countries are scrambling to prevent a coronavirus disaster26:43 One good thing this weekAs our hosts end another week of working from home, they pick out things they’ve seen that have made them smile in the last 7 days.Video: Samuel L. Jackson reads Stay the F*** at homeEvening Standard: Medical fetish site says it’s giving scrubs to NHS hospital amid coronavirus crisisNPR: U.K. Family’s Lockdown-Themed Rendition Of ‘Les Mis’ Is A Delight Twitter: Patrick Stewart reads one of Shakespeare’s sonnets each day28:54 The effect of the COVID-19 outbreak on research animalsWith stay-at-home orders in effect in many parts of the world, scientists are making difficult decisions to safeguard the welfare of their lab animals. We hear from one researcher who plans to care for his fruit flies at home, and another who has had to euthanize many of the mouse colonies used in his institution’s research.News: Cull, release or bring them home: Coronavirus crisis forces hard decisions for labs with animalsNever miss an episode: Subscribe to the Nature Podcast on Apple Podcasts, Google Podcasts, Spotify or your favourite podcast app. Head here for the Nature Podcast RSS feed.


Coronapod: Ramping up responses

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

In this episode:01:33 Testing in the UKThis week, the UK health secretary announced plans to further ramp up testing for COVID-19, with the aim of preforming 100,000 tests a day in England by the end of April. We discuss these plans and why testing remains a key weapon in the fight against the virus.11:37 Pandemic preparation in poorer countriesCOVID-19 cases have started to be reported in many low- and middle-income countries. We hear how a few of these nations are preparing and what might happen if these efforts fail.News article: How poorer countries are scrambling to prevent a coronavirus disaster26:43 One good thing this weekAs our hosts end another week of working from home, they pick out things they’ve seen that have made them smile in the last 7 days.Video: Samuel L. Jackson reads Stay the F*** at homeEvening Standard: Medical fetish site says it’s giving scrubs to NHS hospital amid coronavirus crisisNPR: U.K. Family’s Lockdown-Themed Rendition Of ‘Les Mis’ Is A Delight Twitter: Patrick Stewart reads one of Shakespeare’s sonnets each day28:54 The effect of the COVID-19 outbreak on research animalsWith stay-at-home orders in effect in many parts of the world, scientists are making difficult decisions to safeguard the welfare of their lab animals. We hear from one researcher who plans to care for his fruit flies at home, and another who has had to euthanize many of the mouse colonies used in his institution’s research.News: Cull, release or bring them home: Coronavirus crisis forces hard decisions for labs with animalsNever miss an episode: Subscribe to the Nature Podcast on Apple Podcasts, Google Podcasts, Spotify or your favourite podcast app. Head here for the Nature Podcast RSS feed.


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Power company workers sequester in the office during COVID-19 crisis

Utility providers in New York and Tallahassee are housing employees at work.April 2, 2020, 3:52 PM6 min read
Think how much worse this coronavirus crisis would be if the power went out.

That’s one of the reasons utility operators, the people who run your electricity service, are taking steps to sequester employees in offices, power stations, and control rooms to keep everything running.

Thirty-seven employees of the New York Independent System Operator, a private company that runs part of the electricity grid in New York, are living in RVs and trailers at two of the company’s facilities.
Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.

One of those employees, Tim Pasquini, said he volunteered because about two years ago he got 10 weeks of paid leave to be home with his newborn son, thanks to the paid family leave law in New York state.

“It’s something everyone in the state of New York pays into. And I got that benefit because of everyone, I see it more as giving back to everyone else in this time where there’s like a pandemic going on,” he told ABC News.

Pasquini said the past week that he’s lived at the facility felt kind of like camping and that he sees people on calls with their families every day, but that he could see it getting old if it goes on for too long.

“Last week we had a couple nice, sunny days — we were all out in lawn chairs hanging out outside our trailers. Someone brought a guitar. We’ve been trying to stay busy, we have cornhole we’ve been playing in the parking lot. And we got a bunch of board games, things like that,” he said.

The City of Tallahassee in Florida also has about 120 employees working in power plants and maintaining power and natural gas service to its more than 123,000 customers. They opted to have half that workforce sequestered a week at a time so employees can trade off weeks home with their family, while also following strict social distancing protocols.
General Manager Rob McGarrah said the city is used to housing employees for a few days during hurricanes but had to figure out how to adapt that plan to provide everything they need for weeks, including coordinating meal deliveries from local restaurants, renting dozens of RVs, and converting offices into living spaces.
McGarrah is still going home right now but Chief Electric System Operator Alan Gale is living in a converted office so he can continue to work. Gale said his wife is considered high risk so she has more freedom if he’s out of the house and when he goes home he’ll work out in his shed.

“The way we look at it is, we’re sleeping there. It’s better than having a hurricane and having to restore power. So we’re just operating and being sequestered, and I’ve got 9 out of my 15 people are previous military members so it’s better than being deployed it’s better than being on a submarine or on a ship,” he said, comparing the situation to his 22 years on nuclear submarines in the Navy.

And as a bonus, Gale said, at least he got his office cleaned.
Rich Dewey, President and CEO of the NY ISO, said they’re lucky to have a dedicated team committed to maintaining service during the emergency.

“When you start looking at everything that is being endured down in New York City with all of the disruptions in day to day life and, and, and the horrible, you know, medical situation they got, you know, just imagine how much more horrible it would be if the lights weren’t on,” he said.
What to know about coronavirus: How it started and how to protect yourself: coronavirus explained What to do if you have symptoms: coronavirus symptomsTracking the spread in the US and Worldwide: coronavirus map

Google donates 4,000 Chromebooks, free Wi-Fi to rural areas

As many students are urged to work from home, Google is working on providing equipment to 100, 000 households, ensuring they can work through this difficult time.
CEO Sundar Pichai made the announcement on Twitter in April, saying:

Proud to work with
& partners to help bridge the digital divide in our home state. We’re providing 4,000 Chromebooks to California students in greatest need & free wifi to 100,000 rural households during the #COVID19 crisis to make distance learning more accessible.

A study from PEW in 2019 found that a third of rural Americans didn’t have a broadband connection despite a steady increase in growth from 2007. They would also have less access to multiple devices and go online less, limiting familiarity with online tools and providing less opportunity for students to work from discrete devices in a home with more than one student. The donation of Chromebooks will help a little in alleviating the latter problem while the benefits of free Wi-Fi are rather obvious.
This isn’t Google’s only move in coronavirus community support. The company committed $800 million towards helping small and mid-sized businesses with their coronavirus relief.
“In addition to these commitments, we also increased the gift match Google offers every employee annually to $10,000 from $7,500. That means our employees can now give $20,000 to organizations in their communities, in addition to the $50 million has already donated,” Sundar Pichai said last week, “Together, we’ll continue to help our communities—including our businesses, educators, researchers, and nonprofits—to navigate the challenges ahead.”
Coronavirus and tech: Ongoing list of event cancellations, disruptions, product delays, and more


Innovations in times of Covid19

IIT-Ropar makes device to clean, reuse PPE kitsResearchers at the Indian Institute of Technology (IIT), Ropar have come up with a technique to clean and sterilise personal protection equipment (PPE) kits, including surgical masks and other protective gears, without causing any damage to those.

PPE kits are in high demand by doctors and medical staff. Medical staff in Patiala even staged a protest to get PPE kits to deal with Covid19 patients. The researchers said that the countries affected with the pandemic face scarcity of these kits. The IIT-Ropar researchers have created a unique equipment that can clean and sterilise the protective wears in a three-way sterilisation process using ultrasonication, UV-C irradiation and oxidising treatment of the kits.
A diagram of the sterilisation unit developed by IIT-Ropar
The research was carried out by professor Naresh Rakha and assistant professor Khushboo Rakha, along with their team members Manigandan, Dhiraj Mahajan, Neha Sardana, Shahriar Reza and Kushagra Goyal.

“In the wake of the Covid19 crisis, surgical masks, N-95 Face Respirators and PPE have become scarce. The scarcity of PPE has forced many people to reuse these items. But, washing PPE like ordinary clothes has limitations, as it destroys the texture and pore size of the surgical masks and face respirators. Sterility of the inner layers of PPE is also a serious issue. We have come up with a prototype of a unique equipment which will sterilise and clean once used masks and PPEs by three proven pathogen-killers, namely ultraviolet-C irradiation, ultra-sonication (ultrasonic waves) and an oxidising agent,” said Khushboo from the metallurgy and materials engineering department.
An app for community kitchens
Three students in Areekode have developed a mobile application which will enable people to easily access nearby community kitchens. These kitchens were opened under the Kudumbashree Mission in Kerala to address food crisis. The application ‘Kooy Community Kitchen’ which functions on Android platform enables people to check available food in community kitchens across the state and order from home.

The application was developed by three brothers Razil Salam, Nimil Salam and Azil Salam who belong to a small town called Therattammal. It will be rolled out in the coming days as Kudumbashree Mission has given the go ahead to the project. Razil is class XII student of Sullaussalam Oriental Higher Secondary School, Areekode. Nimil Salam is a third-year MBBS student at Karuna Medical college, Palakkad and Azil Salam is a third year mechanical engineering student.
Razil, Nimil and Azil (L to R), the brothers who developed the mobile application that can be used to order from community kitchens
“As the growing concerns of Covid-19 increase, availability needs are getting short in homes around us, so the people are worried. We have developed the app for essentials to support thousands who are in search of food during lockdown,” said Azil Salam.
As the growing concerns of Covid-19 increase, availability needs are getting short in every home. We have developed the app for essentials to support thousands who are in search of food during lockdownAzil Salam, developer, Kooy Community Kitchen app
The developers are also planning to launch ‘Kooy-Grocery’ application for the public in order to enable them to identify the nearest grocery.

The district coordinator of Kudumbashree Mission, C K Hemalatha said that Kudumbashree is planning to launch the ‘Kooy-Community Kitchen’ app as a trial run in the district. “We will examine the possibility of making all 109 community kitchens as part of the move. If it is not practical, the project would be piloted in selected community kitchens,” she said adding that the application can be used as an online food-delivery platform to support the restaurant chain of Kudumbashree across the state in future.
Tirupur’s ‘disinfectant tunnel’ a runaway hit
Visitors to the Thennampalayam vegetable market in Tirupur, Tamil Nadu, were in for a surprise after they were asked by civic body officials to pass through a 16-foot-long disinfectant tunnel.

A first-of-its-kind in the state, the tunnel was inaugurated by Tirupur collector K Vijayakarthikeyan on Wednesday. Designed and developed by D Venkatesh, an expert in the sphere of water treatment, the tunnel is made of stainless steel and costs Rs 1 lakh.

“The time that people take to walk through the structure is enough to spray disinfectants all over them to ensure their safety,” Venkatesh said.
We have set up a first of it’s kind #disinfection tunnel in Thennampalayam market in #Tiruppur where people will ha…— Vijayakarthikeyan K (@Vijaykarthikeyn) 1585722942000
The stainless steel structure, resembling a narrow passageway, is made up of thousands of tiny nozzles used to spray disinfectants on anyone who passes through. The nozzles are attached to a central container filled with sodium hypochlorite, a common disinfectant, in a water base, said Venkatesh. The disinfectant works well and does not harm the skin, he said.

Venkatesh said the novel idea was borne out of his disappointment after he saw a lot of people in his district flouting norms of social distancing.

“Scores of people are thronging vegetable markets when they should be maintaining a safe distance. I thought if a country like Turkey can install disinfectant tunnels, so can we,” he said.

It was then that he decided to build the structure on his own. It took him two days to come up with the final model. Venkatesh demonstrated the pilot to the collector and a team of health officials, who decided to try it out at Thennampalayam.
Scores of people are thronging vegetable markets when they should be maintaining a safe distance. I thought if a country like Turkey can install disinfectant tunnels, so can weD Venkatesh, designer of the disinfectant tunnel

Vijayakartikeyan said the tunnel can be operated for 16 hours continuously. Plans are on to instal ten more disinfectant tunnels at busy hubs in Tirupur. The collector also shared a video of the tunnel on his Twitter page. The novel initiative has garnered a lot of interest from officials in other districts of the state.


COVID19: Apurvi pledges to donate Rs 5 lakh

Apurvi Chandela. (Getty Images)NEW DELHI: Indian shooter Apurvi Chandela pledged to donate Rs 3 lakh to PM-CARES Fund while Rs 2 lakh to Rajasthan CM Relief Fund to support the battle against Coronavirus pandemic in the country.

“I pledge to contribute 3 Lakhs to PM CARE Fund and 2 Lakhs to Rajasthan Chief Minister’s Relief Fund. India can, and will fight this pandemic. @narendramodi @PMOIndia @ashokgehlot51 @KirenRijiju,” Chandela tweeted.

I pledge to contribute 3 Lakhs to PM CARE Fund and 2 Lakhs to Rajasthan Chief Minister’s Relief Fund. India can, an…— Apurvi Chandela (@apurvichandela) 1585755960000
On Wednesday, All India Football Federation (AIFF) pledged to donate Rs 25 lakh to the PM-Cares Fund to support the fight against the coronavirus threat.

Hockey India also contributed Rs 25 lakh towards the PM-CARES Fund. On Saturday, PM Narendra Modi announced the creation of the Prime Minister’s Citizen Assistance and Relief in Emergency Situations (PM-CARES) Fund and appealed to all the countrymen to show their support for the cause.
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More coronavirus shortages come into focus: ventilator operators, critical drugs

As states sound the alarm over a lack of ventilators to help hospitalized novel coronavirus patients — including a plea for 30,000 machines for New York state alone — experts warned that even if the equipment arrives, facilities could face a shortage of health care workers trained to use them.

“If you have a thousand more ventilators magically appear, do you have the 20 ICU [Intensive Care Unit] doctors, 300 ICU nurses, 150 respiratory therapists and all of the [personal protective equipment] needed to support those 1,000 new ventilators?” Dr. Doug White, an intensive care physician with the University of Pittsburgh School of Medicine, told ABC News. “Simply put, ventilators don’t run themselves.”
Personnel specially trained to treat patients with ventilators is just one of the latest possible second-order shortages that government and hospital officials are discovering as the battle against the coronavirus relentlessly drags on, a list that some doctors now say also includes critical drugs used to sedate patients who need to be intubated as part of their treatment.

New York Gov. Andrew Cuomo on Monday called on other states to send as many health care workers as they can to assist the strained system in his state.

Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.
There are approximately 6,800 licensed respiratory therapists in New York state, according to the state’s Education Department, which handles professional licensing. They are specialists who closely monitor patients and adjust treatments using the lifesaving — and in some cases highly sophisticated — ventilators to breathe.

But even with the addition of hundreds of respiratory therapists expected to graduate from schools in New York this spring, the help of anesthesiologists and other physicians freed up by the postponement of elective procedures and tens of thousands of volunteer health care workers, health officials remain concerned about personnel shortages. They could limit hospitals’ abilities to treat patients at the peak of the outbreak in the state and nationwide that could be as many as two weeks away. Experts said those with specialty training are key.
New York state counts more than 75,000 cases of coronavirus infections so far, according to Cuomo. Nationwide, over 186,000 people have tested positive for the virus and more than 4,000 have died, according to a count by Johns Hopkins University.

Cuomo said Tuesday that in New York state 2,710 patients were currently in the state’s intensive care units and nearly 300 had to be intubated and put on ventilators.

According to medical experts, the normal standard of care for a ventilated patient includes around-the-clock care from a team of nurses and respiratory therapists, under the supervision of an intensive care doctor.

Now, due to the influx of patients needing ICU care, one ICU doctor may now manage four times the number of ventilated patients they normally do, with a team of non-ICU specialist doctors working underneath them.

It’s a strained system that could buckle even further if large numbers of front-line nurses and doctors contract the coronavirus due to shortages of personal protective equipment.

“This will likely result in a lower quality of care, and [it’s] why the standard of care changes in an emergency,” said White. “Critical care physicians are trained in respiratory and multi-organ failure in a way that no other specialty is.”

When those physicians are transitioned from being directly involved to now managing a group of non-ICU doctors, it changes the care the patient gets, he said.
Dr. Greg Martin with the Society of Critical Care Medicine, a professional organization devoted to the care of the most critical patients, said it’s hard to project which workforce of the three — doctors, nurses and respiratory therapists — will be the first to become stretched. But he speculated it would be the 28,000 intensivist physicians or ICU doctors who work in the U.S.: “You will realize you can’t rely on the intensivists to be available for every patient.”

Roughly 5,800 nurses in New York state are critical-care certified, according to the American Association of Critical-Care Nurses. Some 120,000 are credentialed for acute and critical care nationwide, the group said.

“You can’t win a war with no troops,” Dr. Peter Papadakos, the director of critical care medicine at the University of Rochester Medical Center, told ABC News about the potential personnel shortage. “You can have fancy equipment, but if you don’t have any troops and if you don’t have any gasoline … you lose the war.”
Doctors fear drug shortages after ‘tsunami of patients’

At Elmhurst Hospital in the borough of Queens in New York City, said to be the “ground zero” of infections in the U.S., the problem isn’t a shortage of ventilators or even people — it’s drugs used to sedate patients when they’re intubated, along with the equipment used to deliver those drugs, according to a doctor who works there.

In another New York City ICU, a critical care physician told ABC News their hospital is also having to confront drug shortages, including those used to sedate patients.

“If you aren’t sedating someone enough, you always run the risk of someone self-excavating, which is ripping the tube out of themselves because they’re too awake,” the physician said.
When a patient is intubated, they are usually given a combination of sedatives and anesthetics before a breathing tube is inserted down their throat. Patients sometimes also require paralytic drugs to loosen up their vocal cords and other muscles to prevent damage when the breathing tube is inserted.

Patients continue to receive sedatives and pain relievers to keep them asleep while intubated, to prevent their bodies from fighting against both the breathing tube and the ventilator, which performs breathing functions for patients to allow their own lungs to heal.

With many COVID-19 patients requiring ventilators for weeks, some health officials are worried that the nation’s supply of necessary drugs won’t be enough to help the country weather a prolonged and sustained outbreak across multiple cities and states.
Dr. Erin Fox, who tracks and investigates drug shortages reported from hospitals around the country, told ABC News that some of the most commonly used drugs to intubate and maintain a patient on ventilator are running in short supply.

“We see a tsunami of patients coming our way, and we don’t see a tsunami of drug availability coming our way. It’s scary to think, you might not have enough medicine,” she said.

Three of the drugs reportedly in short supply, according to Fox, are the sedative etomidate, an anesthetic ketamine and a muscle-relaxing medication called rocuronium. Several hospitals with whom ABC News spoke said they were running low on the critical medications.
While doctors and hospitals have the ability to use alternative drugs in some cases to help intubate and sedate patients, experts worry that a prolonged worldwide outbreak could severely stretch the global pharmaceutical supply chain, forcing countries to fight among one another for resources as several states have been forced to do for protective equipment in the U.S.

The American Society of Health System Pharmacists runs the database that monitors drug shortages reported from their 55,000 members across the country who work in hospital pharmacies. The demand for drugs is not just in hot spots, but nationwide.

“With all this surge capacity that’s being built, do we have the drug supply to match it? Right now the answer appears to be ‘no,'” said Dr. Michael Ganio, a senior director with the society.

At one health system that runs over 40 hospitals in Ohio and Virginia, a pharmacy director told ABC News they are starting to see shortages in medications used to sedate patients who are ventilated. Their pharmacy team is already coming up with contingency plans for when the preferred drugs run out.

“The problem is, we’re all using the same manufacturers and same wholesalers. We’re all competing for the same resource,” the director said.

This report was featured in the Wednesday, April 1, 2020, episode of “Start Here,” ABC News’ daily news podcast.
“Start Here” offers a straightforward look at the day’s top stories in 20 minutes. Listen for free every weekday on Apple Podcasts, Google Podcasts, Spotify, the ABC News app or wherever you get your podcasts.

How Ford is balancing the company’s coronavirus action and brand advertising

By Jeff Beer4 minute ReadThree weeks ago (which right now feels like three years ago) Ford’s U.S. director of marketing, Matt VanDyke, had to make a decision.As the spread of COVID-19 began to rapidly increase, sports leagues like Major League Baseball and the NBA began suspending play, and the NCAA made the move to cancel the March Madness basketball tournaments.Ford had planned to boost ongoing campaigns around its Escape and Explorer models with ads during March Madness but now had to alter its approach. VanDyke worked with his team, and ad agency Wieden+Kennedy, to quickly create two new ads that addressed the crisis, launching them just days later. In those spots, the company said that if customers were impacted by COVID-19 and were financing or leasing through Ford Credit, they should contact the company about payment relief.It’s a move that the company routinely does around regional emergencies, like hurricanes and wildfires—but typically doesn’t advertise.
If you are impacted by #COVID19 and you’re leasing or financing through Ford Credit, we’re here to help.
Call 1-800-723-4016 or visit for more information.
— Ford Motor Company (@Ford) March 16, 2020“We saw things were changing rapidly, and knew our messaging then scheduled for the following week would be incredibly tone-deaf as is,” says VanDyke. “So at that point we knew we needed to be empathetic, we needed to be reassuring, so that was the initial tone of those ads.”Over the following two weeks, VanDyke has been working with his team to maintain that same agility, to alter the company’s messaging to reflect its efforts in different areas. On Monday, the company made headlines when it announced that it would be teaming with General Electric to manufacture 50,000 ventilators in the next 100 days. But there are other, less high-profile moves, such as dealers keeping service departments accessible to cars being used by healthcare, food delivery, and other frontline workers, or dealers lending service cars out to make medical supply deliveries.But VanDyke does acknowledge the balance between communicating those services as both information and inspiration, and having these efforts appearing as blatant advertising.
This past weekend, Tulsa Ford Dealer Bill Knight and team provided important maintenance for fleet vehicles that help hospitals & medical teams in their community, including delivering #COVID19 test kits.
Thank you, @BillKnight_Ford, for helping your community. #BuiltForAmerica
— Ford Motor Company (@Ford) March 25, 2020“Our approach is that we’re trying to reassure people to say this is what our company is doing,” says VanDyke. “Even when we’re put in the headlines by President Trump, asking for the auto industry to step up and turn manufacturing capabilities into support for medical devices and things, our response is we should be really factual about it, and we don’t want to get over our skis and talk about things we haven’t done. So we really only want to talk about what we are actually doing, so that people are aware that companies and individuals are contributing to the community and trying to help.”To make sure they’re doing just that, VanDyke says Ford has been in constant contact—more than ever before—with Ford’s dealers to understand what they’re seeing for their customers, their employees, and what they think is the right message from the brand. Given the cancellation of live sports, a major media investment for Ford, the brand has been doing most of its work across social channels in the last few weeks.
Properly deep cleaning your vehicle is more important than ever.
Here are some tips on how to keep your vehicle clean and help prevent the spread of #COVID19.
— Ford Motor Company (@Ford) March 29, 2020Another area VanDyke sees as crucial for Ford’s marketing communications at the moment is using its reach to amplify the call for help among its charitable partners, who may need it now more than ever. “For example, we’ve been supporting disabled American veterans’ charity for more than 100 years, and right now they’re under pressure, because they need people to deliver food and things like that,” says VanDyke. “So we’re using some of our media to let people know how they can help. That’s essentially the next round of things you’ll see from us.”
We’re honored to lend a hand to organizations like @WCKitchen and @chefjoseandres who are doing their part to help their communities during this time. ​
Our donated vehicles are helping the team serve around 20,000 meals per day in #LosAngeles. ​​We are #BetterTogether.
— Ford Motor Company (@Ford) March 31, 2020It’s still early days, but Ford is already planning for when we’re in the later innings of this crisis. VanDyke says the company—as a major brand, manufacturer, and employer—is well aware that it has a role to play in the overall recovery.“Right now we’re still in that initial crisis phase where we want to make sure we’re helping anywhere we can, we’re being reassuring, we’re empathetic, and we’re telling the story of what the company is doing. I think that continues for the next couple of weeks, and then it may move into another phase of, as we’re hopefully looking to transition out of this, what can we do to help reignite the economy,” says VanDyke. “Cars are often the second-biggest purchase in anyone’s lifetime after a home, but we’re not looking to make this into a sales event. However we do need—and we feel an obligation to—the economy, by keeping manufacturing going, keeping commerce going, and supporting our dealers and customers.”

Larry David Is Ticked Off At Coronavirus Idiots. ‘You Know Who You Are.’

Larry David has a message for all the “idiots” out there: Stay inside. 
The “Curb Your Enthusiasm” star on Tuesday joined the parade of celebrities recording PSAs urging people to keep home to curb the spread of the coronavirus.
“I basically want to address the idiots out there, and you know who you are,” he said, referring to people still going out despite the warnings and shelter-in-place orders. 
“You’re hurting old people like me,” he said. “Well, not me, I have nothing to do with you. I’ll never see you. But, you know, other — let’s say, other old people who might be your relatives. Who the hell knows.”
The “Seinfeld” co-creator told people they’re missing out on a once-in-a-lifetime opportunity to sit home and watch TV:
— Office of the Governor of California (@CAgovernor) March 31, 2020

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The Top Ways Apps are Stopping Bots and Fake Accounts

Every year, we spend more and more time on the Internet. With the arrival of COVID19, millions of people are using it from home more than before. From work to online shopping, social media, and dating, apps integrate with our lives in new ways all the time. But as more users join these apps and websites, where we go to consume content and interact with people become hubs for online scams, bots, and fake accounts.
Campaigns that prey on the trust of people are rampant online. It might be advertising campaigns that astroturf social media websites with bots or fake accounts to make it look like a specific product is extremely popular. It could be fake emails from your bank asking you to reset your password. Unfortunately, these campaigns are quite lucrative for the scammers running them. In fact, people reported more than 250,000 cases of online scams last year in the U.S. alone, with more than $300 million in damages.
Of course, apps don’t want fake users and scammers on their platforms either. There’s an ever-evolving battle between malicious actors and the developers behind these apps. Below are some of the unique approaches developers use to detect fake users and get them off their platforms quickly and effectively.
Multi-Step Authentication
People who create spam bot accounts generally try to make many hundreds of accounts at the same time. Usually, this is because app users are able to detect fake accounts with ease. That means these developers want a simple account creation process that can be easily automated. Similarly, scammers want easy verification steps to speed up the process or brute-force hack their way onto already-existing apps easily. One way that apps are stopping quick account creation is through captcha and multiple account verification steps.
By asking users for a password, then sending a security code to a device owned by the person who knows the password, users can verify their identity quickly and securely so they can gain access. Some of the first major companies to adopt two-factor authentication included Wells Fargo. Now, most software companies and social media apps use it to make sure that your account is truly yours.
For slowing down automated threats, platforms like Twitter and massively multiplayer online games like League of Legends require users to link accounts to other pre-existing accounts. When you create an account, the service uses these existing accounts to verify your online presence and act as a way to observe human actions like clicking and typing during all sign-up steps.
Manual Review
It’s clear that tech-based solutions are useful for stopping the majority of bad bots. But, sometimes stopping human-like bots takes a simpler solution – manual review of accounts. For example, Twitter and Facebook use automated systems as their first line of defense, but then flag certain accounts for actual humans to look at. Using metrics collected by the account creation and posting system, reviewers can look through an account’s history to determine whether it has a particular agenda that’s related to other bot activity on the platform.
For example, a set of accounts may be created on a similar date and post regularly about innocuous content. But then, they suddenly transition their posting style to one that matches a particular agenda. These accounts won’t be flagged by automatic systems early on because they won’t match the traditional flagging metrics. But, their later posts might be reported by other platform users. Manual reviewers are then able to determine if it’s a group of real people or a set of bot accounts.
Real-Time Verification
Some apps try to create real-life situations where people can meet up and interact in person. For example, Pokémon Go requires users to band together in a physical location so they can take down powerful, legendary Pokémon. Other dating and friend-making apps entirely rely on users to interact in-person to establish relationships. These types of apps have a unique problem. They must ensure their users are entirely real, so others can trust the app to find them safe social situations.
Many of these apps use a significant amount of manual reviews to find fake users. But others use extensive verification and new, unique technology to do the same. Dating apps like Hily (Hey, I Like You) capture new user information by linking to pre-existing Facebook accounts and comparing uploaded photos to Facebook photos to ensure that the same person is using both accounts.
Other social apps are now introducing real-time photo requirements. A real-time photo obligation involves snapping a current picture to compare against uploaded images (pictures). The goal is to use built-in technology to make the account creation process more challenging to automate. By requiring multiple verification steps, apps can curb scam accounts and increase user safety.
A Problem that Isn’t Going Way
Online scams and malicious bots will likely continue to increase in number as we devote more time and trust to Internet-based technology. But app creators and developers realize this and are taking necessary steps to develop better security systems.
Entrepreneurs are testing many approaches, from detecting fake accounts through machine learning and facial recognition to manually reviewing user-flagged accounts. And, as nefarious tactics evolve, we’re likely to see even better methods to stop these spammers from succeeding.
Image Credit: Polina Zimmerman; Pexels

John Boitnott

CEO, Boitnott Consulting LLC

A journalist and digital consultant, John Boitnott has worked at TV, print, radio and Internet companies for 25 years. He’s an advisor at StartupGrind and has written for BusinessInsider, Fortune, NBC, Fast Company, Inc., Entrepreneur and Venturebeat. You can see his latest work on his blog,


Doctor’s Unsettling Graphic Will Ensure You Stay Home During Coronavirus Pandemic

A doctor has shared an unnerving illustration of how the coronavirus is tested for in a bid to encourage people to stay at home amid the pandemic.
Dr. Jessica Peck, a clinical professor at the Baylor University Louise Herrington School of Nursing in Dallas, Texas, on Sunday tweeted an image showing “how far back we have to put the swab to test you for #COVID19.” “You might want to follow medical recommendations and #StayHome,” Peck wrote.
— Jessica Peck, DNP APRN CPNP-PC (@DrPeckPNP) March 29, 2020

Peck did not immediately respond to HuffPost’s request for comment. But people who have been tested for the virus ― that has so far sickened more than 164,000 people in the U.S. and killed more than 3,100 ― attested to the unpleasantness of the procedure:
I can attest to this. I was tested last week, and right before the swab, my doctor says, “You’re going to HATE this.”He was right.My test was negative, but the sentiment is the same. #StayHome#StayHome— Michael Jenkins (@JenksNBCS) March 31, 2020

I had to have one a few weeks ago and it was the most unpleasant and physically uncomfortable experiences I’ve ever had in a doctor’s office. I hated it so much and was so relieved when it was over.— Ryan Sloane (@RyanFSloane) March 30, 2020

I went through this for a regular flu and wow it was incredibly unpleasant. After the doctor took it out I said “HOLY SHIT” and she was like “…Yeah”— Stephanie Foo (@imontheradio) March 30, 2020

Others, meanwhile, suggested the image was the perfect motivation to continue social distancing and remaining in shelter:
No thanks, I would rather stay inside for 2 years.— Gia Milinovich (@giagia) March 30, 2020

I’ll just stay at home, thank you 😱— Henry Manampiring (@newsplatter) March 30, 2020

“Stay at home or this is where the swab goes” might motivate anybody else who isn’t already socially distancing.— Paul Fairie (@paulisci) March 30, 2020

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What to Consider when Designing Face Shields #COVID19 #3DPrinting @flowalistik

March 30, 2020 AT 10:00 pm
What to Consider when Designing Face Shields #COVID19 #3DPrinting @flowalistik

Agustin Arroyo (Flowalistik) shared on Twitter:What to consider when designing and manufacturing a COVID-19 face shieldIn such a complex situation due to COVID-19, the maker community has stood out thanks to its ability to tackle issues such as protection equipment shortage by manufacturing and distributing open-source face shields. But, what do you have to consider when designing and manufacturing your own face shield?
First of all, it is important to understand who is going to use the face shield and how. Most of the equipment is used for several hours by doctors, police officers, cashiers and other people exposed to COVID-19. The face shield design must be ergonomic and comfortable for the largest possible public…Read Full ArticleSource

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