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Coronavirus Created an Obstacle Course for Safe Abortions Coronavirus Created an Obstacle Course for Safe Abortions
(5 days later)
BRUSSELS — When a 19-year-old woman from southern Poland decided to end her pregnancy at 18 weeks, she knew the only way to get an abortion was to rush to a neighboring European country.BRUSSELS — When a 19-year-old woman from southern Poland decided to end her pregnancy at 18 weeks, she knew the only way to get an abortion was to rush to a neighboring European country.
Abortion is illegal in most circumstances in Poland, and so for years, many women have traveled within Europe to seek the procedure.Abortion is illegal in most circumstances in Poland, and so for years, many women have traveled within Europe to seek the procedure.
But it was April, and across the continent, borders were closing fast because of the coronavirus pandemic. So she and a friend loaded up their Renault with instant noodles and candy for a 14-hour race to Utrecht, in the Netherlands. They made it just in time for her to have the procedure and return home, her friend said.But it was April, and across the continent, borders were closing fast because of the coronavirus pandemic. So she and a friend loaded up their Renault with instant noodles and candy for a 14-hour race to Utrecht, in the Netherlands. They made it just in time for her to have the procedure and return home, her friend said.
From the world’s richest nations to some of its poorest, the pandemic has unleashed suffering, bringing governments and health care systems to their knees. For many women in Europe seeking abortions, the virus added another obstacle in an already complicated and time-sensitive course.From the world’s richest nations to some of its poorest, the pandemic has unleashed suffering, bringing governments and health care systems to their knees. For many women in Europe seeking abortions, the virus added another obstacle in an already complicated and time-sensitive course.
Closing borders made it harder for women in countries with strict abortion regulations, like Poland, to seek the procedure elsewhere.Closing borders made it harder for women in countries with strict abortion regulations, like Poland, to seek the procedure elsewhere.
And governments in Germany, Austria, Romania, Croatia and Slovakia, trying to tackle the health care demands of the pandemic, did not label abortions as essential, time-sensitive procedures.And governments in Germany, Austria, Romania, Croatia and Slovakia, trying to tackle the health care demands of the pandemic, did not label abortions as essential, time-sensitive procedures.
Under normal circumstances women in these countries can get an abortion during the first half of a pregnancy. But not including abortions on the essential procedures list meant that hospitals and clinics were free to turn women away. And some did, although they have now reopened or will this month.Under normal circumstances women in these countries can get an abortion during the first half of a pregnancy. But not including abortions on the essential procedures list meant that hospitals and clinics were free to turn women away. And some did, although they have now reopened or will this month.
But for a time, the continent had “a combination of factors coinciding: Hospital care is restricted, doctors are shutting down services, states are not classifying abortions as an essential service,” said Leah Hoctor, the Europe director of the Center for Reproductive Rights, an advocacy group.But for a time, the continent had “a combination of factors coinciding: Hospital care is restricted, doctors are shutting down services, states are not classifying abortions as an essential service,” said Leah Hoctor, the Europe director of the Center for Reproductive Rights, an advocacy group.
She added that governments failed to understand that women who need an abortion need to have it in a timely manner.She added that governments failed to understand that women who need an abortion need to have it in a timely manner.
The pandemic also unexpectedly cracked open a window in a small number of places in Europe.The pandemic also unexpectedly cracked open a window in a small number of places in Europe.
France, Ireland and England, Scotland and Wales in Britain, all loosened restrictions and permitted at-home abortions with medication administered by prescription and the guidance of a medical professional over the phone or online.France, Ireland and England, Scotland and Wales in Britain, all loosened restrictions and permitted at-home abortions with medication administered by prescription and the guidance of a medical professional over the phone or online.
Before the pandemic, medical abortions in these countries were permitted only after an in-person consultation with a doctor, and the medication had to be taken in a clinic, not at home.Before the pandemic, medical abortions in these countries were permitted only after an in-person consultation with a doctor, and the medication had to be taken in a clinic, not at home.
Authorities in Britain said allowing at-home medical abortions with remote guidance was a temporary measure. But Ms. Hoctor said she hoped the countries that permitted the procedure would not go back to restricting it.Authorities in Britain said allowing at-home medical abortions with remote guidance was a temporary measure. But Ms. Hoctor said she hoped the countries that permitted the procedure would not go back to restricting it.
At-home abortions “represent women-centered, evidence-based policy changes,” Ms. Hoctor said. “The fact that these laws and policies were changed quickly in order to respond to the pandemic demonstrates that it is possible to modernize European countries’ abortion laws.”At-home abortions “represent women-centered, evidence-based policy changes,” Ms. Hoctor said. “The fact that these laws and policies were changed quickly in order to respond to the pandemic demonstrates that it is possible to modernize European countries’ abortion laws.”
From the outset of the coronavirus outbreak, advocacy groups and the United Nations warned that women’s access to reproductive services could be imperiled.From the outset of the coronavirus outbreak, advocacy groups and the United Nations warned that women’s access to reproductive services could be imperiled.
In April, the United Nations’ sexual and reproductive health agency estimated that there could be seven million unintended pregnancies around the world — potentially increasing the demand for abortions — if lockdowns continued for six months and there were disruptions to reproductive services.In April, the United Nations’ sexual and reproductive health agency estimated that there could be seven million unintended pregnancies around the world — potentially increasing the demand for abortions — if lockdowns continued for six months and there were disruptions to reproductive services.
“As a corollary, unsafe abortions will increase,” Natalia Kanem, executive director of the agency, said in April.“As a corollary, unsafe abortions will increase,” Natalia Kanem, executive director of the agency, said in April.
Earlier this month, the World Health Organization reiterated the need for governments to maintain access to safe reproductive services.Earlier this month, the World Health Organization reiterated the need for governments to maintain access to safe reproductive services.
“Even a 10 percent reduction in these services could result in an estimated 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths during the next 12 months,” the organization stated in a recent report.“Even a 10 percent reduction in these services could result in an estimated 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths during the next 12 months,” the organization stated in a recent report.
Ms. Hoctor said that as the coronavirus swept Europe, demand for abortions rose. Although hard numbers are scarce, there are anecdotal reports that more women were worried about raising a family in the midst of the economic destruction caused by the measures to combat the virus.Ms. Hoctor said that as the coronavirus swept Europe, demand for abortions rose. Although hard numbers are scarce, there are anecdotal reports that more women were worried about raising a family in the midst of the economic destruction caused by the measures to combat the virus.
In many European Union countries, abortions are legal and relatively accessible. Still, restrictions exist in some parts of the region, so women have historically used the continent’s open borders to choose providers and legal frameworks that suit them most, a largely unseen byproduct of mobility within Europe.In many European Union countries, abortions are legal and relatively accessible. Still, restrictions exist in some parts of the region, so women have historically used the continent’s open borders to choose providers and legal frameworks that suit them most, a largely unseen byproduct of mobility within Europe.
Advocacy groups and doctors say it’s impossible to know how many women have been affected by closing borders, given that records of abortions and who has them are not public.Advocacy groups and doctors say it’s impossible to know how many women have been affected by closing borders, given that records of abortions and who has them are not public.
Germany offers a case study on how the virus affected abortion services in Europe.Germany offers a case study on how the virus affected abortion services in Europe.
In a policy decision that was replicated in many parts of Europe, the German federal government did not list abortions — which are legal in the country — as essential medical services during the pandemic.In a policy decision that was replicated in many parts of Europe, the German federal government did not list abortions — which are legal in the country — as essential medical services during the pandemic.
Instead it was up to state health authorities and individual providers to determine how to handle requests, and, according to the German Hospital Federation, “depended on whether clinics were extremely involved in corona care.”Instead it was up to state health authorities and individual providers to determine how to handle requests, and, according to the German Hospital Federation, “depended on whether clinics were extremely involved in corona care.”
In at least four German states, a few clinics and hospitals stopped offering abortions for some time — saying that in some cases they were focusing exclusively on virus cases, and in others because they shut down entirely.In at least four German states, a few clinics and hospitals stopped offering abortions for some time — saying that in some cases they were focusing exclusively on virus cases, and in others because they shut down entirely.
In Niederbayern, a district in the state of Bavaria, the only doctor who performed abortions was older than 70, and in an at-risk category himself. He stopped going to work, making access to the service harder in the already underserved rural area.In Niederbayern, a district in the state of Bavaria, the only doctor who performed abortions was older than 70, and in an at-risk category himself. He stopped going to work, making access to the service harder in the already underserved rural area.
In Munich, 8 of the 20 abortion providers in the city suspended their services during the lockdown, and larger providers had to pick up the slack.In Munich, 8 of the 20 abortion providers in the city suspended their services during the lockdown, and larger providers had to pick up the slack.
In Merseburg, in Germany’s Saxony-Anhalt state, abortions were suspended as of March 16 in at least one hospital, which said its aim was to minimize new Covid-19 infections and to prepare personnel and other resources for the pandemic. Services are set to resume on Monday.In Merseburg, in Germany’s Saxony-Anhalt state, abortions were suspended as of March 16 in at least one hospital, which said its aim was to minimize new Covid-19 infections and to prepare personnel and other resources for the pandemic. Services are set to resume on Monday.
Kristina Hänel, a doctor and an activist in Hesse, said that although individual women had problems, “overall the system did not break down.”Kristina Hänel, a doctor and an activist in Hesse, said that although individual women had problems, “overall the system did not break down.”
Updated June 16, 2020 Updated June 22, 2020
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.
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.
“We had to make politicians aware of some of the hurdles,” she added.“We had to make politicians aware of some of the hurdles,” she added.
One hurdle for each woman was getting a certificate saying she had seen a consultant to discuss her decision, as German law requires.One hurdle for each woman was getting a certificate saying she had seen a consultant to discuss her decision, as German law requires.
These consultations — which German activists consider an obstacle to abortions — have been made available online or by phone because of the pandemic.These consultations — which German activists consider an obstacle to abortions — have been made available online or by phone because of the pandemic.
Another obstacle was that, before getting an abortion, a woman needed to physically visit her insurance company to get a voucher to cover the costs. That was impossible during the lockdown as insurance offices were shut.Another obstacle was that, before getting an abortion, a woman needed to physically visit her insurance company to get a voucher to cover the costs. That was impossible during the lockdown as insurance offices were shut.
Finally, the authorities figured out a way for women to get this voucher through the mail.Finally, the authorities figured out a way for women to get this voucher through the mail.
But, Ms. Hoctor said, both those solutions posed problems for girls and women trying to keep their pregnancies private, for example, teenagers living with their parents, or those sharing a living space with someone during the lockdown.But, Ms. Hoctor said, both those solutions posed problems for girls and women trying to keep their pregnancies private, for example, teenagers living with their parents, or those sharing a living space with someone during the lockdown.
In Europe, the pandemic’s interruption of abortion procedures seemed largely the byproduct of a hurried and frantic response to a public-health crisis. Across the Atlantic, where the debate over abortion is more highly politicized, disruptions to services were more deliberate.In Europe, the pandemic’s interruption of abortion procedures seemed largely the byproduct of a hurried and frantic response to a public-health crisis. Across the Atlantic, where the debate over abortion is more highly politicized, disruptions to services were more deliberate.
Anti-abortion governors in Oklahoma, Texas, Ohio, Iowa and Alabama listed abortions as “nonessential” procedures, arguing that performing them would threaten supplies of medical resources and protective equipment in the midst of the pandemic.Anti-abortion governors in Oklahoma, Texas, Ohio, Iowa and Alabama listed abortions as “nonessential” procedures, arguing that performing them would threaten supplies of medical resources and protective equipment in the midst of the pandemic.
The medical community pushed back, setting off a flurry of lawsuits to keep services running.The medical community pushed back, setting off a flurry of lawsuits to keep services running.
But some women ended up racing across state lines to avoid the new limitations. One traveled from Arkansas to Oklahoma to Kansas before she could terminate her pregnancy.But some women ended up racing across state lines to avoid the new limitations. One traveled from Arkansas to Oklahoma to Kansas before she could terminate her pregnancy.
“I firmly believe that this is a coordinated movement among the anti-abortion folks,” said Julie Burkhart, founder and chief executive of Trust Women, which operates a clinic in Oklahoma City and another in Wichita, Kan. She noted that even before the pandemic, states that deemed abortion nonessential were debating legislation to curb access.“I firmly believe that this is a coordinated movement among the anti-abortion folks,” said Julie Burkhart, founder and chief executive of Trust Women, which operates a clinic in Oklahoma City and another in Wichita, Kan. She noted that even before the pandemic, states that deemed abortion nonessential were debating legislation to curb access.
Her clinics, she said, saw a surge in the number of women seeking abortions, many of them coming in from other states. “We saw, in one week, over 250 patients,” she said, compared with the usual number of 40 patients per week per clinic.Her clinics, she said, saw a surge in the number of women seeking abortions, many of them coming in from other states. “We saw, in one week, over 250 patients,” she said, compared with the usual number of 40 patients per week per clinic.
Dr. Kanem, of the United Nations agency, said the approaches in the United States, where the debate over abortion was highly polarized, and in Europe, where governments failed to make women’s health needs a priority, can both lead “to terrible outcomes.”Dr. Kanem, of the United Nations agency, said the approaches in the United States, where the debate over abortion was highly polarized, and in Europe, where governments failed to make women’s health needs a priority, can both lead “to terrible outcomes.”
She added, “Women and girls should not be shoved to the end of the line.”She added, “Women and girls should not be shoved to the end of the line.”
Matina Stevis-Gridneff and Monika Pronczuk reported from Brussels, and Alisha Haridasani Gupta from New York. Christopher Schuetze contributed reporting from Berlin.Matina Stevis-Gridneff and Monika Pronczuk reported from Brussels, and Alisha Haridasani Gupta from New York. Christopher Schuetze contributed reporting from Berlin.