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How New Mexico, One of the Poorest States, Averted a Steep Death Toll How New Mexico, One of the Poorest States, Averted a Steep Death Toll
(7 days later)
ALBUQUERQUE — New Mexico has fewer hospital beds per capita than nearly every other state. It has a rapidly aging population and widespread poverty. Its residents have the highest rate by far of chronic liver disease — just one of the underlying medical conditions that are widespread in New Mexico that heighten the risk of dying from Covid-19.ALBUQUERQUE — New Mexico has fewer hospital beds per capita than nearly every other state. It has a rapidly aging population and widespread poverty. Its residents have the highest rate by far of chronic liver disease — just one of the underlying medical conditions that are widespread in New Mexico that heighten the risk of dying from Covid-19.
Still, infectious disease specialists say New Mexico seems to have staved off disaster — for the moment, at least — with a coronavirus death rate that is lower than neighboring states like Colorado and Oklahoma.Still, infectious disease specialists say New Mexico seems to have staved off disaster — for the moment, at least — with a coronavirus death rate that is lower than neighboring states like Colorado and Oklahoma.
New Mexico, which this week is reporting a crucial slowing in the spread of the infection, is not the only relatively poor state yielding impressive results against the virus. West Virginia has also moved aggressively, with even fewer per capita deaths.New Mexico, which this week is reporting a crucial slowing in the spread of the infection, is not the only relatively poor state yielding impressive results against the virus. West Virginia has also moved aggressively, with even fewer per capita deaths.
The fast-spreading virus has caught more than one state by surprise, as unexpected new outbreaks develop. But as state and local authorities grasp for strategies, New Mexico’s series of decisive moves early in the crisis reflect how even states with a dearth of resources can mount a dynamic pandemic response.The fast-spreading virus has caught more than one state by surprise, as unexpected new outbreaks develop. But as state and local authorities grasp for strategies, New Mexico’s series of decisive moves early in the crisis reflect how even states with a dearth of resources can mount a dynamic pandemic response.
New Mexico’s measures included shutting down schools before most states, aggressively expanding social distancing, ramping up testing beyond levels achieved in richer states and using a pioneering telemedicine initiative to quickly train rural health workers for coronavirus care.New Mexico’s measures included shutting down schools before most states, aggressively expanding social distancing, ramping up testing beyond levels achieved in richer states and using a pioneering telemedicine initiative to quickly train rural health workers for coronavirus care.
“Hundreds of lives were saved because of what the state did early on, and that’s using conservative estimates,” said Helen Wearing, a mathematician specializing in disease ecology at the University of New Mexico.“Hundreds of lives were saved because of what the state did early on, and that’s using conservative estimates,” said Helen Wearing, a mathematician specializing in disease ecology at the University of New Mexico.
Still, Dr. Wearing, who is part of a virus modeling group working with state health officials, warned that the state could see new waves of infection if nearby states loosen stay-at-home restrictions more quickly.Still, Dr. Wearing, who is part of a virus modeling group working with state health officials, warned that the state could see new waves of infection if nearby states loosen stay-at-home restrictions more quickly.
“As neighboring states ease back, New Mexico could get hit badly,” Dr. Wearing said. “But right now, we have some breathing space we didn’t think would exist just a few weeks ago.”“As neighboring states ease back, New Mexico could get hit badly,” Dr. Wearing said. “But right now, we have some breathing space we didn’t think would exist just a few weeks ago.”
Epidemiologists express concern about other risks for a coronavirus surge in New Mexico, including the potential that construction crews working to expand the wall on the border with Mexico could spread the virus around the southern part of the state. Moves by local authorities could also prompt outbreaks. The mayor of Grants, a small town in western New Mexico, said on Thursday that he would allow small businesses to reopen next week in defiance of shutdown orders.Epidemiologists express concern about other risks for a coronavirus surge in New Mexico, including the potential that construction crews working to expand the wall on the border with Mexico could spread the virus around the southern part of the state. Moves by local authorities could also prompt outbreaks. The mayor of Grants, a small town in western New Mexico, said on Thursday that he would allow small businesses to reopen next week in defiance of shutdown orders.
Disease specialists point out that outbreaks in some places come down to chance, though an array of factors can play an important role. New Mexico is more sparsely populated than some hard-hit states, potentially curbing the virus’s expansion. But the deadly onslaught of cases in the Navajo Nation, which spreads over parts of New Mexico, Arizona and Utah, shows how the virus can easily ravage rural areas.Disease specialists point out that outbreaks in some places come down to chance, though an array of factors can play an important role. New Mexico is more sparsely populated than some hard-hit states, potentially curbing the virus’s expansion. But the deadly onslaught of cases in the Navajo Nation, which spreads over parts of New Mexico, Arizona and Utah, shows how the virus can easily ravage rural areas.
Political acrimony could also erode some of New Mexico’s gains in fighting the virus. Republicans are hitting back at the state’s Democratic leadership, contending that social distancing measures are crippling businesses and religious congregations.Political acrimony could also erode some of New Mexico’s gains in fighting the virus. Republicans are hitting back at the state’s Democratic leadership, contending that social distancing measures are crippling businesses and religious congregations.
Even so, prominent Republican leaders in New Mexico have somewhat refrained from attacking the broader containment strategies established by Gov. Michelle Lujan Grisham, focusing instead on the economic strain in the state.Even so, prominent Republican leaders in New Mexico have somewhat refrained from attacking the broader containment strategies established by Gov. Michelle Lujan Grisham, focusing instead on the economic strain in the state.
“Our main difference with the governor is the inequity,” said Steve Pearce, chairman of the Republican Party in New Mexico and a former candidate for governor who lost to Ms. Lujan Grisham in 2018.“Our main difference with the governor is the inequity,” said Steve Pearce, chairman of the Republican Party in New Mexico and a former candidate for governor who lost to Ms. Lujan Grisham in 2018.
Mr. Pearce said he was focusing criticism on Ms. Lujan Grisham’s decision to allow large stores like Walmart to remain functioning while smaller operations are shut down. “It’s unfair to side with major out-of-state corporations over local businesses,” Mr. Pearce said.Mr. Pearce said he was focusing criticism on Ms. Lujan Grisham’s decision to allow large stores like Walmart to remain functioning while smaller operations are shut down. “It’s unfair to side with major out-of-state corporations over local businesses,” Mr. Pearce said.
While New Mexico has not experienced so-called reopen protests of the size or intensity as those in other states, some legal challenges to virus-containment measures are emerging from conservative groups, including the National Rifle Association.While New Mexico has not experienced so-called reopen protests of the size or intensity as those in other states, some legal challenges to virus-containment measures are emerging from conservative groups, including the National Rifle Association.
“Our governor left abortion clinics open but closed us down,” said Steve Smothermon, the senior pastor of Legacy Church, an Albuquerque megachurch that sued Ms. Lujan Grisham this month over a ban on mass gatherings in places of worship.“Our governor left abortion clinics open but closed us down,” said Steve Smothermon, the senior pastor of Legacy Church, an Albuquerque megachurch that sued Ms. Lujan Grisham this month over a ban on mass gatherings in places of worship.
A judge rejected Legacy’s request to throw out the ban. Mr. Smothermon is holding Friday night services in Legacy’s parking lot where congregants can tune into services from their cars.A judge rejected Legacy’s request to throw out the ban. Mr. Smothermon is holding Friday night services in Legacy’s parking lot where congregants can tune into services from their cars.
Ms. Lujan Grisham said her previous experience as state health secretary and director of New Mexico’s agency on aging informed her strategies in the chaotic early days of the crisis.Ms. Lujan Grisham said her previous experience as state health secretary and director of New Mexico’s agency on aging informed her strategies in the chaotic early days of the crisis.
“I was looking at our chronic care issues and our levels of poverty, and I was praying every day,” said Ms. Lujan Grisham, who announced on March 12 that schools in the state would close at a time when New Mexico had no coronavirus deaths and six identified cases.“I was looking at our chronic care issues and our levels of poverty, and I was praying every day,” said Ms. Lujan Grisham, who announced on March 12 that schools in the state would close at a time when New Mexico had no coronavirus deaths and six identified cases.
Ms. Lujan Grisham followed that announcement with calls to the leaders of New Mexico’s tribal nations, pleading with them to shut down casinos and begin their own distancing measures. They did so, potentially averting deadly outbreaks in some tribal areas that have scarce running water and multiple generations living under the same roof.Ms. Lujan Grisham followed that announcement with calls to the leaders of New Mexico’s tribal nations, pleading with them to shut down casinos and begin their own distancing measures. They did so, potentially averting deadly outbreaks in some tribal areas that have scarce running water and multiple generations living under the same roof.
The spread of the virus among Native Americans in the state remained a pressing crisis, the governor emphasized. While Native Americans account for about 11 percent of New Mexico’s population, new data on Thursday showed that they make up 44 percent of the state’s confirmed coronavirus cases.The spread of the virus among Native Americans in the state remained a pressing crisis, the governor emphasized. While Native Americans account for about 11 percent of New Mexico’s population, new data on Thursday showed that they make up 44 percent of the state’s confirmed coronavirus cases.
As the pandemic approached, Ms. Lujan Grisham also moved quickly to offer free testing, including for people not showing symptoms. She directed the state scientific laboratory to work with a private company, TriCore Reference Laboratories of Albuquerque, to establish testing sites in each of New Mexico’s 33 counties. Updated June 22, 2020
Citing New Mexico’s financial constraints, Ms. Lujan Grisham said federal assistance was also crucial for the state’s virus response. But tension with federal authorities has also shaped the state’s pandemic policies. A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
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.
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.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.
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.
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.
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.
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.
As the pandemic approached, Ms. Lujan Grisham also moved quickly to offer free testing, including for people not showing symptoms. She directed the state scientific laboratory to work with a private company, TriCore Reference Laboratories of Albuquerque, to establish testing sites in each of New Mexico’s 33 counties.
Citing New Mexico’s financial constraints, Ms. Lujan Grisham said federal assistance was also crucial for the state’s virus response. But tension with federal authorities has also shaped the state’s pandemic policies.
For instance, Ms. Lujan Grisham voiced frustration over obtaining equipment in a phone call in March between governors and President Trump. Her concern involved being placed by federal authorities in a queue without prioritization to buy testing equipment.For instance, Ms. Lujan Grisham voiced frustration over obtaining equipment in a phone call in March between governors and President Trump. Her concern involved being placed by federal authorities in a queue without prioritization to buy testing equipment.
Ms. Lujan Grisham requested a follow-up call with Vice President Mike Pence, who moved to ease the delays. As of Wednesday, New Mexico figured among the top 10 states in coronavirus testing with a rate of 19.5 tests per 1,000 people, according to the Kaiser Family Foundation. That compares with a rate of 8.2 tests per 1,000 people in neighboring Colorado.Ms. Lujan Grisham requested a follow-up call with Vice President Mike Pence, who moved to ease the delays. As of Wednesday, New Mexico figured among the top 10 states in coronavirus testing with a rate of 19.5 tests per 1,000 people, according to the Kaiser Family Foundation. That compares with a rate of 8.2 tests per 1,000 people in neighboring Colorado.
The testing capacity has allowed health officials to determine where the virus is spreading, as it is now in counties near the Navajo Nation, and allocate resources to these areas.The testing capacity has allowed health officials to determine where the virus is spreading, as it is now in counties near the Navajo Nation, and allocate resources to these areas.
Another factor in New Mexico’s response involved Project ECHO, a telemedicine initiative developed at the University of New Mexico that has previously been used in developing countries such as India and Vietnam.Another factor in New Mexico’s response involved Project ECHO, a telemedicine initiative developed at the University of New Mexico that has previously been used in developing countries such as India and Vietnam.
In New Mexico, Project ECHO, which already has extensive experience working in rural areas in the state, pivoted to prepare doctors and other health workers in those areas for treating coronavirus patients and to convert operating rooms in hospitals into acute respiratory care units.In New Mexico, Project ECHO, which already has extensive experience working in rural areas in the state, pivoted to prepare doctors and other health workers in those areas for treating coronavirus patients and to convert operating rooms in hospitals into acute respiratory care units.
Epidemiologists credit the state’s early moves to put into place social distancing measures as crucial in limiting the spread of the virus, especially in cities such as Albuquerque, Santa Fe and Las Cruces.Epidemiologists credit the state’s early moves to put into place social distancing measures as crucial in limiting the spread of the virus, especially in cities such as Albuquerque, Santa Fe and Las Cruces.
New Mexico is drawing from a team of national defense scientists from Los Alamos National Laboratory — which was created in 1943 to design and build an atomic bomb — to assist with contagion forecasts.New Mexico is drawing from a team of national defense scientists from Los Alamos National Laboratory — which was created in 1943 to design and build an atomic bomb — to assist with contagion forecasts.
Sara Del Valle and Carrie Manore, mathematical epidemiologists at Los Alamos, said that by April 19, New Mexico had already experienced a stunning decline of more than 40 percent in the number of originally forecast total cases.Sara Del Valle and Carrie Manore, mathematical epidemiologists at Los Alamos, said that by April 19, New Mexico had already experienced a stunning decline of more than 40 percent in the number of originally forecast total cases.
“Because of the stay-at-home order,” Ms. Del Valle and Ms. Manore said in a statement, “the virus had fewer people to infect so the growth rate declined.”“Because of the stay-at-home order,” Ms. Del Valle and Ms. Manore said in a statement, “the virus had fewer people to infect so the growth rate declined.”
Mitch Smith contributed reporting from Overland Park, Kan.Mitch Smith contributed reporting from Overland Park, Kan.