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Peaks, Testing, Lockdowns: How Coronavirus Vocabulary Causes Confusion Peaks, Testing, Lockdowns: How Coronavirus Vocabulary Causes Confusion
(about 7 hours later)
Making sense of the coronavirus pandemic requires getting up to speed on semantics as much as epidemiology.Making sense of the coronavirus pandemic requires getting up to speed on semantics as much as epidemiology.
Government officials and health care professionals toss off mentions of mortality rates, flattening the curve and lockdowns, assuming that we know what they mean. But the terms mean different things from country to country, state to state, even city to city and person to person.Government officials and health care professionals toss off mentions of mortality rates, flattening the curve and lockdowns, assuming that we know what they mean. But the terms mean different things from country to country, state to state, even city to city and person to person.
Officials use the same phrases about mass testing, caseloads and deaths to describe very different situations. That makes it hard to give clear answers to vital questions: How bad are things? Where are they headed?Officials use the same phrases about mass testing, caseloads and deaths to describe very different situations. That makes it hard to give clear answers to vital questions: How bad are things? Where are they headed?
People search for insight by comparing their countries to those that are further along in the epidemic. But if the terms are misleading or used in differing ways, the comparisons are flawed. Also, the statistics and vocabulary offer a false sense of precision while in reality, the information we have shows only a fraction of what’s going on.People search for insight by comparing their countries to those that are further along in the epidemic. But if the terms are misleading or used in differing ways, the comparisons are flawed. Also, the statistics and vocabulary offer a false sense of precision while in reality, the information we have shows only a fraction of what’s going on.
“The new cases or deaths each day are given as exact numbers, and we’re trained to take that at face value,” said Mark N. Lurie, an epidemiologist at Brown University’s School of Public Health. “But those are far from exact, they’re deeply flawed, and their meaning varies from place to place and from time period to time period.”“The new cases or deaths each day are given as exact numbers, and we’re trained to take that at face value,” said Mark N. Lurie, an epidemiologist at Brown University’s School of Public Health. “But those are far from exact, they’re deeply flawed, and their meaning varies from place to place and from time period to time period.”
The United States recently hit an attention-getting milestone, passing China as the country with the most reported infections. But there is deep uncertainty about whether there really are more American cases, and about how well the figures reflect reality.The United States recently hit an attention-getting milestone, passing China as the country with the most reported infections. But there is deep uncertainty about whether there really are more American cases, and about how well the figures reflect reality.
Countries vary wildly in testing for the virus and how they report the numbers, and experts say most infections are going undetected. So the publicized national tallies are rough, incomplete pictures that may not be all that comparable.Countries vary wildly in testing for the virus and how they report the numbers, and experts say most infections are going undetected. So the publicized national tallies are rough, incomplete pictures that may not be all that comparable.
And that’s if countries are forthcoming about their data.And that’s if countries are forthcoming about their data.
Officials in the United States say that China, which has reported more than 82,000 infections, has understated its epidemic. Until this week, the Chinese government excluded those patients who tested positive for the virus but had no symptoms.Officials in the United States say that China, which has reported more than 82,000 infections, has understated its epidemic. Until this week, the Chinese government excluded those patients who tested positive for the virus but had no symptoms.
China also doesn’t say how many tests it has conducted, and doubts have been raised about whether it has tested extensively in Xinjiang, the province where it holds hundreds of thousands of Muslims in indoctrination camps.China also doesn’t say how many tests it has conducted, and doubts have been raised about whether it has tested extensively in Xinjiang, the province where it holds hundreds of thousands of Muslims in indoctrination camps.
Few countries have done aggressive testing. And of course, the more testing there is, the more cases are found.Few countries have done aggressive testing. And of course, the more testing there is, the more cases are found.
Japan, with relatively few confirmed cases, has conducted only about 500 tests for every million people, raising fears that the virus might be spreading undetected. Similar concerns have been aired in Britain, whose testing rate — more than 2,400 people per million so far — is low by Western European standards, and includes relatively few health workers.Japan, with relatively few confirmed cases, has conducted only about 500 tests for every million people, raising fears that the virus might be spreading undetected. Similar concerns have been aired in Britain, whose testing rate — more than 2,400 people per million so far — is low by Western European standards, and includes relatively few health workers.
In contrast, South Korea has tested more than 8,000 people per million, and Norway about 17,000.In contrast, South Korea has tested more than 8,000 people per million, and Norway about 17,000.
In the United States, state and local authorities collect figures from public and private labs, but they can be like apples and oranges: Some labs report the number of tests conducted, some report how many people were tested, and some report only positive test results.In the United States, state and local authorities collect figures from public and private labs, but they can be like apples and oranges: Some labs report the number of tests conducted, some report how many people were tested, and some report only positive test results.
The Covid Tracking Project, run by The Atlantic, has tried to compile all the numbers in the United States and reports more than 1.2 million tests so far, over 3,600 per million people.The Covid Tracking Project, run by The Atlantic, has tried to compile all the numbers in the United States and reports more than 1.2 million tests so far, over 3,600 per million people.
President Trump has boasted that more people have been tested in the United States than any other country, though on a per-capita basis, many developed countries have done more.President Trump has boasted that more people have been tested in the United States than any other country, though on a per-capita basis, many developed countries have done more.
But it matters not only how many people are tested, but also when, and who they are. Once again, countries differ, shaping what the numbers mean.But it matters not only how many people are tested, but also when, and who they are. Once again, countries differ, shaping what the numbers mean.
A few countries, like South Korea, Australia and Singapore, got serious about mass testing early on. They used the information to do ambitious contact-tracing — finding and testing those who had recently been near infected people, even if they had no symptoms.A few countries, like South Korea, Australia and Singapore, got serious about mass testing early on. They used the information to do ambitious contact-tracing — finding and testing those who had recently been near infected people, even if they had no symptoms.
That provided a pretty full picture of the outbreak while the numbers were still manageable, and made it possible to slow it down.That provided a pretty full picture of the outbreak while the numbers were still manageable, and made it possible to slow it down.
Though it did not act on the same scale as those countries, Germany did more testing and contact-tracing in the early going than most of Europe.Though it did not act on the same scale as those countries, Germany did more testing and contact-tracing in the early going than most of Europe.
But most nations with large numbers of cases have done less testing, waited longer to do it in bulk, and made little attempt at contact tracing. They find themselves playing catch-up with the virus, ramping up testing after their outbreaks had already mushroomed.But most nations with large numbers of cases have done less testing, waited longer to do it in bulk, and made little attempt at contact tracing. They find themselves playing catch-up with the virus, ramping up testing after their outbreaks had already mushroomed.
They detect more cases, but by then it’s hard to tell how much of that growth is the expanding epidemic and how much is expanding surveillance. Unable to meet the demand, they often limit testing to the sickest patients and health workers.They detect more cases, but by then it’s hard to tell how much of that growth is the expanding epidemic and how much is expanding surveillance. Unable to meet the demand, they often limit testing to the sickest patients and health workers.
A prime example is the United States, where about 90 percent of the tests so far were done in just the last two weeks. Doctors, patients and state and local officials report that there still isn’t enough testing available, and ailing people are routinely told that they are not sick enough to warrant a test.A prime example is the United States, where about 90 percent of the tests so far were done in just the last two weeks. Doctors, patients and state and local officials report that there still isn’t enough testing available, and ailing people are routinely told that they are not sick enough to warrant a test.
It has been stated time and again: Italy and Spain have high mortality rates among coronavirus patients, Germany’s is low, and China’s is somewhere between.It has been stated time and again: Italy and Spain have high mortality rates among coronavirus patients, Germany’s is low, and China’s is somewhere between.
It may not be that simple. Counting the dead is as flawed and inconsistent as counting the infected.It may not be that simple. Counting the dead is as flawed and inconsistent as counting the infected.
Recent reports say that mortuaries in Wuhan, China, where the disease was first discovered, have ordered thousands more urns than usual, suggesting a much higher death toll than the city’s official count, 2,535.Recent reports say that mortuaries in Wuhan, China, where the disease was first discovered, have ordered thousands more urns than usual, suggesting a much higher death toll than the city’s official count, 2,535.
The outbreaks in Wuhan, and parts of Italy and Spain, overwhelmed hospitals, forcing many sick people to ride it out at home. No one knows how many people have recovered or died without ever being tested.The outbreaks in Wuhan, and parts of Italy and Spain, overwhelmed hospitals, forcing many sick people to ride it out at home. No one knows how many people have recovered or died without ever being tested.
Italy and France have reported death tolls that generally included only those who died in hospitals. In Germany, even some of those patients are excluded, because post-mortem testing for the virus is not standard in hospitals.Italy and France have reported death tolls that generally included only those who died in hospitals. In Germany, even some of those patients are excluded, because post-mortem testing for the virus is not standard in hospitals.
And if only the sickest patients are tested, then the number of infections will appear smaller and the percentage who die will seem higher.And if only the sickest patients are tested, then the number of infections will appear smaller and the percentage who die will seem higher.
Germany’s low apparent fatality rate — about 1 percent of those infected — may stem partly from its broader testing of those who are healthy or who have mild to no symptoms, and its narrower testing of the dead.Germany’s low apparent fatality rate — about 1 percent of those infected — may stem partly from its broader testing of those who are healthy or who have mild to no symptoms, and its narrower testing of the dead.
Officials often talk about when the epidemic peaks or plateaus — when a country “flattens the curve.” But they rarely specify, the peak of what? And how can we be sure we’re past it?Officials often talk about when the epidemic peaks or plateaus — when a country “flattens the curve.” But they rarely specify, the peak of what? And how can we be sure we’re past it?
When an outbreak is growing unchecked, more people become infected and more die each day than the day before. Italy went from reporting a few hundred newly detected infections per day in early March to more than 6,500 on March 21.When an outbreak is growing unchecked, more people become infected and more die each day than the day before. Italy went from reporting a few hundred newly detected infections per day in early March to more than 6,500 on March 21.
Updated June 12, 2020 Updated June 5, 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.
That acceleration cannot continue indefinitely, and more important, Italy has strengthened social distancing, apparently slowing transmission of the virus. Since March 21, new confirmed infections have varied between about 4,000 and 6,000 daily. Despite the problems with the available figures, and the dangers of drawing conclusions based on just a few days, it seems clear after almost two weeks that Italy has passed a turning point.That acceleration cannot continue indefinitely, and more important, Italy has strengthened social distancing, apparently slowing transmission of the virus. Since March 21, new confirmed infections have varied between about 4,000 and 6,000 daily. Despite the problems with the available figures, and the dangers of drawing conclusions based on just a few days, it seems clear after almost two weeks that Italy has passed a turning point.
On a graph, the curve showing the daily count of new cases has gone from rising sharply to moving sideways — the curve has flattened — and even begun to move downward.On a graph, the curve showing the daily count of new cases has gone from rising sharply to moving sideways — the curve has flattened — and even begun to move downward.
That is one corner being turned: The rate of the spread of the virus has slowed down. It takes longer to turn another: the rate of people dying. But that, too, appears to have leveled off in Italy, fluctuating around 800 a day in the last week.That is one corner being turned: The rate of the spread of the virus has slowed down. It takes longer to turn another: the rate of people dying. But that, too, appears to have leveled off in Italy, fluctuating around 800 a day in the last week.
But even when those curves flatten, the epidemic still has not “peaked” by another crucial measure: the number of active cases. That figure continues to rise until the number of patients who either die or recover each day is larger than the number of new infections.But even when those curves flatten, the epidemic still has not “peaked” by another crucial measure: the number of active cases. That figure continues to rise until the number of patients who either die or recover each day is larger than the number of new infections.
To ease the staggering load on health care systems, the active cases curve must also flatten and then fall.To ease the staggering load on health care systems, the active cases curve must also flatten and then fall.
More than two billion people, including most Americans, are living under something usually called a lockdown. But there is no set definition of that word — or related terms like stay-at-home mandates and social distancing — so the details differ from place to place.More than two billion people, including most Americans, are living under something usually called a lockdown. But there is no set definition of that word — or related terms like stay-at-home mandates and social distancing — so the details differ from place to place.
The lockdowns have varying exceptions for certain lines of work, personal circumstances or exercise. Some allow gatherings of up to ten people, or five, or forbid groups of any size; some exempt funerals, others do not.The lockdowns have varying exceptions for certain lines of work, personal circumstances or exercise. Some allow gatherings of up to ten people, or five, or forbid groups of any size; some exempt funerals, others do not.
The biggest differences may be in enforcement. Some places, like those in the United States with lockdowns, mostly rely on people to follow the rules without coercion.The biggest differences may be in enforcement. Some places, like those in the United States with lockdowns, mostly rely on people to follow the rules without coercion.
But Italy and others have deployed soldiers to ensure compliance, and French police have fined hundreds of thousands of people for violating restrictions. China, in addition to using security forces, mobilized an army of volunteers, ratcheting up social pressure to obey.But Italy and others have deployed soldiers to ensure compliance, and French police have fined hundreds of thousands of people for violating restrictions. China, in addition to using security forces, mobilized an army of volunteers, ratcheting up social pressure to obey.
And on Wednesday, President Rodrigo Duterte of the Philippines threatened to have lockdown violators shot.And on Wednesday, President Rodrigo Duterte of the Philippines threatened to have lockdown violators shot.
Italy’s experience shows the looseness of the term. It has gone through several phases of restrictions, applying them to more people, making them stricter and increasing enforcement.Italy’s experience shows the looseness of the term. It has gone through several phases of restrictions, applying them to more people, making them stricter and increasing enforcement.
A few weeks ago, a person could travel around Italy for a valid work or family reason. Now, people are fined for nonessential walking too far from their homes.A few weeks ago, a person could travel around Italy for a valid work or family reason. Now, people are fined for nonessential walking too far from their homes.
But each stage was widely called by the same name: lockdown.But each stage was widely called by the same name: lockdown.