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What Made New York So Hospitable for Coronavirus? What Made New York So Hospitable for Coronavirus?
(3 days later)
Perhaps it was inevitable that New York City and its suburbs would become an epicenter of the coronavirus epidemic in the United States. The population density, reliance on public transportation and constant influx of tourists — all would seem to make the metropolitan area a target.Perhaps it was inevitable that New York City and its suburbs would become an epicenter of the coronavirus epidemic in the United States. The population density, reliance on public transportation and constant influx of tourists — all would seem to make the metropolitan area a target.
But to stop the virus, scientists have to figure out which factors played a greater role than others. As it turns out, that is not so simple.But to stop the virus, scientists have to figure out which factors played a greater role than others. As it turns out, that is not so simple.
“We have more speculation than facts,” said Dr. Arnold Monto, professor of epidemiology and global health at the University of Michigan.“We have more speculation than facts,” said Dr. Arnold Monto, professor of epidemiology and global health at the University of Michigan.
More than 20,000 New York City residents have tested positive for the virus so far — nearly a third of all confirmed cases in the nation. The prevalence in New York and the areas close to it is far greater than anywhere else in the country.More than 20,000 New York City residents have tested positive for the virus so far — nearly a third of all confirmed cases in the nation. The prevalence in New York and the areas close to it is far greater than anywhere else in the country.
The problem is that so little is known about the spread of this new virus that it is hard to draw conclusions about whether New York is unique or a harbinger of things to come elsewhere.The problem is that so little is known about the spread of this new virus that it is hard to draw conclusions about whether New York is unique or a harbinger of things to come elsewhere.
There was almost certainly an early and undetected introduction of the virus into the city, probably in mid- to late January, said Benjamin Cowling, professor of infectious disease epidemiology at the University of Hong Kong.There was almost certainly an early and undetected introduction of the virus into the city, probably in mid- to late January, said Benjamin Cowling, professor of infectious disease epidemiology at the University of Hong Kong.
“Many of the cases being detected in the past week are the result of that slow process that has built up over two months,” he said.“Many of the cases being detected in the past week are the result of that slow process that has built up over two months,” he said.
With many viral diseases, scientists can get a sense of the exact timing by comparing the mutations in the virus from samples taken at various times. But human coronaviruses are surprisingly stable, said Dr. Paul Offit, an infectious disease expert at the University of Pennsylvania and Children’s Hospital of Philadelphia.With many viral diseases, scientists can get a sense of the exact timing by comparing the mutations in the virus from samples taken at various times. But human coronaviruses are surprisingly stable, said Dr. Paul Offit, an infectious disease expert at the University of Pennsylvania and Children’s Hospital of Philadelphia.
Once in the area, New York’s density played some role in its rapid spread but was probably not the whole story, epidemiologists said. Many New Yorkers live in high rises. Sidewalks are crowded. Subways can be jammed. The city has 27,000 residents per square mile, far surpassing the second densest city, San Francisco, with 18,000 per mile.Once in the area, New York’s density played some role in its rapid spread but was probably not the whole story, epidemiologists said. Many New Yorkers live in high rises. Sidewalks are crowded. Subways can be jammed. The city has 27,000 residents per square mile, far surpassing the second densest city, San Francisco, with 18,000 per mile.
But, noted Jon Zelner, an epidemiologist at the University of Michigan, other cities such as Tokyo, Seoul, and Taipei also are very dense and have not seen the same kind of explosive growth.But, noted Jon Zelner, an epidemiologist at the University of Michigan, other cities such as Tokyo, Seoul, and Taipei also are very dense and have not seen the same kind of explosive growth.
The extraordinary number of cases might reflect a high level of coronavirus testing. New York City seems to be testing more aggressively than many other places, Dr. Zelner said.The extraordinary number of cases might reflect a high level of coronavirus testing. New York City seems to be testing more aggressively than many other places, Dr. Zelner said.
Maybe, others said, the age structure in the city — the many older people who live close together — played a role. At first, only those with typical coronavirus symptoms were being tested. Older people seem more likely to get very ill with the virus and show symptoms. New York might have more confirmed cases in part because of the age group it was testing.Maybe, others said, the age structure in the city — the many older people who live close together — played a role. At first, only those with typical coronavirus symptoms were being tested. Older people seem more likely to get very ill with the virus and show symptoms. New York might have more confirmed cases in part because of the age group it was testing.
Could the effect be at least in part explained as a statistical fluke, like cancer clusters that can look ominous but turn out to be random?Could the effect be at least in part explained as a statistical fluke, like cancer clusters that can look ominous but turn out to be random?
Chance may play some role in situations like this, said Donald Berry, a statistician at MD Anderson Cancer center. What matters, he says, is not the number of cases but the clusters.Chance may play some role in situations like this, said Donald Berry, a statistician at MD Anderson Cancer center. What matters, he says, is not the number of cases but the clusters.
Suppose an executive on Wall Street was infected early in the epidemic and exposed a group of others by shaking hands. It was the start of a cluster that ballooned out as each person infected others. Suppose that at the same time an actor on Broadway was infected and started another cluster. And a patient in a nursing home started yet another cluster. The number of cases can start to explode.Suppose an executive on Wall Street was infected early in the epidemic and exposed a group of others by shaking hands. It was the start of a cluster that ballooned out as each person infected others. Suppose that at the same time an actor on Broadway was infected and started another cluster. And a patient in a nursing home started yet another cluster. The number of cases can start to explode.
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.
Analyzing spread is not a case by case situation, Dr. Berry said. It is a cluster by cluster issue.Analyzing spread is not a case by case situation, Dr. Berry said. It is a cluster by cluster issue.
“When you see a case you see a lot of cases,” Dr. Berry said. The number of cases becomes the cluster size times the number of clusters. In New York, he added, “it all comes together to spell a very bad picture.”“When you see a case you see a lot of cases,” Dr. Berry said. The number of cases becomes the cluster size times the number of clusters. In New York, he added, “it all comes together to spell a very bad picture.”
Clusters also can contribute to what looks like random rapid spread of the virus.Clusters also can contribute to what looks like random rapid spread of the virus.
Suppose 100 infected New Yorkers fly to other cities. Clusters can start in the cities where they landed. Other cities will escape because the infected people did not go there.Suppose 100 infected New Yorkers fly to other cities. Clusters can start in the cities where they landed. Other cities will escape because the infected people did not go there.
Dr. Monto pointed to unexpected aspects of the virus’s spread.Dr. Monto pointed to unexpected aspects of the virus’s spread.
It took off in a region of Italy with small cities, not in the larger more crowded areas. And when those regions were closed off, many people fled to the south. Yet even though the coronavirus undoubtedly was introduced to southern Italy, so far there have been relatively few deaths. “It is nothing like what you see in the north,” Dr. Monto said.It took off in a region of Italy with small cities, not in the larger more crowded areas. And when those regions were closed off, many people fled to the south. Yet even though the coronavirus undoubtedly was introduced to southern Italy, so far there have been relatively few deaths. “It is nothing like what you see in the north,” Dr. Monto said.
The west coast of the United States also is puzzling, he added. Los Angeles and San Francisco “must have had multiple introductions” of the virus, he said. But the California cases have been concentrated in the Silicon Valley area and are nowhere near as numerous as the cases in Seattle.The west coast of the United States also is puzzling, he added. Los Angeles and San Francisco “must have had multiple introductions” of the virus, he said. But the California cases have been concentrated in the Silicon Valley area and are nowhere near as numerous as the cases in Seattle.
“There are no answers,” Dr. Monto said.“There are no answers,” Dr. Monto said.
“That is what scares people.”“That is what scares people.”