COVID-19 News from Around the Web

As COVID-19 spreads rapidly through the United States, many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing: Which patients get lifesaving treatment, and which ones do not? Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage. As the number of coronavirus cases rises in the U.S., hospitals have a new urgency in revisiting and updating those guidelines.

Scientists who have fought pandemics describe difficult measures needed to defend the United States against a fast-moving pathogen. Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel. Whether they can keep it suppressed remains to be seen. But for the United States to repeat their successes will take extraordinary levels of coordination and money from the country’s leaders, and extraordinary levels of trust and cooperation from citizens. It will also require international partnerships in an interconnected world.

The governor of California on Thursday evening issued a statewide stay at home order to help combat the spread of the novel coronavirus. The order is effective Thursday night and asks residents to leave their homes only when necessary. It remains in place until further notice. … California, which has a population of around 40 million, appears to be the first state to order restrictions statewide. “We project that roughly 56 percent of our population — 25.5 million people — will be infected with the virus over an eight week period," Newsom wrote in a letter to President Donald Trump dated Wednesday.

The US State Department on Thursday warned American citizens not to travel abroad due to the coronavirus pandemic, issuing the highest possible level of travel advisory. The Level 4: Do Not Travel advisory "advises U.S. citizens to avoid all international travel due to the global impact of COVID-19." The State Department urged Americans "in countries where commercial departure options remain available" to "arrange for immediate return to the United States, unless they are prepared to remain abroad for an indefinite period." The updated advisory also cautioned US citizens living abroad to "avoid all international travel." … Prior to the coronavirus pandemic, the Level 4 travel advisory had been used sparingly for only a handful of countries, including Syria, Iran, Yemen and North Korea.

A total 427 deaths were registered in Italy over the past 24 hours, bringing the total nationwide tally to 3,405 since the outbreak surfaced on Feb. 21. China has recorded 3,245 deaths since early January. However, Italy has far fewer confirmed cases - 41,035 as of Thursday against 80,907 in China. Officials and experts believe the total number of infections here is significantly higher, with testing largely limited to those arriving for hospital care. The country’s large, elderly population, who are particularly vulnerable to the virus, is also seen as factor for the high number of fatalities.

Diarrhea and other digestive symptoms are the main complaint in nearly half of coronavirus patients, Chinese researchers report. Most patients with the coronavirus have respiratory symptoms, but these findings from the early stages of the outbreak show that digestive problems are prevalent in many patients with COVID-19. "Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge," wrote the investigators from the Wuhan Medical Treatment Expert Group for COVID-19. The researchers analyzed data from 204 COVID-19 patients, average age nearly 55, who were admitted to three hospitals in the Hubei province between Jan. 18 and Feb. 28, 2020. The average time from symptom onset to hospital admission was 8.1 days. However, the finding showed that patients with digestive symptoms had a longer time from symptom onset to hospital admission than patients without digestive symptoms, 9 days versus 7.3 days. This suggests that patients with digestive symptoms sought care later because they didn't yet suspect they had COVID-19 due to a lack of respiratory symptoms, such as cough or shortness of breath, the researchers explained. Patients with digestive symptoms had a variety of problems, including loss of appetite (nearly 84%), diarrhea (29%), vomiting (0.8%) and abdominal pain (0.4%). Seven of the patients in the study had digestive symptoms but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more serious, the researchers found. Patients without digestive symptoms were more likely to be cured and discharged than those with digestive symptoms (60% versus 34%), according to the study published March 18 in the American Journal of Gastroenterology.

The proposal, expected to cost around $1 trillion, calls for direct payments on a tiered scale. Individuals making $75,000 based on a 2018 tax return would be eligible for $1,200 payments, or $2,400 for couples filing jointly. The payments would decrease for those making more than $75,000, with an income cap of $99,000 per individual or $198,000 for couples. The payments would also increase $500 for each child a person or couple has. However, taxpayers with little or no income tax liability but at least $2,500 of qualifying income would be eligible for only $600 or $1,200 for couples. The direct deposits appear to be just a one-time payment, rather than two payments as initially proposed by the White House. The Republican proposal also includes emergency aid for small businesses and industries such as airline companies. The GOP proposal would provide $208 billion for loans or loan guarantees to air carriers and other distressed industries but no more than $50 billion for passenger air carriers and $8 billion for cargo air carriers. The rest, around $150 billion, would be for other industries.

This individual is in good condition and is isolated to prevent spread of infection to others. Our best wishes go to the employee for a rapid and full recovery. This individual was not involved in the COVID-19 response, has not been present in the CDC workplace since March 6, and was asymptomatic at that time. Staff working in the same unit are teleworking while we will do a deep cleaning of the office space. After developing symptoms, the individual took the appropriate action and stayed home.

New C.D.C. data showed that nearly 40 percent of patients sick enough to be hospitalized were aged 20 to 54. But the risk of dying was significantly higher in older people.

"Just because it’s much more uncommon for children to get severe disease, these data show it is indeed possible," an expert said of the study of more than 2,000 children in China.

President Donald Trump on Wednesday signed into law a coronavirus relief package that includes provisions for free testing for Covid-19 and paid emergency leave. The Senate had earlier Wednesday approved the House-passed bill. The move allowed the upper chamber to devote its full attention to passing the next relief package in response to the coronavirus crisis.

Hospitals have already sounded the alarm on quickly vanishing supplies as the outbreak in the US shows no signs of slowing -- in just 24 hours, cases soared by more than 40%. The US government announced this week it would help make up for potential medical supply shortages and deploy two hospital ships to help increase medical capacity. Nearly 9,000 Americans have tested positive for the virus. At least 149 have died. "I view it as, in a sense, of wartime president," President Donald Trump said in a news conference Wednesday. "I mean, that's what we're fighting. It's a very tough situation here."

Reps. Mario Diaz-Balart, R-Fla., and Ben McAdams, D-Utah, are the first two members of Congress who have said they tested positive for COVID-19.

Celebrities, politicians and professional athletes faced a backlash this week as many revealed that they had been tested for the coronavirus, even when they didn’t have a fever or other tell-tale symptoms. That’s fueling a perception that the wealthy and famous have been able to jump to the head of the line to get tested while others have been turned away or met with long delays. The concerns over preferential treatment underscores a fundamental truth about inequalities baked into the American health care system — those with the financial means can often receive a different level of service.

As the Trump administration scrambles to make more coronavirus tests available, demand for testing still outstrips availability. More than 71,000 tests have been done so far in the U.S., according to the Covid Tracking Project, and thousands more are being conducted each week by federal and state labs, hospitals and private companies, officials say. The federal government hopes to open 47 drive-through sites in 12 states soon. But there's still not nearly enough testing, experts say. Most other countries with outbreaks have done a great deal more testing. For instance South Korea has tested more than 270,000 people to date. "The testing capacity remains extraordinarily limited compared to where we should be. And in many ways we are absolutely flying blind at the moment," says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. In response to continued critique of the limited testing capacity, the Food and Drug Administration announced Monday night it has taken several new steps, including letting states get their own testing systems going. "States can now take responsibility for overseeing tests developed and used by laboratories in their states," says FDA Commissioner Stephen Hahn. New York had requested and received this authorization to expand testing capacity. This new flexibility from the FDA could allow states to take steps such as permitting the use of new unapproved tests or letting labs not previously authorized to begin testing. But some experts fear that step may not help much because most states don't have the legal authority, expertise or staff to set up their own testing systems.

Hospitals and doctors say they are critically low on swabs needed to test patients for the coronavirus, as well as face masks and other gear to protect health care workers.