Wall Street wrapped up a horrific three-month run defined by trillions in losses from an economy paralyzed by the coronavirus pandemic. Just weeks ago, investors had been riding high from a historic bull market that put the blue chip index within a wisp of 30,000. |
Tuesday, March 31, 2020
Dow caps worst first quarter of its 135-year history by sliding more than 400 points
US Stats
As of Tuesday morning, at least 163,575 people across every state, plus Washington, D.C., and four U.S. territories, have tested positive for the virus, according to a New York Times database. At least 3,073 patients with the virus have died.
Fatality rate: 0.0184
Monday, March 30, 2020
UC San Francisco Machine translates brainwaves into sentences
Machine translates brainwaves into sentences - https://www.bbc.co.uk/news/science-environment-52094111
Tesla bids to deploy one of the biggest batteries in the world with 244 Megapacks in Hawaii - As always, it's ultimately about scale
Electrek: Tesla bids to deploy one of the biggest batteries in the world with 244 Megapacks in Hawaii.
https://electrek.co/2020/03/29/tesla-biggest-batteries-world-hawaii-megapacks/
https://electrek.co/2020/03/29/tesla-biggest-batteries-world-hawaii-megapacks/
These facts will certainly be in the record in the end. From the London Guardian today
'A fiasco of incredible proportions'
When the definitive history of the coronavirus pandemic is written, the date 20 January 2020 is certain to feature prominently. It was on that day that a 35-year-old man in Washington state, recently returned from visiting family in Wuhan in China, became the first person in the US to be diagnosed with the virus.
A week after that, the Wall Street Journal published an opinion article by two former top health policy officials within the Trump administration under the headline Act Now to Prevent an American Epidemic. In it, Luciana Borio and Scott Gottlieb laid out a menu of what had to be done instantly to avert a massive health disaster.
Top of their to-do list: work with private industry to develop an "easy-to-use, rapid diagnostic test" – just what South Korea was doing.
It was not until 29 February, more than a month after the Journal article and almost six weeks after the first case of coronavirus was confirmed in the country that the Trump administration put that advice into practice. Laboratories and hospitals would finally be allowed to conduct their own Covid-19 tests to speed up the process.
In the two months since that fateful day, the responses to coronavirus displayed by the US and South Korea have been polar opposites.
One country acted swiftly and aggressively to detect and isolate the virus, and by doing so has largely contained the crisis. The other country dithered and procrastinated, became mired in chaos and confusion, was distracted by the individual whims of its leader, and is now confronted by a health emergency of daunting proportions.
Monty Bannerman
Managing Director
Tel: +1 646-402-5076
Managing Director
Tel: +1 646-402-5076
Cell: +1 305-984-1177
Trump Rollback of Environmental Regulations Continues Unabated During Pandemic
Trump Administration, in Biggest Environmental Rollback, to Announce Auto Pollution Rules
Ms. Davenport has been covering federal climate change policy since the George W. Bush administration.
- March 30, 2020Updated 4:30 p.m. ET
WASHINGTON — The Trump administration is expected on Tuesday to announce its final rule to roll back Obama-era automobile fuel efficiency standards, relaxing efforts to limit climate-warming tailpipe pollution and virtually undoing the government's biggest effort to combat climate change.
The new rule, written by the Environmental Protection Agency and the Department of Transportation, would allow vehicles on American roads to emit nearly a billion tons more carbon dioxide over the lifetime of the cars than they would have under the Obama standards and hundreds of millions of tons more than will be emitted under standards being implemented in Europe and Asia.
Trump administration officials have raced to complete the auto rule by this spring, even as the White House is consumed with responding to the coronavirus crisis. President Trump is expected to extol the rule, which will stand as one of the most consequential regulatory rollbacks of his administration, as a needed salve for an economy crippled by the pandemic.
The lower fuel-efficiency standard "is the single most important thing that the administration can do to fulfill President Trump's campaign promise of reforming the regulatory state, and to undo the impact that the previous administration has had on the economy," said Thomas J. Pyle, the president of the Institute for Energy Research, an organization that supports the use of fossil fuels.
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Mr. Trump's critics say the rule shows the president's disregard for science and could actually harm the economy over time. The administration's own draft economic analyses of the rule showed that it could hurt consumers by forcing them to purchase more gasoline. And a February report by a panel of government-appointed scientists, many of them selected by the Trump administration, concluded that "there are significant weaknesses in the scientific analysis" of the rule.
"This is not just an inopportune moment to finalize a major rule-making," said Senator Thomas R. Carper of Delaware, the ranking Democrat on the Senate Environment Committee. "In this case, it's a completely irresponsible one."
Even many large automakers, which had asked Mr. Trump to slightly loosen the Obama-era rule, had urged him not to roll it back so aggressively, since that plan is certain to get bogged down in court for years, leaving their industry in regulatory limbo.
"The auto industry has consistently called for year-over-year increases in fuel efficiency," said John Bozzella, president of the Alliance for Automotive Innovation, a lobbying group that represents the world's largest auto companies. "We need a policy environment that drives improvements in fuel economy, and the infrastructure that supports a transformation to net-zero emissions."
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The new rule, which is expected to be implemented by late spring, will roll back a 2012 rule that required automakers' fleets to average about 54 miles per gallon by 2025. Instead, the fleets would have to average about 40 miles per gallon. To meet the new number, fuel economy standards would have to rise by about 1.5 percent a year, compared to the 5 percent annual increase required by the Obama rule. The industry has said it would increase fuel economy standards by about 2.4 percent a year without any regulation.
The new standard would lead to nearly a billion more tons of planet-warming carbon dioxide released and the consumption of about 80 billion more gallons of gasoline over the lifetime of the vehicles built during the terms of the rule, according to a recent draft of the plan.
For Mr. Trump, completing the rollback of his predecessor's climate change policy caps a three-year march to weaken or undo nearly 100 rules and regulations that had limited industrial pollution of smog, toxic chemicals, greenhouse gases and water contaminants.
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Businesses said those rules had hamstrung their growth and left them less competitive in a global economy. Environmentalists said they were vital to the health and future of the planet and its inhabitants.
For environmentalists, the tailpipe-emissions rule culminates Mr. Trump's quest to dismantle the United States' efforts to fight climate change, which has so far included pulling out of the global Paris climate change accord, weakening rules to curb greenhouse gas emissions from coal-fired electric plants, and undermining the basic science that underpins environmental regulations.
The regulation on vehicle fuel economy, first issued in 2009 and updated in 2012, was the first federal policy to lower emissions of greenhouse gases that causes climate change, and it remains the policy that would have reduced emissions the most, chiefly by targeting the nation's largest source of climate-warming emissions: cars and trucks.
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"In the march of rollbacks of climate rules, this is the biggest step," said David Victor, director of the Laboratory on International Law and Regulation at the University of California, San Diego.
The new rule creates short-term regulatory relief for automakers, lifting requirements that had forced them to invest heavily in developing and marketing hybrid, electric and low-pollution vehicles.
But in the long run, analysts say, the new standard could actually bring more uncertainty to the auto industry. The legal status of the new Trump rule remains unclear; about 20 states are expected to sue the administration to undo it in a case expected to be resolved by the Supreme Court in the coming years. The new rule is also expected to become a divisive issue in the 2020 presidential campaign, with Democrats vowing to reinstate the Obama rule.
Trump administration officials have been plagued with difficulties and delays as they have tried to write a rule that would meet the president's desire for a drastic regulatory rollback that also would be scientifically sound and legally defensible.
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The chief cause of the delay has been an internal economic analysis concluding that the rule would harm consumers more than helping them. A draft of the rule sent to the White House in January calculated that the new fuel economy target would lower the prices of new cars and light trucks by about $1,000, but it would increase the amount consumers would pay for gasoline by about $1,400.
The administration's draft analysis concluded that the rule could actually cost the American economy between $13 billion and $22 billion.
As administration officials sought to rework those numbers to show that the rule would help consumers, automakers pushed the White House to complete the rule by March 30, the deadline needed to begin manufacturing vehicles under the new standard for the 2022 model year.
Over the weekend, White House officials looked at a new option for their cost-benefit analysis, according to two people familiar with the matter, who asked to speak anonymously because the rule was not yet final. The new analysis would put a price tag on consumer preference for less fuel-efficient vehicles, between $38 billion and $58 billion, hoping to show an economic benefit for removing the requirement that auto companies sell higher-mileage cars.
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Some analysts scoffed at that assertion.
"It's not going to be supported by the science," said Chet France, a former senior E.P.A. vehicle emissions specialist who is now a consultant who works with the Environmental Defense Fund, an advocacy group. This will be the icing on cake of the legal flaws."
If the rule does survive legal challenges, it would put the United States out of step with the rest of the global auto market, moving it from one of the strongest fuel economy standards in the world to one of the weakest. The American standard would be lower than those of the European Union, China, India, Japan and South Korea. That could present long-term challenges to the American auto industry, as other automakers develop more sophisticated, high-efficiency, low-pollution vehicles while American ones focus on gas guzzlers.
"The U.S. went from being the laggard of the world on these standards, to being the country that was setting the pace for the rest of the world — and now it's going back to being the laggard," said Anup Bandivadekar, director of the passenger vehicle program for the International Council on Clean Transportation, a nonprofit research organization. "Among the major markets, automakers now will no longer first have to think of U.S."
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The new measure will combine with a related rule, issued last year, that revoked the right of California and other states to set their own tougher vehicle emissions standards. California has spearheaded a pair of multistate lawsuits to block both rules, escalating a political war between Mr. Trump and the nation's most populous state.
Those legal wars have already left automakers in limbo. The chief executives of the Big Three automakers personally asked Mr. Trump at the outset of his administration to loosen the Obama auto rules, chiefly by giving them a longer timeline to comply, but many auto executives grew alarmed at the scale of the president's rollbacks and the lawsuits they triggered.
In a letter to Mr. Trump last June, 17 companies — including Ford, General Motors, Toyota and Volvo — asked Mr. Trump to go back to the negotiating table on the planned rollback, saying a drastic reversal threatened to cut their profits and produce "untenable" instability. They predicted "an extended period of litigation and instability" if his plans were implemented.
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"We strongly believe the best path to preserve good auto jobs and keep new vehicles affordable for more Americans is a final rule supported by all parties — including California," the companies wrote.
Then, in July, four automakers — Ford Motor Company, Volkswagen of America, Honda and BMW — announced that they had struck a deal with California to comply with state-level standards that demand fuel economy of 51 miles per gallon by 2026.
Ultimately, the limits on atmospheric emissions will likely be decided by the Supreme Court. Automakers most fear verdicts that uphold the legal authority of California and other states to enact their own standards, and allow the Trump standards to move forward elsewhere. That would split the nation's auto market in two.
"One thing we've learned from the Trump administration is be careful what you ask for," said Dr. Victor of the University of California, San Diego.
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"The auto industry wanted a smoother glide path to a more efficient future," he added. "Instead what they got was the populist politics of the far right, which is blowing up in their faces."
Mr. Trump's defenders say his moves are not aimed at automakers but at consumers who generally prefer larger vehicles, such as pickup trucks and sport utility vehicles.
"He's not doing it to be conciliatory to industry, he's doing it for consumers, and for his own personal and political reason," Mr. Pyle said.
For more climate news sign up for the Climate Fwd: newsletter or follow @NYTClimate on Twitter.
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USNS Comfort arrives in New York City
Docked just west of me on the Hudson, very close to Mt. Sinai West (my own for recent events) hospital, which has been hard hit and the scene of the first medical professional fatality (front line nurse).
https://www.politico.com/states/new-york/city-hall/story/2020/03/30/usns-comfort-arrives-in-new-york-city-1269589
NY Stats - cases still escalating. effects of distancing showing up, but coming from behind
New York reported almost 7,000 new cases of the virus since Sunday, bringing the total to nearly 66,500. Most of the cases are in New York City, where 36,221 people have tested positive, the city says.
The number of people hospitalized was 9,517, up 12 percent from yesterday. Of those, 2,352 are in ventilator-equipped intensive care rooms.
In a hopeful note, Mr. Cuomo said that while the number of hospitalizations continues to grow, the rate which it is growing was tapering off. "We had a doubling of cases every two days, then a doubling every three days and a doubling every four days, then every five," Mr. Cuomo said. "We now have a doubling of cases every six days. So while the overall number is going up, the rate of doubling is actually down."
a beautiful thing
Every single thing attached to this mounting structure, every cable path, every plug and jack a revenue producer.
Monty Bannerman
Managing Director
Cell: 305-984-1177
Tel: 646-402-5076
Fwd: Resilient Power Newsletter, March 2020
---------- Forwarded message ---------
From: Clean Energy Group <resilient-power@cleanegroup.org>
Date: Mon, Mar 30, 2020 at 1:46 PM
Subject: Resilient Power Newsletter, March 2020
To: <mbannerman@arcstarenergy.com>
From: Clean Energy Group <resilient-power@cleanegroup.org>
Date: Mon, Mar 30, 2020 at 1:46 PM
Subject: Resilient Power Newsletter, March 2020
To: <mbannerman@arcstarenergy.com>
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This message was sent to mbannerman@arcstarenergy.com from resilient-power@cleanegroup.org
Clean Energy Group
Resilient Power Project
50 State StreetSuite 1
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Clean Energy Group
Resilient Power Project
50 State StreetSuite 1
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NYC hospitals: Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines
Regulatory: Battle between States Renewable Goals and Trump Administration Fossil Protection Heats Up
Century-old TB vaccine called to service
Bloomberg:
A vaccine that's been used to prevent tuberculosis is being given to health-care workers in Melbourne to see if it will protect them against the coronavirus.The bacillus Calmette-Guerin, or BCG, shot has been used widely for about 100 years, with a growing appreciation for its off-target benefits. Not only is it a common immunotherapy for early-stage bladder cancer, it also seems to train the body's first line of immune defense to better fight infections.
Sunday, March 29, 2020
Oil Plummets to 17-Year Low as Broken Market Drowns in Crude
Crude dropped to its lowest in 17 years as virus lockdowns cascaded through the world's largest economies, leaving the market overwhelmed by cratering demand and an unmanageable surplus.
Futures in London fell as much as 7.6% to their lowest since November 2002 while also slumping in New York to trade below $20 a barrel. Physical oil markets are struggling to store fuel, hit by a double whammy of coronavirus restrictions eroding demand while Saudi Arabia and Russia dig in their heels over a damaging war for market share.
Futures in London fell as much as 7.6% to their lowest since November 2002 while also slumping in New York to trade below $20 a barrel. Physical oil markets are struggling to store fuel, hit by a double whammy of coronavirus restrictions eroding demand while Saudi Arabia and Russia dig in their heels over a damaging war for market share.
Monty Bannerman
Managing Director
Tel: +1 646-402-5076
Managing Director
Tel: +1 646-402-5076
Cell: +1 305-984-1177
Trump thinks there must be some reason other than the virus (like theft) for the need for so many masks
Bloomberg News tonight:
President Donald Trump alleged a New York hospital is losing medical masks or even allowing them to be stolen, questioning how demand for the product could have spiked so rapidly during the coronavirus outbreak.
Trump cited no evidence and didn't identify the hospital. At a news conference Sunday in the White House Rose Garden, after the chief executive officer of medical distributor Owens & Minor Inc. said that one of its customers had gone from using 10,000 to 20,000 masks a week to 200,000 to 300,000, the president suggested a criminal reason.
"How do you go from 10 to 20, to 300,000 -- 10 to 20,000 masks to 300,000, even though this is different. Something's going on, and you ought to look into it, as reporters," Trump said.
"Where are the masks going -- are they going out the backdoor?" he added. "Somebody should probably look into that, because I just don't see from a practical standpoint how that's possible to go from that to that, and we have that happening in numerous places."
Monty Bannerman
Managing Director
Tel: +1 646-402-5076
Managing Director
Tel: +1 646-402-5076
Cell: +1 305-984-1177
In the Absence of Federal Leadership, Experts converge and publish plans for establish and easing coronavirus restrictions - link to plan provided in article
If there's one thing people agree on, even as they debate the government's coronavirus response, it is this: We can't do this forever.
The nationwide shutdowns, the home quarantines, hospital shortages, layoffs, deaths and infections. All seemingly without end. So what exactly is our next step?
Concerned about the nation's halting, uncoordinated response — which has featured a patchwork of state-by-state, competing and at times contradictory decisions — health experts are rushing to offer their own long-term strategies to combat the virus and edge America closer back to normal.
Their proposals come as the White House's current 15-day guidelines on social distancing are set to expire early this week, with President Trump suggesting he might loosen them soon to help the economy. What he decides could have sweeping effects on his presidency and the lives of millions across the country. His comments of late about reopening parts of the country by Easter, which is April 12, have worried outside experts it might raise infections and the U.S. death count.
In response, epidemiologists and infectious disease specialists, as well as former top agency officials, have put out their own ideas — in preprint papers online, by Twitter and in op-eds. In a recent flurry of proposals, a consensus of sorts has begun to coalesce around several key ingredients for an American strategy to move forward while minimizing human and economic casualties. They include mounting a large-scale contact tracing effort, widespread testing, building up health care capacity before easing restrictions, making future quarantines more targeted, and allowing those who have recovered and have some immunity to go back to work.
The latest proposal, which has not been previously reported, is a 19-page plan with a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step. The plan was published Sunday by the American Enterprise Institute. Its lead author — Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration — has been acting as an informal adviser to the White House and has shared the paper with administration officials. His collaborators include Mark McClellan, a former FDA commissioner from the George W. Bush Administration; Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, and other leading policy experts and infectious disease specialists.
"People feel anxious about the future, and you need to have milestones to show people how their lives are going to improve," Gottlieb said in an interview late Saturday. "The goal is to outline a plan that will allow a gradual return to a more normal way of life without increasing the risk" that the outbreak will resurge.
Road map for coming months
Many economists and health experts say there is no way to restart the economy without addressing the underlying problem of the coronavirus. As long as the pandemic continues, the markets will be in turmoil and businesses will struggle to stay open, they say.
"The question is once you take your foot off the pedal, what happens then?" said Michael Osterholm, director of University of Minnesota's Center for Infectious Disease Research and Policy. Osterholm, Gottlieb and others stressed lifting restrictions too soon could be disastrous.
Like others, Osterholm has argued in op-eds and interviews that instead of giving false reassurances and deadlines, the White House should tell people the hard truth about the current situation and a coherent strategy they can work toward. "The social distancing, being stuck at home, the deaths we're going to be seeing. People want to know what it's for. That there's a plan."
Similarly, the road map Gottlieb's group outlined stresses the need to move away from the current decentralized system and "toward more coordinated execution of response."
The report was co-written by Lauren Silvis, an attorney who was Gottlieb's chief of staff at the FDA, and was reviewed by prominent experts including Thomas Inglesby of the Hopkins Center for Health Security and Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center.
The plan divides coming months into four phases and sets "triggers" for states to move from one phase to the next. Given the uneven spread and stages of outbreak, not all states would move through the phases at the same time. While the overall peak of the epidemic may occur in late April or early May, the timing may be different in different states. New York, the current epicenter, may see a decline in infection rates as other states have an increase.
With most of the nation in phase one of the epidemic, the goal should be a sharp increase in hospital critical care beds and an increase of testing to 750,000 people a week to track the epidemic — a number Gottlieb said could be achieved in the next week or two. For a state to move to phase two, it should see a sustained reduction in new cases for at least 14 days, and its hospitals need to be able to provide care without being overwhelmed.
"The reason we set it at 14 days is that's the incubation period of the virus," said Rivers, of Johns Hopkins. "That way you know the downward trend is certain and not because of a holiday or blip or some other delay in reported cases."
States moving into phase two would gradually lift social distancing measures and open schools and businesses, while increasing surveillance. The key goals thereafter would be accelerating the development of new treatments and deploying tests to determine who has recovered from infection with some immunity and could rejoin the workforce.
Phase three occurs when the nation has a vaccine or drugs to treat covid-19 in place and the government launches mass vaccinations. Phase four involves rebuilding the nation's capacity to deal with the next pandemic by building up its scientific and public health infrastructure.
Moving beyond lockdowns
Trump has repeatedly returned to strategies of bans and movement restriction. On Saturday, Trump indicated he might announce a federally mandated quarantine on the tri-state region, forbidding people to leave parts of New York, New Jersey and Connecticut.
His comments prompted questions about whether it was feasible or legal. New York Gov. Andrew M. Cuomo (D) called a quarantine "preposterous," while New York Mayor Bill de Blasio said he wasn't "sure what the president means."
It was unclear whether Trump was seriously considering the New York-area quarantine or whether it was an off-the-cuff pronouncement. Two White House officials said the idea was spurred by a conversation Saturday morning with Florida Gov. Ron DeSantis who complained about people from New York pouring into his state. Aides spent the day warning the president against it, explaining it would be impossible to enforce and could create more complications, said the officials, who spoke on the condition of anonymity. Saturday evening, Trump tweeted that a quarantine wouldn't be necessary, and instead the Centers for Disease Control and Prevention issued an advisory against unnecessary travel in the three states.
For weeks, World Health Organization officials have stressed such lockdowns are helpful only for slowing the virus and buying time to deploy more targeted and comprehensive measures, which the United States has not done.
Mike Ryan, head of emergency programs for WHO, urged countries to focus on finding and isolating infected people and their contacts. "It's not just about physical distancing, it's not just about locking down," he said at a recent news briefing.
Proposals from many experts for a U.S. strategy have similarly stressed the importance of large-scale contact tracing — a cornerstone for successful efforts in countries including South Korea and Singapore.
In the past, some epidemiologists viewed contact tracing on a large scale both impractical and unhelpful once an outbreak has become widespread in a community. But as countries have shown its success against this coronavirus, that thinking has changed.
In a paper last week and interviews, Marc Lipsitch, an epidemiologist at Harvard University, suggested while contact tracing is "impractical now in many places," it could become practical once the numbers have gone down and testing has gone up. He said it also "could alleviate the need for stringent social distancing to maintain control of the epidemic."
South Korea had already honed this ability during an 2015 outbreak of the deadly MERS coronavirus. Singapore deployed its police force to do the work, drawing on digital footprints with security camera footage and credit card records.
In the United States, however, that task falls to county health departments, which have been weakened by decades of budget cuts and lack the staffing and ability to mount such a response. Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers, of Johns Hopkins. "If you build capacity up and bring cases down, it starts looking a lot more possible."
Getting the White House to listen
Many proposals are also tackling the problem of the tanking economy. The Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing. People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are in quarantine.
Serology tests have not been deployed on such a large scale, although in Africa, during the Ebola outbreaks, survivors often were the ones who provided care, watched over the children of sick patients and buried the dead.
But the one looming challenge unaddressed by most proposals and op-eds is how to get such detailed plans adopted by the White House, whose response has been weighed down by infighting and leadership ping-ponging among Trump, Pence and health advisers including Anthony S. Fauci and Deborah Birx.
Pence said Saturday the covid-19 task force would bring its recommendations to Trump in the coming week on whether to ease social distancing and reopen the economy.
Health officials and scientists involved in the federal response, especially from the CDC, have fought to be heard while straining to avoid offending Trump, who bristles at being publicly contradicted, undercut or overshadowed by praise for ideas or people beside himself, according to people who spoke on the condition of anonymity about sensitive deliberations.
"While the president has said he'd like to open the country up in weeks not months, we're going to be bringing that data forward to him," Pence said in an interview with Fox News. "Ultimately, the president will make a decision that he believes is in the best interest of all of the American people."
On Thursday, Trump unveiled a plan of his own, though scarce in detail. He said he planned to help communities ease their restrictions and reopen for business by using "robust" surveillance and categorizing counties across America into three "risk levels" — low, medium and high. Specifics on how that plan might work, White House officials said, may be announced in coming days.
NY Stats
The number of confirmed cases jumped by 7,200 in one day, putting the total of confirmed cases at 59,513 cases as of Sunday. More than half of the cases, or 33,768, are in New York City, according to the latest figures from the city and state.
About 8,500 people are currently hospitalized, an increase of 16 percent from Saturday to Sunday. Of those, 2,037 are in intensive care units, which are equipped with ventilators.
237 people have died in the last 24 hours, the largest single day total to date.
NYC's 911 Responders
N.Y.C.'s 911 System Is Overwhelmed. 'I'm Terrified,' a Paramedic Says.
With coronavirus cases mounting, emergency workers are making life-or-death decisions about who goes to a hospital, and who is left behind.
Image![In a matter of days, New York City's 911 system was overwhelmed by calls for medical distress seemingly related to the coronavirus.]()
In a matter of days, New York City's 911 system was overwhelmed by calls for medical distress seemingly related to the coronavirus.Credit...Mark Abramson for The New York Times
By Ali Watkins
- March 28, 2020
The first of many calls that night involved a 24-year-old man who had a fever, body aches and a cough that sounded like a cement mixer.
While the Brooklyn paramedics took the man's fever — 103 degrees — they noticed frightening vitals that hinted at coronavirus: a critically low level of oxygen was flowing into his otherwise clear lungs, while his heart thumped with the intensity of a marathon runner's. He was taken to the nearest hospital.
Then almost immediately came the next call: a 73-year-old man with symptoms similar to the young man's. They took him to the hospital, too.
"It's all a war zone," one of the paramedics said.
Days later, another paramedic, Phil Suarez, was dispatched to two homes in Manhattan's Washington Heights neighborhood, where entire families, living in cramped apartments, appeared to be stricken with the virus.
"I'm terrified," said Mr. Suarez, who has been a paramedic in New York City for 26 years and had assisted in rescue efforts during the Sept. 11, 2001, terror attacks and later served in the Iraq war. "I honestly don't know if I'm going to survive. I'm terrified of what I've already possibly brought home."
Image![Phil Suarez, a New York City paramedic.]()
Phil Suarez, a New York City paramedic. "I'm terrified of what I've already possibly brought home," he said. Credit...Jessica Hill for The New York TimesEven as hospitals across New York become inundated with coronavirus cases, some patients are being left behind in their homes because the health care system cannot handle them all, according to dozens of interviews with paramedics, New York Fire Department officials and union representatives, as well as city data.
In a matter of days, the city's 911 system has been overwhelmed by calls for medical distress apparently related to the virus. Typically, the system sees about 4,000 Emergency Medical Services calls a day.
On Thursday, dispatchers took more than 7,000 calls — a volume not seen since the Sept. 11 attacks. The record for amount of calls in a day was broken three times in the last week.
Because of the volume, emergency medical workers are making life-or-death decisions about who is sick enough to take to crowded emergency rooms and who appears well enough to leave behind. They are assessing on scene which patients should receive time-consuming measures like CPR and intubation, and which patients are too far gone to save.
And, they are doing it, in most cases they say, without appropriate equipment to protect themselves from infection.
The paramedics described grim scenes as New York City has become the epicenter of the coronavirus pandemic in the United States, with more than 30,000 cases as of Saturday, and 672 deaths.
If the rate of growth in cases in the New York area continues, it will suffer a more severe outbreak than those experienced in Wuhan, China, or the Lombardy region of Italy.
One New York City paramedic described responding to a suicide attempt of a woman who had drank a liter of vodka after her cancer treatments had been delayed, in part because hospitals were clearing their beds for coronavirus patients.
Another paramedic said she responded to so many cardiac arrests in one shift that the battery on her defibrillator died.
"It does not matter where you are. It doesn't matter how much money you have. This virus is treating everyone equally," the Brooklyn paramedic said.
The amount of work has been record-setting for the city's 911 system, said Frank Dwyer, a Fire Department spokesman.
"Our E.M.T.s and paramedics are on the front line during an unprecedented time in the department's history," Mr. Dwyer said, adding: "They're doing it professionally, and they're doing it because they care about their patients. They care about this city."
The department said it has started rationing protective gear in an attempt to stave off potential shortages. Earlier this month, the department told workers that they must turn in their used N95 masks — which filter out 95 percent of airborne particles when used correctly — in order to receive a new one.
"The department is carefully managing and monitoring usage of personal protective equipment and critical supplies to ensure we have what's needed for this long-term operation," Mr. Dwyer said.
Inside ambulances, on rudimentary digital screens, the dispatches are listed — call No. 2,488, sick; call No. 2,555, sick; call No. 2,894, sick with a fever. The screen goes on for rows, a catalog of the city's ill and dying. Peppered among them are the usual every day calls still demanding attention: injuries, accidents, heart attacks.
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Responding to a 911 call in East Harlem on March 18. Credit...Juan Arredondo for The New York TimesNew York City's soundtrack has always included the sound of ambulance sirens. But now, with many of the city's businesses closed and its neighborhoods quiet, endless wailing seems to echo through the deserted streets.
Three weeks ago, the paramedics said, most coronavirus calls were for respiratory distress or fever. Now the same types of patients, after having been sent home from the hospital, are experiencing organ failure and cardiac arrest.
"We're getting them at the point where they're starting to decompensate," said the Brooklyn paramedic, who is employed by the Fire Department. "The way that it wreaks havoc in the body is almost flying in the face of everything that we know."
In the same way that the city's hospitals are clawing for manpower and resources, the virus has flipped traditional Emergency Medical Services procedures at a dizzying speed. Paramedics who once transported people with even the most mild medical maladies to hospitals are now encouraging anyone who is not critically ill to stay home. When older adults call with a medical issue, paramedics fear taking them to the emergency room, where they could be exposed to the virus.
One paramedic told a 65-year-old patient in Brooklyn, whom she had previously transported to the hospital for recurring issues, to stay home this time and call a doctor.
In New York City, 911 calls are handled by both Fire Department ambulances and ambulance companies staffed by area hospitals. Their duties are effectively the same: They respond to the same medical calls, largely determined by what crew is closer and which is available fastest.
Neither the city, the State Department of Health or the federal Centers for Disease Control and Prevention have issued strict rules as to how paramedics should respond to a coronavirus call. In recent days, Fire Department policy — which applies to all ambulance crews in the 911 system — has given more latitude to paramedics to make decisions on how to handle patients they believe have the virus.
Recent guidance has also directed paramedics to wear surgical masks, gloves, gowns and eye protection for suspected coronavirus patients. N95 masks, in short supply, are only worn for certain procedures.
Since many hospitals are in dire need of personal protective equipment like N95 masks, paramedic crews employed by the hospitals also face shortages.
The Brooklyn paramedic said she had started sewing her homemade masks with bandannas and coffee filters.
Another paramedic in Brooklyn said she had been using the same N95 mask for days. Last week, as she and her partner exited an apartment building after tending to a patient, the building's supervisor — noticing the pair's worn equipment — met them downstairs and shoved new N95 masks and a can of Lysol into their arms.
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In a matter of days, New York City's 911 system was overwhelmed by calls for medical distress seemingly related to the coronavirus.Credit...Jose A. Alvarado Jr. for The New York TimesLike doctors and nurses, many paramedics fear they are already infected and have brought the virus home to their families. On March 18, three members of the Fire Department tested positive for the virus. By Friday, 206 members had positive results.
Officials for the union that represents the city's paramedics believe the actual number who have been infected is far higher. At a single station in Coney Island, Brooklyn, seven Emergency Medical Services workers were infected, one union official said.
At least one E.M.S. worker with the virus was in an intensive care unit last week and on a ventilator.
The growing pandemic has tested paramedics physically and mentally, said Anthony Almojera, an E.M.S. lieutenant for the Fire Department who said he cried on the job for the first time in his 17-year career.
He and his team had responded to a cardiac arrest dispatch for a middle-age woman, a health care worker, who had been infected. When paramedics arrived at her home, the woman's husband, who was also a health care worker, said she had been sick for five days.
The husband frantically explained that he had tried to stay home and tend to his ill wife, but his employer had asked him to work because their facility was overrun with coronavirus patients.
Grudgingly, the man told the medics, he went to work. When he returned home after his shift that day, he found her unconscious in their bed. For 35 minutes, Mr. Almojera's team tried to revive the woman, but she could not be saved.
Usually, Mr. Almojera said, he tries to console family members who have lost a loved one by putting his arm around them or giving them a hug.
But because the husband was also thought to be infected with the coronavirus, Mr. Almojera delivered the bad news from six feet away. He watched the man pound on his car with his fist and then crumble to the ground.
"I'm sitting there, beside myself, and I can't do anything except be at this distance with him," Mr. Almojera said. "So, we left him."
Ali Watkins is a reporter on the Metro desk, covering crime and law enforcement in New York City. Previously, she covered national security in Washington for The Times, BuzzFeed and McClatchy Newspapers. @AliWatkins
Answers to Your Frequently Asked Questions
Updated March 24, 2020
How does coronavirus spread?
It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
Is there a vaccine yet?
No. The first testing in humans of an experimental vaccine began in mid-March. Such rapid development of a potential vaccine is unprecedented, but even if it is proved safe and effective, it probably will not be available for 12 to18 months.
What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
What should I do if I feel sick?
If you've been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you're sick and you think you've been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there's a chance — because of a lack of testing kits or because you're asymptomatic, for instance — you won't be able to get tested.
What if somebody in my family gets sick?
If the family member doesn't need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there's space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don't forget to wash your hands frequently.
Should I wear a mask?
Experts are divided on how much protection a regular surgical mask, or even a scarf, can provide for people who aren't yet sick. The W.H.O. and C.D.C. say that unless you're already sick, or caring for someone who is, wearing a face mask isn't necessary. And stockpiling high-grade N95 masks will make it harder for nurses and other workers to access the resources they need. But researchers are also finding that there are more cases of asymptomatic transmission than were known early on in the pandemic. And a few experts say that masks could offer some protection in crowded places where it is not possible to stay 6 feet away from other people. Masks don't replace hand-washing and social distancing.
Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don't live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Should I pull my money from the markets?
That's not a good idea. Even if you're retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year's worth of living expenses and big payments needed over the next five years.
What should I do with my 401(k)?
Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don't! If your employer matches any part of your contributions, make sure you're at least saving as much as you can to get that "free money."
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