Original title: What is happening in the United States “wake up”
Our reporter / Peng Dani is
quiet and empty. Laurie Garrett looks out of the window. New York, the world’s largest city, has completely disappeared from its former bustling scene. She has also greatly reduced her time spent outside, Zoom, Skype, etc. Video telephony software has become a new way of working. Panic sent the store out of stock, but the food supply was adequate.
The New Yorker, who has written at least three books on infectious diseases, has won the Pulitzer Prize for his reports in the public health field. At this time, it does not seem difficult to adapt to life under the epidemic. After studying and observing the disasters caused by the many infectious diseases in human society, she believes that only the September 11 terrorist attacks can be compared with it.
Capital is fleeing.
In the ten days from March 9th to 18th, the US stock market triggered four fusing mechanisms, which broke the historical record again and again. People ridiculed that if Buffett, the god of stocks, could say, “I lived 89 years ago, and I have only seen a US stock market meltdown.” Then now he must feel that he “is still too young.”
March 19, local time At 12 pm Thursday, in the Los Angeles, California West Coast, Zhang Zuofeng, a dean of the School of Public Health and senior tenured professor of epidemiology who has lived in the University of California Los Angeles for more than 20 years, drove home and found that the traffic on the road was never Seen scarce. The road to Los Angeles has never stopped flowing, but this evening, California Governor Gavin Newsom just announced a home order, the state’s strictest enforcement measure since the new crown epidemic. Zhang Zuofeng was worried that the school might be closed, so he rushed back to the school at night to get some necessary documents to prepare for home office.
Only two weeks ago, there were only a dozen confirmed patients in Los Angeles, and an infected person appeared in the hospital near Zhang Zuofeng’s residence. But at that time, only Chinese people went to buy rice and store water, and others seemed not nervous. Two weeks later, the new crown epidemic has exploded in the United States, and the social atmosphere has changed dramatically.
Also on March 19, the number of newly diagnosed patients in Hubei, China was zero, while the number of confirmed cases in the United States exceeded 10,000. The latest real-time data shows that as of 5 pm on March 23, the number of confirmed infections in the United States has exceeded 35,000, making it the third most diagnosed country in the world.
The United States is in a complete shutdown, from economics to social life.
“Wake up” United States.
in the Nicholas Zhuell, a professor at the University of California, Berkeley School of Public Health, and his daughter are experts in epidemiological statistics. Back in mid-January, when the epidemic seemed to be just across the Pacific Ocean, they were discussing the new crown virus closely, and started to make some reserve plans for their homes, preparing the goods needed for two weeks at home. At that time, they tried to convey the severity of the epidemic to people, but the response was hopeless.
Even by the end of February, Trump was still saying that there are only 15 cases of infected people in the United States, less than anywhere, “he is not worried at all” and “fully in control.” At the White House conference on February 29, U.S. Secretary of Health Alex Azar also said, “It’s like being infected with a severe cold or flu.” But Nicholas Juwell said, “Every epidemiologist Everyone knows what will be approached ruthlessly towards us. ”
On March 13, when Nicholas Juell was interviewed by The New York Times, there were at least 1,700 infected people in the United States. He expected that the next Wednesday, March On the 18th, the number of confirmed patients in the United States will reach 8,000, and then the epidemic will grow at an alarming rate. By March 18th, the United States had reported that the actual number of confirmed infections was 8,736—more than he had predicted.
On March 11, Hollywood star Tom Hanks and his wife were diagnosed with the new crown virus in Australia. The new crown epidemic was assessed as a “global pandemic” on this day. The next day, the NBA jazz star Gobert was infected with the new crown. Announcing the season. The change in public sentiment in the United States has accumulated little by little, and has been shaken time and time again by these news. For the week of March 8-14, Nicholas Juwell believes that people have been hit, and that feeling will only increase in the future.
In an interview with The Atlantic Monthly on March 14, the director of the National Institutes of Health, Francis Collins, said that apparently in the past few days, Americans have started to wake up and realize how serious the threat of the new crown virus is. Also waking up was US President Trump, who had previously intended to downplay the severity of the epidemic. On the afternoon of March 13, Eastern Time, Trump declared a national emergency. He will be able to use the $ 50 billion federal funds authorized by Congress to respond to the new crown crisis. This move is considered to be the Trump administration ’s move to active epidemic prevention. Sign.
On the same day, a federal government document, the Viral Action Act, warned policy makers that the epidemic would last 18 months or more and could explode multiple times, resulting in large-scale supply shortages for consumers and the United States. The medical system is putting pressure.
After March 13, the US federal government has begun to act frequently in improving detection capabilities, mobilizing resources, and economic subsidies. “If anything, we are underreacting,” said a respiratory infectious disease specialist at the University of California, San Francisco. The speed of response and detection in the United States in mid-March should have been reached a month ago.
Laurie Garrett believes that it now looks like the United Kingdom is the world’s worst response to the new crown. When a reporter asked her what the government should do, she was always sharp and answered directly: We have no time to make this complete list because the government has hardly done anything they should do.
One prediction cited by many experts is that the rate of development of the US epidemic is only about 8-10 days later than that of Italy. Laurie Garrett believes that maybe in the last week of March, you will see a sudden surge in the number of new crown cases. In some places, such as New York, hospitals are completely overloaded. Nationwide, the epidemic is spreading at different paces, from now on, until summer.
Coneglia Grigos is a doctor in a large hospital in New York City. She has received long-term training in the Department of Critical Medicine at Harvard University Hospital. . But a readme she published on March 19 took a seemingly “terrifying” title-“The Sky is Falling” because she saw people waiting in a long line at the entrance to the emergency room, and the medical staff did not Stopping work still can’t cope with the surge of patients, as well as depleting protective equipment and vacant vaccines.
“We are living in a global public health crisis with unprecedented speed and scale. The cracks in our medical and financial systems are cracking like a wound. Regardless of the outcome, life will always look for us all. It’s a little different, “Grigos wrote.
It coincides with the meaning of this sentence, as well as the sentence said by the British epidemiologist Neil Ferguson in an interview: In the next year or so, the world we live in will be completely different from the past. . On March 19th, he tweeted that his new crown virus test was positive.
Neil Ferguson’s MRC Global Infectious Disease Analysis Center, led by Imperial College London, has been continuously researching the new crown epidemic since January. Recently, his team predicted through models that in the worst case, 2.2 million people in the United States may die from the new crown epidemic. If you ask him what is the most optimistic situation, the number of deaths he gives is also large enough-100 More than ten thousand.
has number of tests, tests, and diagnoses.
witnessed an increase in the Liu Jigao is the president of the Asian American Medical Association and a doctor in a private clinic in New York City. Many private clinic doctors, including him, contact a commercial laboratory called Bio-Reference Laboratories. On March 13, the laboratory was officially approved by the government for testing. The number of tests on the first day was 1,400, and the number of tests on the next two days reached 2,000. The other side told him that the maximum detection capacity can reach 5000 per day, so the detection ability is not a problem at all.
Also on this day, although still very nervous, Grigos felt that the New Crown test in New York has become easier. A laboratory next to her office is being remodeled for the new crown test, which is expected to reach 1,000 tests a day. the amount.
On March 13, while the U.S. declared a state of emergency, Trump issued a series of policies to improve testing capabilities, including maximizing convenience for states, medical institutions, and commercial laboratories, and providing more in the coming week. Up to two million additional test kits, appointment of assistant secretary of the Ministry of Health Brett Gilroy to specialize in testing matters, and more.
According to data from the private statistics project COVID Tracking Project, as of March 17, approximately 41,000 people in the United States have been tested. Based on this figure, the number of detections per million people in the United States is only 125, which is significantly lower than the United Kingdom and Italy. And South Korea. But things are getting better. Brett Giroyle reports that as of March 19, the United States has achieved 103,000 tests, almost double the 58878 tests two days ago.
At the large hospital in Nashville, the capital of the state of Tennessee, Vanderbilt University Medical Center, infectious disease expert William Schaffner breathed a sigh of relief because the testing ability finally came up. A week ago, the hospital he worked in could do one day. 200 tests, can now reach 10,000 a day. The hospital has set up a screening center, one in the hospital and three in other parts of the city. Many of his colleagues work there.
Trump hopes to imitate the “get-away” test set up in South Korea-fill out a questionnaire, and if the test is really needed, take a sample at the nearest parking lot inspection center at a large US department store, Wal-Mart, Target, and chain drug stores Walgreen and CVS. But this practice has not yet been rolled out on a large scale. William Schaffner’s state has not yet started, but he thinks it is also important to get the testees out of the car so that doctors can see patients for a quick face consultation. New York State has set up some of these detection points, but Liu Jigao doesn’t think it will be effective, at least in places like Manhattan, New York, because there are not enough parking spaces and not many people have cars.
Beginning March 16th, because the community required significantly more people to test, Wu Xin (pseudonym) working in the emergency department of Shengming Hospital in New Jersey was transferred to one of the four defense lines of the department: rapid screening of medical tents, responsible for Initial consultation, body temperature measurement, to maintain the speed of the team. This is a separate passageway, where registration and testing are done outdoors and isolated from the hospital. At noon the next day, Wu Xin was transferred to a testing post. After taking the test, she described “one test after another, no chance to rest.” And she was responsible for the screening there in the morning. She left with only a few people, and after half an hour, she had queued up outside.
This medical facility is one of the main treatment sites for patients with New Crown pneumonia in New Jersey. The hospital CEO said on March 14 that the CDC test was unreliable. The first sample sent has not been diagnosed yet. The state laboratory is also overloaded. The hospital is currently working with a commercial laboratory, LabCorp.
On March 20, the New Jersey State Government opened a testing center with the help of several agencies such as the Federal Emergency Management Agency (FEMA). The test was started at 8 am, and the maximum testing capacity was reached within 4 hours. Don’t tell people waiting to leave early. The state plans to open two more “get-away” checkpoints, and some private hospitals have opened several such checkpoints.
Although testing channels of various avenues are being opened, testing is still in short supply. Liu Jigao said that the testing authority has been decentralized for more than two weeks, and many testing laboratories need a process of material preparation and personnel training, which takes time. He feels that there will be no major problems in testing in a week or two.
But Liu Jigao had other concerns. Due to the lack of masks and the lack of awareness of wearing masks, the detection process itself may bring more infections. This risk seems to be everywhere, for example, when people coming to the test take public transportation, when they wait in line at a screening center or an emergency room, and let their family drive a patient to test … “Very bad!” Liu Jigao said. He and the members of the Asian American Physician Association are trying to find a way. One of the plans is to test those patients who have been diagnosed by the family doctor after the initial screening, and drive them to take samples for testing. They are actively promoting this approach and hope to get the government’s attention and promotion.
In order to avoid such risks and unnecessary waste of masks and protective clothing by unnecessary testing, in places affected by the epidemic, including New York, Washington, and some cities in California, the government hopes that medical personnel, critically ill patients and high-risk groups will give priority to testing. . A New York City CDC official said that the new crown has become widespread and that there is no exact cure. For people with mild symptoms such as cough and fever, they should be presumed to have the new crown and be isolated. For these people, the test will not change the course of their disease, but will also waste the testers’ protective equipment. And once a “false negative” result occurs, it is not conducive to self-isolation.
The American government is a decentralized structure, and it is also true in the field of public health. Laurie Garrett told China News Weekly that public health in the United States has been driven from the bottom up since the late 1700s. Public health (functions) at the federal government level are mostly advisory in nature and lack legal authority for enforcement action. For example, the United States CDC can advise New York to close schools, but it cannot legally enforce this. Only the Mayor of New York City can legally close local schools.
In this epidemic, Andrew Cuomo, the governor of New York State, who has been compared to “Batman” by netizens, has repeatedly opened Trump and acted in a tough manner. On February 28, the United States CDC decentralized testing authority to the state level, but on March 8, Como criticized the CDC for decentralizing the testing authority of private laboratories for being too slow, delaying case discovery, and there were 7 laboratories in New York State. Testing can be carried out only after the Federal CDC orders.
Judging from the three-day data from March 18 to 20, the number of people tested in New York State has always accounted for about one-fifth of the total number of tests in the United States. The large number of tests has made New York the most diagnosed state in the United States. On the afternoon of March 20th, Eastern time, state officials disclosed that more than 10,000 tests were performed in New York overnight. As a result, more than 2,000 new cases of infection were found. The cumulative number of confirmed cases reached 7,845, accounting for approximately US About 40% of the people diagnosed at that time. By the afternoon of the 22nd, the number of people tested in the state was about 61,400, accounting for 27% of the total number of tests in the United States. The number of confirmed patients soared to 15,168, nearly doubled.
Zhang Zuofeng, who lives in California, said that the reason why the New York epidemic is so serious is not only because of the increase in detection, but also because of the large number of young people, social activities, and dense population. He also pointed out that this also means that California, Washington, and other states with obvious community infections are currently under-assessed due to insufficient detection. As the number of tests increases, cases in these areas will rise simultaneously. As more infected people are diagnosed, the battlefield moves to front-line doctors.
Without a mask, shouted to Musk:
Gao Lei, a cardiologist at Franciscan Medical Center in Seattle, USA, has recently updated his new crown “anti-epidemic” diary. On March 7, although Washington State was the worst place in the United States at the time, Gao Lei received an email from the hospital stating that there were enough N95 masks to use. But on March 20th, the hospital’s email said that the protective equipment of the entire medical institution was only enough for one week of use, requiring everyone to save on the use of masks and all protective supplies, and hoped to get more purchases next week. On this day, he used only one mask, and in the afternoon, he put two layers of tissue paper in the mask. At noon, Gao Lei met an assistant in the hospital’s internal medicine department, who was looking after 3 new crown patients, but the disposable mask film used for a whole day.
According to US media reports, a medical staff member who was fighting the epidemic on the front line in New York was pregnant, but no N95 mask was available. Earlier this week, when Grigos was on duty at the hospital, he saw supplies in boxes containing gloves and other protective equipment that were dwindling. Under her article “The Sky is Falling Down”, a reader replied that her daughter is also a medical resident at a New York hospital, and she is now helping her daughter make a mask. The mother said that if the medical system failed to protect her daughter, at least her remedy could keep the child from being completely exposed to the virus. The mask she made was red with a heart pattern sewn on it. Another reader said that he also turned out the old sewing machine, watched several teaching videos on the Internet, and tried to get some old fabrics and elastic bands to start making masks. He hoped that he could contribute to the front-line medical staff.
The CDC of the United States at the end of the article “Optimization of mask supply” instructed that in the absence of masks, as the ultimate means, medical staff who care for patients with new crowns can use homemade masks (such as handkerchiefs, scarves).
The aforementioned Virus Action Plan predicts that various material shortages may occur in the United States, which will affect medical services, especially the lack of emergency supplies and key medical facilities, including diagnostics, medical supplies (protective equipment and drugs), and eventually lead to some clinical specialties Serious staff reductions, such as emergency room and infectious disease specialists.
Zhang Zuofeng said that despite the announcement of a national emergency, because many of the production lines for the production of masks and protective clothing are abroad, far water does not save near fire, and manufacturing has only begun now, with a waiting period. On the other hand, when the epidemic situation in China was tense, many overseas Chinese students bought a large amount of protective supplies short in the US and sent them to China, which was also one of the reasons for the shortage.
There are about 1,100 Asian-American doctors in the Asian-American Physician Association where Liu Jigao is the chairman. When the epidemic in Wuhan was severe, doctors helped Zhang Luo to buy masks and other protective facilities and sent them back to China. But after more than a month, New York became the largest “epicenter” in the United States, but such supplies became very scarce. One box Fifty common surgical surgical masks previously cost $ 6.90, and now are close to $ 100. Liu Jigao said that the masks and protective clothing of many of them are running out of doctors’ clinics, and they are looking for ways to buy them in other states. The emergency rooms of American hospitals generally do not have the habit of wearing masks, so they do not have sufficient reserves.
On March 22, Trump tried to assure the anxious public that help is on the way. Some private companies, including clothing company Hanes, have agreed to produce and provide much-needed medical supplies, but neither Trump nor Vice President Pence Reveal how long these supplies will be in place. On the 23rd, the governors of several states issued an urgent request to Trump for masks and other medical equipment. Despite pressure from many parties, Trump was hesitant to decide whether to launch the National Defense Production Act. The bill will allow government orders to be prioritized, and companies will need to produce products that are prioritized for national security by the US Department of Defense.
But local governments in the United States have not waited. On March 19, New York Mayor Bai Sihao tweeted to Tesla boss Elon Musk on Twitter: “Our country is facing a serious shortage. We need a ventilator. The sooner the better. We will do our best. I can find a ventilator, but we need your help! “Musk responded quickly, and this week starting on the 23rd, Musk said that he can already provide 1,200 ventilators to the hospital and a large number of N95 masks. The bottom-up form of mobilization is fully reflected in the US’s epidemic resistance.
Beginning on March 19th, Liu Jigao’s assistant’s circle of friends was mostly information on material donations for help. The next day, Dr. Liu Jigao delivered the medical supplies he collected to the Presbyterian Queen’s Hospital, where more than 150 new patients were seriously ill at the time.
At a larger level, not only protective equipment, but also the number of ventilators, beds, and medical staff in American hospitals may face challenges. An article published by the British “Financial Times” on March 17 pointed out that both the United States and the United Kingdom have weaknesses in their healthcare systems. If these two countries experience a severe outbreak of a new crown like Italy, these weaknesses may trigger the collapse of their healthcare systems. One piece of evidence in the article is that according to statistics, the United States and the United Kingdom have about 2 hospital beds per 1,000 people, compared with 6 in Germany and 7.8 in Japan.
On March 18, Andrew Cuomo, Governor of the State of New York, announced that the USS “Soothing” medical ship is expected to dock at the Port of New York in April with a maximum capacity of 1,000 beds; he also ordered a hotel near Times Square in Manhattan to be used As an isolation center and hospital, 1,000 retired doctors and nurses have also started to provide medical services. He stated that he supports continued testing and hopes that the federal government can detect those who have been infected and recovered through antibody testing and address some of the shortages in health care. But Liu Jigao believes that these are still not enough. “In New York, the new crown outbreak is only just beginning.”
Social distance and empty Times Square
at a China-US Respiratory, Critical Care, Infectious Diseases and other relevant top experts participating in the anti-epidemic experience sharing session on March 13th, Shanghai Fudan University Zhang Wenhong, director of the Department of Infectious Diseases, Huashan Hospital, said that a successful experience of the Shanghai epidemic is that after the diagnosis, the hospital will treat patients as soon as possible and shorten their stay outside the hospital to prevent further local transmission. However, Zhang Zuofeng said that in order to avoid the run-up of medical resources, the strategy adopted by the United States is to place patients in the hospital with heavy patients and isolate the light patients at home. The reason is that most families have the conditions, such as independent bedrooms and bathrooms, and then family doctors and CDCs. Provides many specific home isolation instructions.
There are two main strategies for epidemic prevention and control. The first is to contain. The purpose is to reduce the value of the number of reproductive infections R to less than 1, and completely eliminate the human-to-human phenomenon. At present, China and South Korea’s epidemic prevention measures have proven that the suppression measures will be effective in the short term, but these measures need to be maintained until the vaccine is on the market, or there will be a second outbreak once it is relaxed. The second is delay. It cannot prevent the spread of cases, but through protection measures, it does not allow cases to increase rapidly within a certain period of time in order to effectively allocate medical resources and minimize the number of deaths. Currently, Italy, the United Kingdom and the United States have all taken a mitigation route.
Zhang Zuofeng figured it out. The number of confirmed cases in the United States doubled in four days. By March 20, the confirmed cases basically doubled every two days. In this regard, epidemiologists and clinical experts alike have pinned their hopes on the same thing: social distancing. This is an important measure to change the curve of the number of patients from a surge to a gradual one, which will reduce the burden on medical institutions-because the medical demand will be distributed smoothly for months, and it will not overwhelm medical care in just a few weeks. system.
It ’s difficult to enumerate the isolation measures intensive in the U.S. states, at least including: Ohio has delayed presidential primaries; Washington and Maryland announced the closure of restaurants and bars; March 16, San Francisco Bay Area Marin, San Francisco, San Mateo Wait for counties to issue “local asylum orders”, requiring residents to stay at home as much as possible in the next three weeks. If they appear in public places due to “necessary activities and work”, they must maintain a social distance of at least 6 feet with others; March 19 California Governor Gavin Newson issues a “home order” requiring Californians to stay at home as much as possible in the coming weeks. The following day, New York and Illinois also joined California …
Before these measures were announced, many people I have been working from home for some time. “The situation is very passive, but everyone knows the severity now, at least now it is in action.” Zhang Zuofeng said. However, even the more stringent California “home order” is completely different from the closure of Wuhan. The government has only ordered the closure of some commercial and public places, but it is not mandatory for the individual behavior of citizens, it is only recommended that they do not gather Sex groups, residents can still go cycling, dog walking, and shopping.
William Schaffner said that there are 50 states in the United States, and each state behaves differently. Tennessee did not take strict measures similar to California, but when William Schaffner went to work on March 18, he saw that the traffic on the road may only be 5% of the past. People stayed at home voluntarily, bookstores, bars and some restaurants were closed. Shop.
The New York Times states that, to a certain extent, Europeans are paying the price to live in open and rich democracies. In such countries, people are accustomed to free movement, convenient travel and independent decision-making. The government is worried about public opinion and is not used to issuing harsh orders. And the same applies to the United States.
In contrast, many countries in East Asia are moving fast. Fei Heping, the former director of the United States CDC, believes that although China lost a few weeks at first, it then moved faster and more decisively than Western countries. “You must strictly maintain social distance within a week after the start of community communication, otherwise it will break out, and once it breaks out, it will be difficult to control.”
“In the United States, it all depends on consciousness.” William Schaffner said with a smile He explained that they did not follow California’s approach because the governor felt that Tennessee was a model of voluntariness. But he also emphasized that this is not the only state to do so. Yesterday, he saw a picture of Times Square on a TV, and he was surprised by the almost empty sight there. “In fact, I’m very surprised that people across the United States take the suggestions of the mayor and governor so seriously and seriously.”
But not everyone behaves this way. William Schaffner once saw in the TV news that some young people thought that they would not be seriously affected by the new crown virus, so they went out to play as usual, in groups of three or five. Another news is that there are a lot of young people on the Florida coast. As usual, the governor is very angry and asked the mayor where the beach is located to clear these young people.
At a news conference on March 22, New York Governor Andrew Cuomo disputed the “numbness” and “arrogance” of some New York City residents who continue to gather in parks and other public places. He instructed that New York City would be given 24 hours to come up with a plan to reduce the population density in these places.
The call for self-isolation is something that almost all experts are emphasizing. “This means we all need to take responsibility, even if we think we are relatively unsusceptible. It is easy for young people to see the data and think, ‘Well, what if I get infected? I may be fine.'” Collins, director of the National Institutes of Health, said, but you also need to consider other vulnerable groups. Even if you don’t think you need to isolate yourself, you are doing it for the rest of the country.
What is the best ending in the United States? Fei Heping said that by limiting social distance and crowd gathering, the United States has the possibility to reduce the number of infections, and then began to adopt Singapore-style strategies to reduce new infections. Another expert also said that although countries such as Singapore, South Korea, and China have experienced the initial shock, they have later smoothed the number of cases, and the United States may also imitate their experience.
If the examples of countries such as South Korea and Singapore give the United States hope, then British epidemiologist Neil Ferguson questions whether these countries can continue this success for 18 months until the vaccine is launched? Recently, Singapore, Hong Kong and Taiwan have also shown a trend of rebound. One of his colleagues also believes that the big question is, how long can we maintain these current measures, whether it is the government or individuals? “If we can’t count on vaccines for the next year to a year and a half, then we need to find a sustainable way to deal with the epidemic.”