Tuesday, March 31, 2020

New story in Health from Time: Inside Trump’s Coronavirus Theatrics on War Powers, Ventilators and GM



On Friday, Mar. 27, President Donald Trump took what appeared to be bold, decisive action in the fight against the new coronavirus. Reaching for wartime powers under the Defense Production Act, Trump ordered the federal government to “use any and all authority” to force auto giant General Motors to produce ventilators, the life-saving medical devices desperately needed by patients and hospitals struggling to survive the fast-spreading COVID-19 respiratory illness. For good measure, Trump tweeted, “General Motors MUST immediately open their stupidly abandoned Lordstown plant in Ohio, or some other plant, and START MAKING VENTILATORS, NOW!!!!!!”

But if Trump’s Friday performance conveyed urgency and action, four days later, neither is anywhere in evidence. Despite the tough talk and the invocation of presidential powers, Trump and his team by midday on Tuesday had yet to formally file a single order for a GM-made ventilator. While negotiations were ongoing, they had set no mandatory timeline for delivery of the machines, or even suggested a voluntary one. And they had not informed GM of what prices the federal government will pay for the machines under Trump’s executive order. For its part, GM has continued following the plan to produce ventilators that it had discussed with the White House for weeks prior to Trump’s order, a plan that was already well underway when he issued it, according to documents reviewed by TIME.

The GM episode is just the latest in what has become a common Trump-led scene during the pandemic’s spread. As known U.S. cases skyrocketed from 98 to 177,300 over the last four weeks, Trump has made vocal public shows of action that in several cases have yielded few real results. On Mar. 13, he declared Google was building a website to help people find local coronavirus testing sites. Thus far, it has ended up being little more than a bare-bones, aggregational site with a series of links. That same day, he promised big box retailersWalgreens, Walmart and CVSwould roll out drive-thru testing sites in their parking lots, a notion that also hasn’t fully materialized.

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It’s not unusual for a president to use his position to project optimism and progress at times of crisis. FDR famously declared in 1932, during the depths of the Great Depression, that America demanded “bold, persistent experimentation” and that if a first effort failed to “admit it frankly and try another.” Trump aides claim that his efforts are spurring action and setting a positive tone at the top. But Republican and Democratic critics say Trump’s approach appears to be less focused on solving the life and death problems that COVID-19 are imposing on Americans, than on the political challenges the disease is presenting to him.

The GM case in particular brought together several political vulnerabilities for Trump. First, it was taking place in Michigan, a state he barely won in 2016, where Republicans fared poorly in the 2018 mid-terms and where Trump is currently trailing Joe Biden by 3 or more percentage points in several polls. More broadly, Trump’s order came as he was under repeated criticism for not taking more action to help states in desperate need of assistance. “They were getting a lot of pressure,” says Michigan Democratic Rep. Elissa Slotkin, a former Defense Department and CIA official who sponsored bipartisan legislation to require the president to implement the DPA to speed the production and distribution of supplies.

As Trump continues to project action and accomplishment, COVID-19 cases continue to spike and so does the urgency of demand from mayors, governors and leaders around the world for ventilators. The coronavirus pandemic has killed more than 41,650 people across the globe, including more than 3,500 Americans. The sickest of those infected have severe inflammation in their lungs, which stiffens them, and makes it impossible to breathe without help from a ventilator. Some of these victims need the device for weeks at a time. Hospital staff say they are concerned about shortages of specialized equipment. If the system swells over capacity, doctors and nurses worry they may ultimately have to ration health care and decide who lives and who dies. Trump’s medical advisors said Monday that even if everything goes perfectly the number of deaths in America could hit 240,000.

Some at GM say it is unfair for the President to make them the bad guys. “It felt like we were getting punched in the gut,” says a long-time GM employee, who wasn’t authorized to speak publicly on the matter. “We did everything in our power to transition from building Tahoes to building ventilators without any guarantee of a federal contract.”

In any case, the company’s officials say, they’re not waiting for direction from the federal government or anyone else. GM forged a deal with Seattle-area ventilator manufacturer Ventec Life Systems and already has begun retooling a factory to build thousands of them beginning next month. “We’re not waiting around for anyone to dictate what number of ventilators need to be made,” says Chris Brooks, Ventec’s chief strategy officer. “Our north star has always been to make as many ventilators as possible, as quickly as possible, to arm front-line medical professionals with the tools they need to save lives.”

GM Kokomo Operations to Build Ventec Life Systems Ventilators
AJ Mast for General MotorsWork being done Monday, March 30, 2020 at the General Motors manufacturing facility in Kokomo, Indiana, where GM and Ventec Life Systems are partnering to produce Ventec VOCSN critical care ventilators.

GM’s strategy to build ventilators began as the company was facing its own coronavirus crisis. Like other companies around the country, it was projecting dramatic contraction in demand for its cars as unemployment spiked and spending plummeted nationwide. At the same time, it needed to temporarily close plants to prevent the spread of the virus. On March 17, ten days before Trump’s big announcement, and the day before GM announced it would shutter all of its North American factories due to coronavirus, GM CEO Mary Barra called White House economic adviser Larry Kudlow to discuss converting factory space for ventilator production.

Kudlow and the White House turned to a newly formed organization of business leaders, called StopTheSpread.org, for help. The group is led by the former American Express CEO Kenneth Chenault and Rachel Carlson, founder of the online education firm Guild Education, who volunteered to help the Trump Administration in harnessing private industry. In exploratory phone calls with GM, the group discovered what the automaker needed was a medical device-making partner with a reputable product.

StopTheSpread.org matched them up with Ventec, maker of a toaster-sized device known by its acronym, VOCSN (for ventilator, oxygen, cough, suction and nebulizer). On Mar. 18, the two companies held initial phone calls to discuss what could be done. The next day, GM chartered a late-night flight and four engineers, including Phil Kienle, manufacturing chief for North America, flew from Detroit to Seattle for face-to-face talks.

The GM team spent the next three days at Ventec’s headquarters in Bothell, Wash. examining machines that breathe life into immobilized people who can’t do it on their own. They pored over blueprints illustrating where each of the device’s 700 parts come together largely by hand. Images of the parts were handed to a GM purchasing agent see if suppliers could replicate the handiwork. “We sourced literally hundreds of parts and components in just over a week, which is lighting speed, and we will begin production by mid-April,” says Gerald Johnson, GM executive vice president of global manufacturing. “From there, production will scale up to 10,000 or more per month very quickly.”

Next up were workers. GM called 1,000 workers to see if they were willing to come to work for the company on ventilators. Greg Wohlford, chairman of United Auto Workers Local 292, which represents the shuttered GM plant in Kokomo, Ind., told the Kokomo Tribune he was just waiting to hear about the training details. “It’s going to happen, we’re just trying to work out all the details,” he said. “But everybody is thrilled. Everyone is really excited.” New manufacturing space was located in a 2.6 million square foot facility with clean rooms where small electronic components for cars are manufactured. Construction workers began tearing up carpet and knocking down walls to make way for additional workstations. Cameras were installed to document the progress.

All told, it took less than a week for GM to forge a partnership with Ventec, according to internal communications, travel logs and interviews with both companies’ officials. The companies produced a full set of manufacturing plans that leveraged union labor, industrial buying power and a worldwide chain of 700 suppliers. Ultimately, the companies claimed they would be able to produce up to 21,000 ventilators a month, if needed.

On Mar. 23, GM and Ventec presented the Federal Emergency Management Agency with the strategy. The companies provided the administration with an itemized list that laid out how many ventilators could be produced, how quickly and at what cost, depending on the options the federal government selected, according to two officials involved in the contracting process.

And then they waited to hear back.

Four days later, they got their response. First, at 11:16 a.m. on March 27, Trump issued a series of tweets blasting GM and Barra. Then, later, at the White House, he elaborated. “We don’t want prices to be double, triple what they should be,” he told reporters. “So General Motors, we’ll see what happens, but now they’re talking. But they weren’t talking the right way at the beginning, and that was not right to the country.” GM pushed back in a public statement that said the company’s commitment to the Ventec ventilator project “has never wavered” and that “GM is contributing its resources at cost.” Officials insisted nothing had changed in their schedule.

In the days leading up to Trump’s comments, governors and lawmakers from the hardest-hit states pleaded with him to use the DPA, a little-known Cold War-era law that enables the president to force businesses to accept and prioritize government contracts during natural disasters, terrorist attacks and other emergencies. Dwindling supplies of respirator masks, gowns, gloves and other basic protective equipment are pushing the nation’s front-line medical workers toward a breaking point.

Politicians from both parties were convinced that using the statute could prevent counterproductive bidding wars that were breaking out across the country, as states competed with each other to acquire the same medical supplies from suppliers. New York Governor Andrew Cuomo said ventilators on the market now cost more than $50,000, which represents a 150% increase from the $20,000 when his state first tried to purchase them.

Trump has insisted that invoking the DPA was government overreach and that companies were stepping up on their own. But perceptions of a weak federal response to the growing crisis is seen as a political liability to Trump in key election states, including Ohio and Michigan. When on Mar. 26, for example, Michigan Governor Gretchen Whitmer, a Democrat, publicly said her state wasn’t getting the medical equipment it needed, Trump responded on Twitter that she was “way in over her head” and that she “doesn’t have a clue.”

The administration says Trump’s Mar. 27 flare-up had nothing to do with politics. By invoking the DPA, the president compelled GM to “to accept, perform, and prioritize contracts or orders for the number of ventilators,” according the executive order. Peter Navarro, Trump’s Trade Adviser and Policy Coordinator for the DPA, told TIME in a statement that the GM action aimed to jumpstart work on ventilators. “Prior to the DPA order being signed, the GM/Ventec venture was sputtering. Since the DPA order was signed, GM has moved into high gear. That’s the poster child of an effective DPA action,” Navarro said.

Navarro also says the President’s declaration was designed to spur competition between different automakers turning to produce ventilators. Ford is working with GE Healthcare to increase GE’s production of its own advanced ventilators, although manufacturing details remain unclear. Ford announced Monday it plans to make as many as 50,000 smaller ventilators, which are licensed by GE, within 100 days at a plant in Ypsilanti, Mich. Now that GM has been pushed publicly by Trump, Navarro suggests, there will be urgency to sprint to the market first. “Now let’s see which venture rolls the first hundred ventilators off their new assembly lines—Ford/GE or GM/Ventec. We expect that within the next 30 days, American lives are at stake, and GM’s lesson from this should be you can’t get to the finish line until you first get to the starting line. Now, a very real race is on.”

Whatever the logic behind Trump’s public statements about GM and his use of emergency powers, the company maintains that Trump’s tough talk resulted in no change from the Mar. 23 plan they presented to his government. Two days after his Mar. 27 statements, on Sunday, Trump was asked at the White House how negotiations GM were going since he invoked DPA two days earlier. Although nothing had changed, he responded that the automaker was now doing a “fantastic job.”

New story in Health from Time: ‘An Activist, a Warrior, a Mother To So Many.’ Lorena Borjas, Pillar of New York Trans Community, Dies From Coronavirus



Aged 19 and incarcerated on Rikers Island, Bianey Garcia and a friend — victims of a homophobic attack that had led to their arrests, Garcia says — needed help. They called Lorena Borjas.

A pillar of New York City’s Latinx LGBTQ community, Borjas had long been known as a staunch defender of the rights of trans people, Latinx people, undocumented people and sex workers. Borjas helped Garcia and her friend obtain a lawyer, who won their case and later helped them get immigration papers to stay in the U.S. A decade later, Garcia is now a justice workwr with New York City-based advocacy organization Make the Road. “Lorena was like a mother for many in the transgender community,” Garcia tells TIME. “She used to help anyone.

On Monday, March 30, Borjas died from complications related to coronavirus, officials announced, a loss that has rocked the trans community of Queens, N.Y., and beyond. She was 60, per NBC New York.

Lorena Borjas was a real hero for trans people, especially in Queens. She was a leader, a builder and a healer,” Mara Keisling, the executive director of the National Center for Transgender Equality, said in a statement. “The NCTE family is saddened by her passing and has her broad family and the Queens Latinx community in our hearts today.”

Borjas had been a prominent community organizer and health educator for decades, working to end human trafficking, which she herself survived, according to the Transgender Law Center. In 2017, she received a rare pardon from New York Governor Andrew Cuomo for a conviction she received in the 1990s while being trafficked, with Gov. Cuomo praising her advocacy work in New York state. (The conviction had put Borjas, a Mexican national, at high risk of deportation.)

Her community health work included a HIV testing site Borjas set up in her own home, and a syringe exchange program for trans-women using hormone injections, according to Gov. Andrew Cuomo’s office. In 2012, she and activist Chase Strangio co-founded the Lorena Borjas Community Fund, which helped cover bail and pay legal fees for for LGBTQ immigrants.

Just a few weeks ago, Borjas set up a fund for trans-people who had lost their jobs to COVID-19, the disease caused by novel coronavirus.

Activists and community leaders across New York City took to social media after the news of her death broke.

“Lorena was honestly one of the most amazing women I’ve ever met,” Lynly Egyes, the legal director of the Transgender Law Center, tells TIME. “She was an activist, a warrior, a mother to so many.”

Egyes, 38, says she first met Borjas while working for the Sex Workers Project at the Urban Justice Center. At the time, Egyes remembers she was representing two incarcerated transgender women; Borjas “just showed up” with a much-needed birth certificate for one of the women, pulling it out of the Mary Poppins roller bag she always carried with her. “You never knew what was in there,” Egyes laughed.

Egyes later represented Borjas while campaigning for her pardon, and says she she received scores of letters during that time from people who said “Lorena literally saved my life.” They told Egyes about times Borjas protected them from an abusive partner or took them into her home when they had nowhere else to go. “That wasn’t an uncommon story about Lorena,” Egyes says.[She would] provide services and resources to anyone who just got to New York City and needed a hand or help,” she continues. “And she did this without pay. She just did it because it was the right thing to do.”

“What I lived through helped me fight for justice for my sisters,” Borjas said in a 2018 interview. “My goal in life is to help them in everything I can.”

Cristina Herrera, the CEO and founder of the non-profit Translatinx Network, describes Borjas as an outgoing and resourceful woman who was “determined to make her visions come true.” Over the 32 years the women knew each other, Herrera, 49, tells TIME she watched Borjas grow into a respected and powerful community leader. “She was a source of strength for many of us, Herrera adds.

“She’s made the world better so selflessly, so humbly, without often any type of recognition,” Egyes says. “I think she taught everyone she knew about how to be a better person.”

Indiana restaurant owner cuts hair like Joe Exotic to raise money for workers after coronavirus shutdown


Indiana restaurant owner cuts hair like Joe Exotic to raise money for workers after coronavirus shutdown



Desperate times call for desperate hair styles.

New story in Health from Time: Alaska’s Remote Villages Are Cutting Themselves Off to Avoid Even ‘One Single Case’ of Coronavirus



With a deadly coronavirus epidemic creeping northward and the nearest hospital 230 miles away, Galen Gilbert, First Chief of Arctic Village, Alaska, knew his 200-person town could not afford to take any chances. A single case of COVID-19 could lead to the virus quickly spreading around the tight-knit community, but anybody who needed hospitalization would likely face an overstretched medevac system. As national infection rates rose, the 32-year-old leader and his village made an agonizing decision: rather than risk a potentially devastating outbreak, Arctic Village cut itself off almost entirely from the outside world.

“It’s a sacrifice we have to do for our people, because it’s such a small community,” Gilbert says. “You gotta do what you gotta do to survive.”

In recent weeks, dozens of villages like Gilbert’s, mainly populated by indigenous Alaskans or Gwich’in and overseen by tribal authorities, have restricted or completely halted travel in order to keep COVID-19 at bay, in addition to instituting social distancing rules within their borders. Barring travel is an extreme measure for such isolated communities, but leaders say it’s better than risking outbreaks in settlements where a lack of local medical capacity means an infection could easily become a death sentence. “They really don’t have any way other than that to protect themselves,” says Victor Joseph, chief and chairman of the Tanana Chiefs Conference, an Alaska Native non-profit corporation that provides social and health services to 37 federally-recognized tribes spread across an area a bit smaller than the state of Texas.

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100 miles to the south of Arctic Village lies Fort Yukon, a 580-person town where temperatures have reached -79F and the nearest big city is 150 miles away. Leaders there suspended all inbound passenger air travel on March 23, exempting only medical personnel, patients returning from treatment, public safety officers and those who make it through a restrictive waiver process. Anyone who has arrived since March 14 is subject to a mandatory two-week quarantine. Patrolling villagers discourage anyone from entering the settlement by snowmobile.

“We really don’t have the capacity to handle one serious case,” says Dacho Alexander, a local Tribal Council member representing Fort Yukon’s majority Gwich’in community. “We’re just afraid that if we have a single case, that it has the potential to spread through the community like wildfire.”

Sarah BeatyDacho Alexander, a Tribal Council member in Fort Yukon, Alaska

Communities like Arctic Village and Fort Yukon have almost no local medical infrastructure. Instead, they largely depend on medevac services based in cities like Fairbanks and Anchorage to airlift patients in emergencies. But just like ambulance networks in hard-hit cities like New York, village leaders are concerned that those airlift services could quickly be overwhelmed if COVID-19 spreads among numerous villages. Furthermore, the healthcare systems in Alaska’s big cities could easily be consumed with fighting their own local outbreaks.

The new rules have disrupted life in major ways for village residents. Some were away from home when they went into effect, and are now stranded indefinitely. “We got a lot of phone calls about people who are out of town and they want to come home,” says Gilbert. “We straight up tell them the Council doesn’t want people in or out of the village because it’s too risky.” Fort Yukon’s tribal government may pay hotel expenses for some in temporary exile. Gilbert’s own mother is stuck in Fairbanks, which has reported 30 area COVID-19 cases as of March 30. She wishes she could come home, Gilbert says, but she understands the policy.

Not everyone has been so cooperative. A group of Fort Yukon residents recently rode in on snowmobile, bucking the rules. The violators refused to leave, but agreed to at least isolate themselves in their homes. The incident forced the village to restart a community-wide 14-day lockdown.

Elliott Hinz Fort Yukon, Alaska has taken extreme measures to keep COVID-19 at bay

There’s evidence that the villages’ strict isolation could be effective. “Historically there’s precedent for it,” says Dr. Howard Markel, a medical history professor at the University of Michigan’s School of Public Health. He worked on a 2006 Defense Department study examining communities that weathered the 1918 flu epidemic with few or no influenza-related deaths. Those communities, which included the San Francisco Naval Training Station on Yerba Buena Island; Princeton University in New Jersey; and Gunnison, Colorado, effectively shut themselves off from the outside world as the pandemic raged, and emerged months later almost unscathed. Markel says so-called “protective sequestration” can work for small communities, but they come with an enormous degree of social disruption. “It’s a very bold move,” he says. “But if they have the wherewithal to maintain it, it could save a lot of lives.”

In Arctic Village, Fort Yukon, and other small Alaskan villages, that wherewithal comes in large part from a reverence for the elderly, who are particularly at risk from COVID-19, and who have a great deal of influence within these communities. “To protect our elders, that was our main concern,” says Gilbert. It’s an attitude in stark contrast with the calls of some American leaders who have suggested letting the elderly “take care of ourselves.” That COVID-19 is proving especially deadly for older patients makes it a particular treat for many of these communities, which tend to be older than average. (The Yukon-Koyukuk Census Area, which spans nearly 150,000 square miles across central Alaska and has just over 5,000 people — including residents of Arctic Village and Fort Yukon — has a significantly larger proportion of elderly people than the state as a whole.)

Some elders have shared stories of past outbreaks that decimated native communities, helping to convince residents that isolation is the right move. Records are scarce, but a 1927 survey of the Spanish influenza pandemic indicates that the mortality rate of the disease may have been four times higher among Native Americans than for whites. The vast majority of influenza deaths in Alaska, more than 80%, were among native people.

“We had a lot of folks in this area suffer from TB all the way up until the mid 1940s,” says Alexander, who adds that the 1918 pandemic killed massive numbers of people in Fort Yukon. “A lot of folks remember losing a lot of loved ones, and so while it’s not fresh on everyone’s minds, it’s not that far in the past.”

Galen Gilbert Galen Gilbert and his family in May 2017, at his daughter’s kindergarten graduation

For those who regularly hazard long, sometimes dangerous trips over Alaska’s interior, the new protective measures have been ominously apparent. In communities that rely on an airstrip as their only conduit to the outside world, bush plane touchdowns are, in normal times, often met by crowds of residents. But amid the COVID-19 outbreak, those impromptu celebratory gatherings have stopped.

“Usually lots of people get involved … throwing boxes, unloading the plane,” says Max Hanft, chief pilot at the Fairbanks-based Wright Air Service. “It’s usually a fairly festive event, whereas now pretty much all we’re dealing with is our village agents, and no one else is really coming out to meet the plane.”

Hanft and other pilots are still making lonely flights across mountain ranges and vast stretches of boreal forest to resupply settlements like Arctic Village and Fort Yukon, where he says the packages are handled “like hazmat.” But without many passengers to fly, Alaska’s bush airlines have drastically reduced their service. Joseph, of the Tanana Chiefs Conference, worries that fewer flights could mean food shortages in towns that are only accessible by air. A representative of Wright Air Service says it’s committed to keep flying, and that despite “devastating” financial losses, it’s still “part of the societal contract.”

Max HanftA view from Max Hanft’s Cessna Caravan above the Alaska wilderness.

And though many villages are dependent on air transport for important supplies — including online orders — the people of Fort Yukon tend to have a good deal of frozen game put away, says Alexander. He adds that they’re prepared to live off the land if need be. “Elders have always said there may be a time when people are going to need the resources that the land provides,” Alexander says. “And so the people of the Yukon Flats have been protecting that resource for the last hundred years.” It’s unclear how the effects of climate change may affect locals’ ability to hunt, fish, and so on.

Arctic Village is similarly dependent on air shipments, though Gilbert says residents rely on caribou as their main food source, along with moose, ptarmigan and ground squirrel, as well as river grayling, pike, trout and other fish from the area’s lakes and the Chandalar River. Even with those resources at hand, he doesn’t underestimate the seriousness of the pandemic threat, or the severity of the measures in response.

“I had some people of mine that were really freaked out,” says Gilbert. “That’s part of my job, is encouraging them, give them strength and give them hope as well.” Alexander, meanwhile, takes solace in the fact that keeping a pandemic at bay is not altogether different from riding out the punishing winters of the Yukon Flats. “We had minus 40 to minus 50 below for two months,” he says of the past winter. “If anyone is prepared to self isolate, I think it’s the Gwich’in.”

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Burger King, Popeyes to use thermometers on workers, pay bonus for April amid coronavirus outbreak


Burger King, Popeyes to use thermometers on workers, pay bonus for April amid coronavirus outbreak



The owner of several popular fast-food chains recently addressed the coronavirus outbreak.

New story in Health from Time: ‘I Still Can’t Believe What I’m Seeing.’ What It’s Like to Live Across the Street From a Temporary Morgue During the Coronavirus Outbreak



From the living room window of her Brooklyn apartment, Alix Monteleone watched the team of workers assemble the morgue in stages over the weekend. First, they parked the refrigerated trailer along the curb, a white box about the size of a large shipping container. Then, they built a wooden ramp to allow hospital staff to wheel the bodies inside. Finally, on Monday, the workers erected a wall of panels, thin and white, to stop passersby from staring or getting too close to the dead.

After that, the gawkers mostly went away, as it was no longer easy to snap a photo of this scene from the sidewalk. But Monteleone, a 28-year-old event planner from Long Island, kept up her vigil from the third-floor window.

“I spend my entire day like this,” she says, propping her elbows onto the back of her couch and looking out toward the Wyckoff Heights Medical Center, the hospital across the street. “I still can’t believe what I’m seeing.”

Workers build shelves for a refrigerated morgue truck outside Wyckoff Heights Medical Center in Brooklyn, as seen from an apartment building across the street.
Benjamin Norman for TIMEWorkers build shelves for a makeshift morgue outside Wyckoff Heights Medical Center in Brooklyn, New York, on March 30, as seen from an apartment building across the street.

The deployment of temporary morgues across the city—known to emergency planners as Body Collection Points, or BCPs—marks a new phase of the COVID-19 pandemic for New Yorkers, whose city has rapidly become the global center of the crisis. By late Monday, the state’s death toll had surpassed 1,200, with more than 66,000 confirmed infections. More than 900 of the deaths were in New York City.

Until now, it had been largely possible for residents to shut out the worst of this calamity, retreat into their homes and only go out for short trips around the neighborhood, all without confronting anything more grim than empty streets and people wearing face masks.

The arrival of the morgues and makeshift hospitals—which have been installed in public spaces—has thrust the pandemic into full view as it envelopes the nation’s largest city, making this escapism difficult. Anyone strolling through Central Park could observe a field hospital erected on the lawns to alleviate the patient load at hospitals like Wyckoff Heights. Another pop-up hospital has been set up at the Jacob K. Javits Convention Center in Manhattan, and on Monday, the Navy ship Comfort docked in New York to take on more patients.

Marc Kozlow, 33, and Alix Monteleone, 28, look out their window toward Wyckoff Heights Medical Center on March 30. "I want to know," Monteleone says, referencing the refrigerated morgue truck parked nearby. "I want to know the body count."
Benjamin Norman for TIMEMarc Kozlow, 33, and Alix Monteleone, 28, look out their window toward Wyckoff Heights Medical Center on March 30. In one weekend, after a temporary morgue was erected outside, they counted more than a dozen bodies. “I want to know,” Monteleone says, referencing the temporary morgue parked nearby. “I want to know the body count.”

The largest temporary morgue in New York City occupies a tent set up over the weekend outside Bellevue Hospital in Manhattan. “We have them at public and private hospitals throughout the boroughs,” says Aja Worthy-Davis, a spokesperson for the office of the chief medical examiner, the city agency responsible for caring for the dead. At least four had been set up as of Monday, she said: two in Brooklyn, one in Queens, and one in Manhattan. “We expect to start utilizing the large tent in Bellevue soon.”

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Ramon Rodriguez, the President and CEO of the Wyckoff Heights hospital, says it was not his decision to deploy the refrigerated truck, but he is thankful that the office of the medical examiner was able to provide it to his facility, whose morgue can only house nine bodies at a time. “Over the last three weeks we have filled that morgue many times over,” he says of the hospital’s usual morgue space.

The bodies in the refrigerated truck are being picked up by funeral homes for burial as quickly as possible, adds Rodriguez. Given the distress this process was likely to cause local residents, placing the truck on a public street was not an easy decision, he says. But the hospital had no other viable place to put the trailer, which is 53 feet long.

“We want to be respectful and kind both to the people who have left this earth and those who live across the street,” says Rodriguez. And the need for extra privacy is why the hospital put an enclosure around the wooden ramp leading to the trailer.

Under the New York City medical examiner’s protocols for a pandemic, the deployment of temporary morgues becomes necessary when the death toll tops 200 per day, overwhelming the capacity of hospitals to store bodies safely. New York City passed that threshold last week, triggering a new “mobilization level” in the city—the third level on a scale of six—according to a copy of the chief medical examiner’s pandemic “surge plan” for handling the dead, which Worthy-Davis shared with TIME on Monday.

Drafted in 2008 to prepare for a devastating flu pandemic, the plan envisions far more dramatic measures of “mass fatality management” if the virus continues to spread. Officials at Rikers Island, the city’s main jail, could put inmates to work burying some of the dead in the city-run public cemetery on Hart Island, the plan states. Under the current level of mobilization, the city must also draw up contracts with cemeteries that can accommodate temporary mass graves, which the plan describes in jarring detail: “Ten bodies in caskets are placed lengthwise in a long narrow section in the ground.”

Workers transport a casket-sized box near the morgue set up outside Wyckoff Heights Medical Center in Brooklyn on March 30.
Benjamin Norman for TIMEWorkers transport a casket-sized box near the morgue set up outside Wyckoff Heights Medical Center in Brooklyn on March 30.

By comparison, the installation of temporary morgues would seem like a measure New Yorkers could stomach. But it has been enough to unsettle the neighbors of the Wyckoff Heights hospital. Before the refrigerated trailer arrived on Friday, Monteleone and her fiance, Marc Kozlow, had gotten used to the routines of confinement and boredom that come with social distancing. They took turns walking their dog Hank around the neighborhood. She had tried doing needlepoint to pass the time. He had started baking sourdough in the kitchen.

But by Saturday, when they saw the first bodies taken on gurneys from the hospital and carried into the trailer, their hopes for riding out the pandemic at home began to dim. “If a nuclear reactor is exploding near you, you don’t stay near the hot zone,” says Kozlow, 33. “You get out.”

Although they understood from news reports that the hospital across the street was quickly filling with COVID-19 patients last week, the reality only sank in after they began to see the bodies, some of them zipped into bags, others wrapped in what appeared to be white bed sheets. They counted more than a dozen over the weekend.

Monteleone keeps insisting they stay. “This is my home,” she says in the living room of their one-bedroom apartment. “The only semblance of control I have in my life right now is staying in my home. So we just need to adjust. We need to close the blinds.”

But within a few minutes she was back at the window, overcome by what she called a morbid curiosity. “I want to know,” she says. “I want to know the body count.”

New story in Health from Time: ‘No One Mentions the People Who Clean It Up’: What It’s Like to Clean Professionally During the COVID-19 Outbreak



When Vanessa is asked to clean up after patients who have the seasonal flu or measles or MRSA in the Pennsylvania hospital where she works in environmental services, she knows what to do. She knows how to disinfect surfaces, what needs to be thrown away and what she should wear to protect herself. But when she’s asked to clean rooms occupied by COVID-19 patients, she’s flying blind.

“It’s kind of terrifying,” says Vanessa, who TIME is identifying by first name only for professional protection. Her supervisors told her to clean the rooms just as she would for a flu patient, but she says she’s treating them like she would for more serious illnesses—throwing out nearly everything disposable, mopping the walls and scrubbing every inch—to be safe. “No one knows exactly how to clean it. We don’t know how contagious this is.”

At a time when cleaning supplies are invaluable and hand-washing is a national activity, people who clean professionally, like Vanessa, have watched their jobs take on new meaning—and considerable new risks. But what has remained the same, they say, is a lack of respect and, often, inadequate compensation.

Vanessa, for example, makes only about $11 an hour for the unenviable job of disinfecting hospital rooms, often without proper protective gear for herself. The fresh N-95 masks still available in her hospital, she says, are mostly going to doctors and nurses; she and her housekeeping colleagues often have to reuse the ones they have. She says she might have stopped showing up at work if she didn’t need the money, especially since she has underlying health conditions that put her at extra risk of getting COVID-19.

“Because I’m working there,” Vanessa says, “I’m too afraid to go see my family right now.” She lives with her best friend, and is staying away from her parents’ home for now.

Workers across industries are struggling to get the protective equipment they need. Omar, who drives a garbage truck in California, says his company has not even provided hand sanitizer for its workers, even though “we’re dealing with everybody’s trash [and] we don’t know what’s in there.”

When Omar and his coworkers asked for sanitizer, they were given all-purpose cleaner and told to use it on their hands, he says. To stay safe, he’s resorted to asking friends who work in retail to help him find his own sanitizing supplies.

“[Management is] super cheap. In restaurants, do waitresses carry their own [supplies] to clean the tables?” he says, adding that he’s not getting hazard pay. Under his union contract, he makes about $26 per hour.

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K.T., a janitor for a San Francisco office building who asked to be identified by initials only, says her fears have shifted from medical to financial as the outbreak wears on.

“When we [first] heard about coronavirus, we felt like it was something scary,” she says. “We work in a building with a lot of people. We always felt like it was easy for us to get it.” The extra cleaning protocols she was asked to take on—more disinfecting and wiping down high-touch surfaces—didn’t help put her at ease.

But now that the office building in which K.T. works sits empty, she says she’s worried about layoffs or reduced schedules. She has a second job as a plumber and electrician, but she depends on the $21.80 an hour she makes under her 40-hour-per-week union janitorial contract.

Labina Shrestha, the operations manager for environmental services at Boston’s Brigham and Women’s Hospital, is straddling the roles of frontline worker and administrator during COVID-19. She suits up to hold extra cleaning training sessions for her staff, and posts the hospital’s near-daily policy updates in the environmental services lockerroom; she also works with hospital leadership to ensure her team has adequate protective equipment, and that no one feels overworked or unsafe. Communicating openly, she says, helps remind her team why they come in every day.

“We are the first defense when it comes to infection prevention,” she says. “We save lives.”

True as that may be, neither Vanessa nor K.T. believe COVID-19 will change the way the public perceives their work, despite the vital importance it has taken on during the pandemic.

“There are people who really do appreciate [us] and know the janitors are in a big risk,” K.T. says. “But there are a lot of people who…don’t even look at the bottom, and they see us at the bottom.”

The risks cleaning professionals assume might be easier to stomach, Vanessa says, if they were recognized publicly.

“Us housekeepers, we have families, we have health issues, we have people and animals we go home to that we could be giving this to,” Vanessa says. “The doctors and nurses have that too, but they get recognized. No one ever mentions the people who clean it up after they’re gone.”

Please send tips, leads, and stories from the frontlines to virus@time.com.

New story in Health from Time: Chris Cuomo Confirms He Has Coronavirus as Brother Andrew Calls CNN Anchor His ‘Best Friend’



Chris Cuomo has been diagnosed with COVID-19.

The CNN anchor and brother of New York Gov. Andrew Cuomo announced Tuesday that he was found to be positive for the coronavirus, which has affected more than 160,000 people in the U.S. and killed more than 3,000 nationwide.

“I have been exposed to people in recent days who have subsequently tested positive and I had fever, chills and shortness of breath,” Cuomo wrote in a note posted to Twitter. “I just hope I didn’t give it to the kids and Cristina [his wife].”

Cuomo said he is currently quarantined in his basement and plans to continue broadcasting his CNN program, “Cuomo Prime Time,” from there.

Andrew Cuomo, who has received nationwide attention for his response to the outbreak, also shared his brother’s diagnosis during a news conference on Tuesday. Andrew Cuomo has appeared on his brother’s show several times in recent weeks, and gained attention for their good-natured ribbing.

“He is going to be fine. He is young, in good shape, strong—not as strong as he thinks—but he will be fine,” the New York governor said, adding, “He’s a really sweet, beautiful guy. He’s my best friend.”

New story in Health from Time: Your Doctor’s Appointments Have Been Canceled. Are At-Home Tests a Good Solution?



As the COVID-19 outbreak worsens in the U.S., at-home test kits for the virus have been a source of both hope and controversy.

Their appeal is clear: sick individuals could get a diagnosis from the comfort of home, without infecting others. But their downsides are real: the U.S. Food and Drug Administration (FDA) has cracked down on unauthorized at-home COVID-19 tests, updating its emergency use authorization guidelines to exclude at-home test kits and warning Americans that no such tests have received agency authorization.

That means startups previously offering these products—such as Everlywell, Nurx and Carbon Health—must now stop. All three confirmed to TIME that they are not currently offering at-home COVID-19 testing, though all stand by the need for it.

If they can convince the FDA, these kits could help shape public perception of at-home medical testing for years to come. COVID-19 has already proven its ability to alter the way American physicians practice, and the way the U.S. government regulates health care. With millions of Americans confined to their homes and unable to see doctors face-to-face, virtual telehealth platforms are surging after years of slow uptake. In response to the COVID-19 emergency, the Centers for Medicare and Medicaid Services has greatly expanded Medicare’s ability to cover these appointments.

Telehealth’s long-overdue renaissance could usher in more widespread comfort with the idea of at-home medical care. Americans have been conditioned to associate care with a doctor’s office, but telemedicine use during the COVID-19 outbreak has begun to chip away at that. As more and more people grow comfortable with getting care on their couches, at-home diagnostics may be next in line for a revolution.

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The at-home testing market now

At-home testing is already established practice for patients with some chronic diseases. Most people with diabetes, for example, are accustomed to self-testing their blood sugar levels.

Direct-to-consumer (DTC) testing has also become big business for companies offering services to those without chronic conditions. Millions of Americans have used 23andMe’s FDA-approved spit tests to get insights about their genetic predispositions to conditions ranging from breast cancer to food sensitivities.

There has also been a proliferation of DTC tests that promise to detect everything from irregular heartbeats and high cholesterol to sexually transmitted diseases and urinary tract infections. These products usually require people to collect their own urine, blood, spit or swab sample, and then mail them to a lab, where they’re processed by a clinician who sends back results or uploads them onto an app. Typically, if results indicate a medical issue, the companies providing these services will then connect customers with a physician to figure out next steps.

Startup Everlywell is a major player in this space, as is the company LetsGetChecked. “Many issues that are coming to the forefront now”—namely getting all Americans access to the tests they need—”are issues we’ve been working to solve for a long time,” says Everlywell CEO Julia Cheek.

But these and others are not without their skeptics.

The pros and cons of at-home tests

The benefits of at-home testing are obvious. It’s convenient, confidential and potentially improves health care for people in areas where access is limited. The COVID-19 outbreak has emphasized those benefits more than ever. Offering accurate, scientifically validated tests at home could ease dangerous burdens on the health care system, including testing shortages. It could also prevent some routine medical care from grinding to a halt, as more and more resources are diverted toward COVID-19 response.

But doctors have their doubts. “A test is only as good as the specimen,” says Dr. Gary LeRoy, president of the American Academy of Family Physicians. But most people are not experienced at collecting test samples, and so are likely to get it wrong, LeRoy says.

“With a poor sample, you’re more likely to get a false positive or a false negative,” LeRoy says, which could be dangerous if it prevents someone who actually needs medical care from seeing a doctor. LeRoy always recommends patients discuss their plans for at-home testing with a physician.

It can also be hard to tell which tests are legitimate, says Dr. Patrice Harris, president of the American Medical Association. Laboratory-developed tests—a designation for diagnostics developed and used by a single laboratory—can often be sold in the U.S. without going through the FDA premarket review process, as long as they come from laboratories that meet certain compliance criteria. Everlywell, LetsGetChecked, Carbon Health and Nurx are not listed in the FDA’s database of agency-approved at-home tests.

The FDA cautions that laboratory-developed tests, despite having gotten increasingly sophisticated and accessible over time, may overpromise and under-deliver, potentially giving customers incorrect results. One infamous example is the disgraced blood-testing company Theranos, which (although not an at-home test) benefited from the “lab-developed test” loophole before being exposed as a scam.

Finally, on paper, at-home tests may seem cheap, but many are not covered by insurance, and so end up costing people more out-of-pocket than traditional lab tests. But a representative for Nurx counters that at-home tests can save patients time and money, by not requiring them to take off work to travel to a doctor’s office.

Will COVID-19 change the way we think about at-home testing?

Clearly, companies have some hurdles to clear before they prove their tests are accurate and trustworthy. But the demand for them is growing, which may push the FDA to adjust the way it examines DTC tests. The market was expected to be worth $350 million this year, and about half of U.S. consumers feel comfortable with this sort of testing, according to 2018 Deloitte research.

Those numbers may trend upward, as COVID-19 drives cultural acceptance of at-home medical care. Peter Foley, CEO of LetsGetChecked, says his company is already seeing a “distinct uptick in demand for services across the board.”

Shortages of testing equipment and protective gear during the COVID-19 outbreak have made home-based diagnostics more appealing, says Dr. Nisha Basu from the primary care startup Firefly Health, because they could help take some pressure off the country’s hospital system at a time when it’s desperately needed. Both patients who may have COVID-19, and those who need routine testing done during the outbreak, could benefit from at-home care. Social distancing required by the outbreak has also made people reconsider which aspects of health care truly require traveling to an office, lab, or care center, and which can just be handled from home, via a call or video visit.

“It’s going to be a different world that we emerge into as a society,” LeRoy says. “A lot of things we’ve slow-walked because we didn’t see the need for it, such as telemedicine, [will become important].”

Harris agrees that scientifically sound DTC tests can be “a piece of the puzzle,” though there will always be aspects of care that require in-person appointments. It’s hard to know, Harris says, how common they’ll become once the coronavirus outbreak ends, but she says all signs suggest remote health care innovations will continue.

“There may be a time,” she says, “when [every] person has a stethoscope at home.”

Please send any tips, leads, and stories to virus@time.com.

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