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‘Wash Our Hands? Some People Can’t Wash Their Kids for a Week.’ ‘Wash Our Hands? Some People Can’t Wash Their Kids for a Week.’
(3 days later)
MAARAT MISRIN, Syria — In northwestern Syria, where a million people who have fled the civil war are sheltering in muddy tent camps and abandoned buildings, the spread of the coronavirus could wreak untold disaster on a devastated region.MAARAT MISRIN, Syria — In northwestern Syria, where a million people who have fled the civil war are sheltering in muddy tent camps and abandoned buildings, the spread of the coronavirus could wreak untold disaster on a devastated region.
Forget hand washing and social distancing, the preventive measures recommended by health authorities around the world.Forget hand washing and social distancing, the preventive measures recommended by health authorities around the world.
There is little to no running water in the camps, and up to a dozen people often live in the same tent.There is little to no running water in the camps, and up to a dozen people often live in the same tent.
“You want us to wash our hands?” asked Fadi Mesaher, the Idlib director for the Maram Foundation for Relief and Development. “Some people can’t wash their kids for a week. They are living outdoors.”“You want us to wash our hands?” asked Fadi Mesaher, the Idlib director for the Maram Foundation for Relief and Development. “Some people can’t wash their kids for a week. They are living outdoors.”
Syrian doctors believe the virus has already swept into the camps, with deaths and illness that bear the hallmarks of the outbreak. But the international response has been slow to nonexistent, according to more than a dozen experts and Syrian medical professionals.Syrian doctors believe the virus has already swept into the camps, with deaths and illness that bear the hallmarks of the outbreak. But the international response has been slow to nonexistent, according to more than a dozen experts and Syrian medical professionals.
The World Health Organization has not yet delivered coronavirus testing kits to the opposition-held northwest, despite making its first delivery of such kits to the Syrian government more than a month ago.The World Health Organization has not yet delivered coronavirus testing kits to the opposition-held northwest, despite making its first delivery of such kits to the Syrian government more than a month ago.
Doctors said the delay has probably allowed the virus to spread undetected for weeks in a uniquely dangerous environment.Doctors said the delay has probably allowed the virus to spread undetected for weeks in a uniquely dangerous environment.
“We currently have cases that are similar, and we’ve had people die,” said Dr. Mohamed Ghaleb Tennari, who manages the Syrian American Medical Society’s hospitals in the region. “But unfortunately because we don’t have the test, we can’t confirm that these cases are truly corona or not.”“We currently have cases that are similar, and we’ve had people die,” said Dr. Mohamed Ghaleb Tennari, who manages the Syrian American Medical Society’s hospitals in the region. “But unfortunately because we don’t have the test, we can’t confirm that these cases are truly corona or not.”
About three million people are crowded into Idlib Province, which has been outside the control of President Bashar al-Assad’s government since 2012 and is the country’s last rebel-held pocket.About three million people are crowded into Idlib Province, which has been outside the control of President Bashar al-Assad’s government since 2012 and is the country’s last rebel-held pocket.
Mr. Assad’s forces and their Russian allies began a final push to retake the area last spring, and a renewed offensive in early December drove nearly a million people from their homes.Mr. Assad’s forces and their Russian allies began a final push to retake the area last spring, and a renewed offensive in early December drove nearly a million people from their homes.
About a third of them are living in large camps or tents, the United Nations estimates. The rest are sleeping along roadsides, squatting in unfinished or abandoned buildings, or sharing quarters with other families.About a third of them are living in large camps or tents, the United Nations estimates. The rest are sleeping along roadsides, squatting in unfinished or abandoned buildings, or sharing quarters with other families.
A cease-fire has held for two weeks but no one expects it to last. Mr. Assad has vowed to continue the offensive and rebel groups in the province have vowed to resist.A cease-fire has held for two weeks but no one expects it to last. Mr. Assad has vowed to continue the offensive and rebel groups in the province have vowed to resist.
Across the province, hospitals and medical facilities have been decimated by eight years of war. Syrian government and Russian warplanes have repeatedly bombed and shelled hospitals and clinics in opposition-held areas throughout the conflict, killing hundreds of health care workers.Across the province, hospitals and medical facilities have been decimated by eight years of war. Syrian government and Russian warplanes have repeatedly bombed and shelled hospitals and clinics in opposition-held areas throughout the conflict, killing hundreds of health care workers.
Since the December offensive began, more than 84 hospitals and medical facilities in the northwest have been damaged, destroyed or forced to close, according to the World Health Organization.Since the December offensive began, more than 84 hospitals and medical facilities in the northwest have been damaged, destroyed or forced to close, according to the World Health Organization.
Those that are still running lack the needed supplies.Those that are still running lack the needed supplies.
In Idlib City, a lab at Idlib Central Hospital is ready to test for coronavirus but lacks the test kits, said Dr. Naser Almhawish, the surveillance coordinator for the Early Warning Alert and Response Network of the Assistance Coordination Unit, an independent group.In Idlib City, a lab at Idlib Central Hospital is ready to test for coronavirus but lacks the test kits, said Dr. Naser Almhawish, the surveillance coordinator for the Early Warning Alert and Response Network of the Assistance Coordination Unit, an independent group.
Syrian doctors have asked for more protective equipment, like masks and gloves, but the first new shipment from the World Health Organization arrived only Tuesday.Syrian doctors have asked for more protective equipment, like masks and gloves, but the first new shipment from the World Health Organization arrived only Tuesday.
When we visited Idlib Province after crossing from Turkey last week, we saw no screening points for the virus.When we visited Idlib Province after crossing from Turkey last week, we saw no screening points for the virus.
Informal encampments, planted in agricultural fields and on windy hillsides, lined the road from the border to the small town of Maarat Misrin. In the town hospital, bleary-eyed doctors worked in basement operating rooms, while a crowd of people waited above.Informal encampments, planted in agricultural fields and on windy hillsides, lined the road from the border to the small town of Maarat Misrin. In the town hospital, bleary-eyed doctors worked in basement operating rooms, while a crowd of people waited above.
“Unfortunately, we don’t have areas of quarantine available in north Syria,” said Abd al-Razzaq Zaqzouq, a media assistant for the Syrian American Medical Society at the hospital. “If there is any case of corona in north Syria, the situation will be tragic.”“Unfortunately, we don’t have areas of quarantine available in north Syria,” said Abd al-Razzaq Zaqzouq, a media assistant for the Syrian American Medical Society at the hospital. “If there is any case of corona in north Syria, the situation will be tragic.”
Doctors in the region estimate that a million people in Idlib Province could contract the virus, that 100,000 to 120,000 could die, and that 10,000 will need the help of ventilators. There are 153 ventilators in the province now.Doctors in the region estimate that a million people in Idlib Province could contract the virus, that 100,000 to 120,000 could die, and that 10,000 will need the help of ventilators. There are 153 ventilators in the province now.
“You may have seen countries like Italy and China — countries that have a quarantine system, and even they couldn’t handle the pressure of all of these cases,” said Dr. Tennari. “Imagine then — we’re in a state of war and we don’t have a proper health care system. It’s crippled.”“You may have seen countries like Italy and China — countries that have a quarantine system, and even they couldn’t handle the pressure of all of these cases,” said Dr. Tennari. “Imagine then — we’re in a state of war and we don’t have a proper health care system. It’s crippled.”
Hedinn Halldorrson, a spokesman for the World Health Organization’s cross-border efforts in southern Turkey, said Wednesday that the W.H.O. expects test kits to arrive in Idlib next week. He said he did not know how many kits would be sent or exactly when they would arrive. Samples can be sent to labs in Turkey in the meantime, he said.Hedinn Halldorrson, a spokesman for the World Health Organization’s cross-border efforts in southern Turkey, said Wednesday that the W.H.O. expects test kits to arrive in Idlib next week. He said he did not know how many kits would be sent or exactly when they would arrive. Samples can be sent to labs in Turkey in the meantime, he said.
The delay, he said, was because the W.H.O. distributed kits to government health agencies first. “The northwest is not a country,” he said.The delay, he said, was because the W.H.O. distributed kits to government health agencies first. “The northwest is not a country,” he said.
Given the obstacles to delivering supplies to a conflict zone, Mr. Halldorrson said, a month’s delay was not bad.Given the obstacles to delivering supplies to a conflict zone, Mr. Halldorrson said, a month’s delay was not bad.
“When you consider the challenges, I think it’s quite reasonable,” he said. “I don’t know the nitty-gritty details of it, but they will be there soon, that’s all I know.”“When you consider the challenges, I think it’s quite reasonable,” he said. “I don’t know the nitty-gritty details of it, but they will be there soon, that’s all I know.”
He also said that border screening checkpoints would be set up soon and that more protective equipment would be delivered, although he did not know when or how much.He also said that border screening checkpoints would be set up soon and that more protective equipment would be delivered, although he did not know when or how much.
On Sunday, the Idlib Health Directorate, an opposition body, said that there was a “high possibility for a pandemic outbreak to spread in the liberated areas in the very near future, if it isn’t here already.”On Sunday, the Idlib Health Directorate, an opposition body, said that there was a “high possibility for a pandemic outbreak to spread in the liberated areas in the very near future, if it isn’t here already.”
It issued recommendations, including closing the schools and universities that remain open, closing cafes and restaurants except for takeout, halting group prayers, social visits and unnecessary travel, and advice on how to sneeze and cough, wash hands and clean living spaces.It issued recommendations, including closing the schools and universities that remain open, closing cafes and restaurants except for takeout, halting group prayers, social visits and unnecessary travel, and advice on how to sneeze and cough, wash hands and clean living spaces.
Updated June 5, 2020 Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
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.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.
But most of those recommendations are impossible in the tent camps.But most of those recommendations are impossible in the tent camps.
“If there is an elder or anyone being sick, I don’t see how they will separate themselves,” said Michel Olivier Lacharité, a crisis coordinator for Doctors Without Borders.“If there is an elder or anyone being sick, I don’t see how they will separate themselves,” said Michel Olivier Lacharité, a crisis coordinator for Doctors Without Borders.
At the Atmeh camp, pressed against the Turkish border 30 miles north of Idlib City, sewage runs openly in the roads and there is no regular garbage pick up.At the Atmeh camp, pressed against the Turkish border 30 miles north of Idlib City, sewage runs openly in the roads and there is no regular garbage pick up.
Amina Alkaeed, who lives there with her husband, parents and 10-month-old daughter, said that her husband had built a bathroom for their small house, but that nearby, up to 40 people use five toilets with no place to wash their hands.Amina Alkaeed, who lives there with her husband, parents and 10-month-old daughter, said that her husband had built a bathroom for their small house, but that nearby, up to 40 people use five toilets with no place to wash their hands.
Women congregate every day to fill water jugs from a tank and pick up bread.Women congregate every day to fill water jugs from a tank and pick up bread.
“And that bread is wrapped in a bag,” she said. “That bag could be carrying the virus. Then the virus will be transferred to these people.”“And that bread is wrapped in a bag,” she said. “That bag could be carrying the virus. Then the virus will be transferred to these people.”
The camp clinic is small, crowded and overburdened. Relief workers who have come to educate camp residents have not worn masks or gloves or sanitized their hands, she said.The camp clinic is small, crowded and overburdened. Relief workers who have come to educate camp residents have not worn masks or gloves or sanitized their hands, she said.
“This virus can kill more people in one month here in northern Syria than the regime killed in the last 10 years,” she said.“This virus can kill more people in one month here in northern Syria than the regime killed in the last 10 years,” she said.
These conditions will make transmission of the virus significantly easier, experts said. And with hospitals and clinics already stressed by years of conflict, the fatality rate is likely to be much higher than that in better-equipped countries, Mr. Lacharité said.These conditions will make transmission of the virus significantly easier, experts said. And with hospitals and clinics already stressed by years of conflict, the fatality rate is likely to be much higher than that in better-equipped countries, Mr. Lacharité said.
Idlib is under the effective control of Hayat Tahrir al-Sham, a jihadist organization that split from Al Qaeda in 2017 and has used violence against civil society activists, though it has recently made efforts to improve its image.Idlib is under the effective control of Hayat Tahrir al-Sham, a jihadist organization that split from Al Qaeda in 2017 and has used violence against civil society activists, though it has recently made efforts to improve its image.
The group has not issued any statements about preparing for the coronavirus.The group has not issued any statements about preparing for the coronavirus.
This week, the Syrian relief group Violet held training sessions for about 40 nurses and ambulance drivers who will be on the front line of Idlib’s response.This week, the Syrian relief group Violet held training sessions for about 40 nurses and ambulance drivers who will be on the front line of Idlib’s response.
Violet plans to organize them into two teams: those who will deliver advice and baskets with soap, brochures and hand sanitizer, and those who transport people suspected of having the virus. But a global run on sanitizer has left Violet unable to buy much, said Fouad Issa, Violet’s founder.Violet plans to organize them into two teams: those who will deliver advice and baskets with soap, brochures and hand sanitizer, and those who transport people suspected of having the virus. But a global run on sanitizer has left Violet unable to buy much, said Fouad Issa, Violet’s founder.
If, as expected, the cases start expanding exponentially, they will be quickly overwhelmed.If, as expected, the cases start expanding exponentially, they will be quickly overwhelmed.
Relief and medical workers fear that even when test kits and protective gear do finally arrive, they may be too little too late.Relief and medical workers fear that even when test kits and protective gear do finally arrive, they may be too little too late.
“If God forbid corona enters our area,” said Mr. Mesaher of the Maram Foundation, “then it will be the greatest tragedy.”“If God forbid corona enters our area,” said Mr. Mesaher of the Maram Foundation, “then it will be the greatest tragedy.”
Vivian Yee contributed reporting from Beirut.Vivian Yee contributed reporting from Beirut.