'Spain’s Villages Wage a Lonely Fight Against the Coronavirus' diff viewer (2/3)

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Spain’s Villages Wage a Lonely Fight Against the Coronavirus	Spain’s Villages Wage a Lonely Fight Against the Coronavirus
2020-04-28 20:00:13 UTC	2020-06-03 08:40:35 UTC (about 1 month later)
VALDERROBRES, Spain — The deafening rumble rose from the depths of the countryside, a welcome yet unnerving sign of life in a corner of northeastern Spain, where villages perched on craggy hills overlook vineyards and fields of olive and almond trees.	VALDERROBRES, Spain — The deafening rumble rose from the depths of the countryside, a welcome yet unnerving sign of life in a corner of northeastern Spain, where villages perched on craggy hills overlook vineyards and fields of olive and almond trees.
At the wheel of his tractor, a farmer disinfected the narrow streets of the village of Valderrobres, with a spreader normally used to fertilize his fields. The breeze sent flowerpots and chairs flying, but it didn’t matter. There was a virus to kill.	At the wheel of his tractor, a farmer disinfected the narrow streets of the village of Valderrobres, with a spreader normally used to fertilize his fields. The breeze sent flowerpots and chairs flying, but it didn’t matter. There was a virus to kill.
“Everything here arrives later,” said the farmer, Miguel Angel Caldu, about the initial lack of testing kits and protective equipment in the area. Half of the health workers at the local nursing home tested positive for the coronavirus, and so did nearly 50 of the 60 residents, 12 of whom have died.	“Everything here arrives later,” said the farmer, Miguel Angel Caldu, about the initial lack of testing kits and protective equipment in the area. Half of the health workers at the local nursing home tested positive for the coronavirus, and so did nearly 50 of the 60 residents, 12 of whom have died.
So every evening, locals like Mr. Caldu have been cleaning places like Valderrobres, a tourist town of about 2,400 people that is known for its 14th-century gothic castle and stone bridge.	So every evening, locals like Mr. Caldu have been cleaning places like Valderrobres, a tourist town of about 2,400 people that is known for its 14th-century gothic castle and stone bridge.
“If we don’t take care of ourselves, nobody will,” he said.	“If we don’t take care of ourselves, nobody will,” he said.
In terms of deaths, the coronavirus pandemic has hit Spain harder than every European country but Italy and has ravaged large cities such as Barcelona and Madrid. Less noticed has been the plight of villages.	In terms of deaths, the coronavirus pandemic has hit Spain harder than every European country but Italy and has ravaged large cities such as Barcelona and Madrid. Less noticed has been the plight of villages.
Like small communities around the world, Spain’s villages are finding that their isolation is a mixed blessing. It may offer some protection against contagion, but once the coronavirus strikes, it can reveal the particular vulnerabilities that smaller communities face.	Like small communities around the world, Spain’s villages are finding that their isolation is a mixed blessing. It may offer some protection against contagion, but once the coronavirus strikes, it can reveal the particular vulnerabilities that smaller communities face.
In Spain, despite a robust health care system and one of the highest life expectancy levels in Europe, rural areas have suffered from aging health care infrastructure and a lack of doctors, after decades of urbanization and a lack of public investment.	In Spain, despite a robust health care system and one of the highest life expectancy levels in Europe, rural areas have suffered from aging health care infrastructure and a lack of doctors, after decades of urbanization and a lack of public investment.
Rural areas also have an abundance of older adults. In Teruel, the province in a remote corner of Aragon that contains Valderrobres, they make up a quarter of the population. Villages in the region, many with centuries-old ramparts overlooking the countryside, now have the appearance of boarded-up fortresses trying to keep their aged populations safe.	Rural areas also have an abundance of older adults. In Teruel, the province in a remote corner of Aragon that contains Valderrobres, they make up a quarter of the population. Villages in the region, many with centuries-old ramparts overlooking the countryside, now have the appearance of boarded-up fortresses trying to keep their aged populations safe.
In other rural areas, such as the province of Soria, in the neighboring region of Castile and León, outbreaks overwhelmed for weeks the only hospital with intensive care units. Such rural stretches of Spain have among the lowest population density levels in Europe, and many there have long complained about being neglected and cut off by the national authorities.	In other rural areas, such as the province of Soria, in the neighboring region of Castile and León, outbreaks overwhelmed for weeks the only hospital with intensive care units. Such rural stretches of Spain have among the lowest population density levels in Europe, and many there have long complained about being neglected and cut off by the national authorities.
In one village in Teruel, the only doctor in the area interrupted his weekly visits after he had to go into isolation; in another, the only grocery store closed for days after the shopkeeper left.	In one village in Teruel, the only doctor in the area interrupted his weekly visits after he had to go into isolation; in another, the only grocery store closed for days after the shopkeeper left.
In Valderrobres, where the closest hospital with intensive care in the region is two hours away, the health authorities initially refused to test those at the nursing home who didn’t have symptoms, said the mayor, Carlos Boné, even as it became the epicenter of a local outbreak.	In Valderrobres, where the closest hospital with intensive care in the region is two hours away, the health authorities initially refused to test those at the nursing home who didn’t have symptoms, said the mayor, Carlos Boné, even as it became the epicenter of a local outbreak.
When Mr. Boné bought tests and discovered that two-thirds of the staff and residents had the virus, the regional authorities rejected the results because they came from a private lab, and then conducted their own tests a week later.	When Mr. Boné bought tests and discovered that two-thirds of the staff and residents had the virus, the regional authorities rejected the results because they came from a private lab, and then conducted their own tests a week later.
“In villages, it’s always ‘It will arrive soon,’ or ‘You will get this shortly,’” Mr. Boné said. “In the meantime, we’re risking lives, and here, 35 workers are 35 people you know.”	“In villages, it’s always ‘It will arrive soon,’ or ‘You will get this shortly,’” Mr. Boné said. “In the meantime, we’re risking lives, and here, 35 workers are 35 people you know.”
Mr. Boné, a former nurse, worked in the nursing home for two straight weeks because most of its nurses have had to isolate themselves at some point and he couldn’t find replacements.	Mr. Boné, a former nurse, worked in the nursing home for two straight weeks because most of its nurses have had to isolate themselves at some point and he couldn’t find replacements.
Like many other European countries, Spain has struggled to contain the spread of the coronavirus in many parts of its territory. Unions are taking the authorities to court after thousands of health care workers became infected. Soldiers have found residents abandoned or dead in nursing homes. But in remote areas, the crisis has accentuated a perception that the right to health care might differ depending on where a person lives.	Like many other European countries, Spain has struggled to contain the spread of the coronavirus in many parts of its territory. Unions are taking the authorities to court after thousands of health care workers became infected. Soldiers have found residents abandoned or dead in nursing homes. But in remote areas, the crisis has accentuated a perception that the right to health care might differ depending on where a person lives.
“In the areas that may have been neglected, the feeling of abandonment can be as much emotional as it is material,” said Sergio del Molino, a novel writer and journalist who has coined the expression “España vacía,” or “empty Spain,” to refer to the draining away of people and skilled workers, and the hollowing out of infrastructure, especially in rural areas.	“In the areas that may have been neglected, the feeling of abandonment can be as much emotional as it is material,” said Sergio del Molino, a novel writer and journalist who has coined the expression “España vacía,” or “empty Spain,” to refer to the draining away of people and skilled workers, and the hollowing out of infrastructure, especially in rural areas.
Confinement measures enforced throughout Europe have plunged other rural areas into similar situations. In a small village in the Lombardy region, the epicenter of Italy’s outbreak, a ban on leaving a town without a health or work reason has forced the national agency managing the crisis response to make multiple trips per day to the closest supermarket to bring food to locals there.	Confinement measures enforced throughout Europe have plunged other rural areas into similar situations. In a small village in the Lombardy region, the epicenter of Italy’s outbreak, a ban on leaving a town without a health or work reason has forced the national agency managing the crisis response to make multiple trips per day to the closest supermarket to bring food to locals there.
In France, which has long struggled against a shortage of doctors in some rural areas, an organization representing small towns has recommended that municipal employees deliver bread and groceries to aging populations.	In France, which has long struggled against a shortage of doctors in some rural areas, an organization representing small towns has recommended that municipal employees deliver bread and groceries to aging populations.
In Spain, Aragon has received roughly as many tests per inhabitant as the Madrid region, the epicenter of Spain’s outbreak, but half as many masks per inhabitant. And mayors of isolated villages in Teruel argue that the masks that have been sent have mostly gone to Aragon’s larger cities.	In Spain, Aragon has received roughly as many tests per inhabitant as the Madrid region, the epicenter of Spain’s outbreak, but half as many masks per inhabitant. And mayors of isolated villages in Teruel argue that the masks that have been sent have mostly gone to Aragon’s larger cities.
“There is an advantage in isolation, distance provides protection,” said Angel Paniagua, a researcher at the National Research Council of Spain, who has studied the country’s most isolated regions. “But when the virus hits, you’re left with your own problems.”	“There is an advantage in isolation, distance provides protection,” said Angel Paniagua, a researcher at the National Research Council of Spain, who has studied the country’s most isolated regions. “But when the virus hits, you’re left with your own problems.”
	Updated June 2, 2020
	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.
	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.
	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.)
	More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
	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’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.
Mr. del Molino, the author and journalist, said that resources had dwindled in many rural areas after health care was gradually decentralized to the regions in the 1980s and ’90s.	Mr. del Molino, the author and journalist, said that resources had dwindled in many rural areas after health care was gradually decentralized to the regions in the 1980s and ’90s.
In the province of Soria, about 120 miles north of Madrid, a death rate of more than one per 1,000 inhabitants has been more than double the national average. Local politicians have denounced the shortage of doctors after the hospital in the city of Soria had to almost triple intensive care capacity but without any extra staff. “We are not fighting this virus with the same weapons” as in the bigger cities, Soria’s mayor, Carlos Martínez, said in a telephone interview.	In the province of Soria, about 120 miles north of Madrid, a death rate of more than one per 1,000 inhabitants has been more than double the national average. Local politicians have denounced the shortage of doctors after the hospital in the city of Soria had to almost triple intensive care capacity but without any extra staff. “We are not fighting this virus with the same weapons” as in the bigger cities, Soria’s mayor, Carlos Martínez, said in a telephone interview.
Regional authorities reported 44 confirmed coronavirus deaths in Soria in March, but Mr. Martínez said that the toll was surely higher. Total deaths from all causes in the province that month was nearly 250, he noted, up from 83 over the same period in 2019. “The numbers don’t add up,” he said.	Regional authorities reported 44 confirmed coronavirus deaths in Soria in March, but Mr. Martínez said that the toll was surely higher. Total deaths from all causes in the province that month was nearly 250, he noted, up from 83 over the same period in 2019. “The numbers don’t add up,” he said.
According to Mr. del Molino, “When you had a serious health condition in Soria, you were sent to Zaragoza or Madrid,” referring to hospitals in larger cities. “The pressure could be rationed in normal times, but it’s been impossible with overwhelmed hospitals,” he added. Weeks into the crisis, neighboring regions have taken in patients from Soria.	According to Mr. del Molino, “When you had a serious health condition in Soria, you were sent to Zaragoza or Madrid,” referring to hospitals in larger cities. “The pressure could be rationed in normal times, but it’s been impossible with overwhelmed hospitals,” he added. Weeks into the crisis, neighboring regions have taken in patients from Soria.
In the province of Teruel, more than 500 cases have been detected, and more than 60 people have died. On a recent afternoon at the nursing home in Valderrobres, Esther Pitart, an 81-year-old resident who tested positive days earlier, sat in an ambulance, ready to be transferred to a center with more resources. “I’ll come back stronger,” she said with a grin as she coughed and clenched her fist.	In the province of Teruel, more than 500 cases have been detected, and more than 60 people have died. On a recent afternoon at the nursing home in Valderrobres, Esther Pitart, an 81-year-old resident who tested positive days earlier, sat in an ambulance, ready to be transferred to a center with more resources. “I’ll come back stronger,” she said with a grin as she coughed and clenched her fist.