Mexico now has the third most COVID-19 deaths in the world, behind Brazil and the United States, where a hurricane bearing down on the East Coast on Saturday is threatening to complicate efforts to contain the virus.Hurricane Isaias’ imminent arrival forced the closure of some outdoor testing sites even though Florida has become a major hot spot, and other states in the path of the storm prepared emergency shelters that comply with social-distancing measures.”We had to put safety first,” Miami-Dade County Mayor Carlos Gimenez said Friday.But Florida Gov. Ron DeSantis said no immediate evacuation orders have been given and that hospitals in general are not being evacuated of coronavirus or other patients.Meanwhile, Mexican health officials on Friday reported 688 new deaths, pushing the country’s confirmed total to over 46,600. That put Mexico just ahead of the United Kingdom, which has more than 46,100, according to the tally by Johns Hopkins University.Where Has the New Coronavirus Spread?New virus, denoted 2019-nCoV by the WHO, has caused alarm because of its similarity to SARS in 2002-2003Some countries are seeing hopeful signs: China reported a more than 50% drop in newly confirmed cases in a possible indication that its latest major outbreak in the northwestern region of Xinjiang may have run its course.However, in Hong Kong and elsewhere, infections continue to surge. Hong Kong reported more than 100 new cases as of Saturday among the population of 7.5 million. Officials have reimposed dining restrictions and mask requirements.Tokyo on Saturday saw its third day straight of record case numbers, the metropolitan government said. Nationwide, Japan’s daily count of cases totaled a record 1,579 people Friday, the health ministry said.And Vietnam, a former success story, is struggling to control an outbreak spreading in its most famous beach resort. A third person died there of coronavirus complications, officials said Saturday, a day after it recorded its first-ever death as it wrestles with a renewed outbreak after 99 days with no local cases.All three died in a hospital in Da Nang, a hot spot with more than 100 cases in the past week. Thousands of visitors had been in the city for summer vacation and are now being tested in Hanoi and elsewhere.Twelve additional cases were confirmed on Saturday, all linked to Da Nang Hospital. Officials tightened security and set up more checkpoints to prevent people from leaving or entering the city, which has been in lockdown since Tuesday.A makeshift hospital was set up, and doctors have been mobilized from other cities to help.”I want to be tested, so I can stop worrying if I have the virus or not,” said Pham Thuy Hoa, a banking official who returned to the capital from Da Nang.In South Korea, prosecutors arrested the elderly leader of a secretive religious sect linked to more than 5,200 of the country’s approximately 14,300 confirmed cases. He has denied charges of hiding members and underreporting gatherings to avoid broader quarantines.The global pandemic has affected nearly every aspect of this year’s Muslim pilgrimage to Mecca, with as few as 1,000 pilgrims already residing in Saudi Arabia taking part, down from 2.5 million last year.Poverty brought on by the pandemic is also making it harder for many to join in the four-day Eid al-Adha, or “Feast of Sacrifice,” in which Muslims slaughter livestock and distribute the meat to the poor.”I could hardly buy food for my family,” Somali civil servant Abdishakur Dahir said. “We are just surviving for now. Life is getting tougher by the day.”The Saudi Health Ministry said there have been no cases of COVID-19 among this year’s pilgrims. All were tested, their movements monitored with electronic wristbands and required to be quarantined before and after.Meanwhile, India recorded its steepest spike of 57,118 new cases in the past 24 hours, taking its coronavirus caseload close to 1.7 million, with July alone accounting for nearly 1.1 million infections.The country’s Civil Aviation Ministry delayed resumption of international flights by another month until Aug. 31. But it will continue to allow several international carriers from the United States, Europe and the Middle East to operate special flights to evacuate stranded nationals.In France, travelers entering from 16 countries where the virus is circulating widely now must undergo virus tests upon arrival at airports and ports. The country is not permitting general travel to and from the countries, which include the United States and Brazil. The testing requirement therefore only applies to people entering under limited circumstances, including French citizens who live in these countries. Those who test positive as of Saturday must quarantine for 14 days.As autumn approaches, nations around the world are grappling with how to safely reopen schools.A scientist advising the British government on the coronavirus pandemic says pubs in England may have to be closed to allow schools to reopen in September. Graham Medley, a member of the government’s Scientific Advisory Group for Emergencies, told the BBC that there may have to be a “trade off.”In Utah, the Salt Lake City School District Board of Education announced that its schools will start the year with all online-only classes in response to an increasing number of confirmed cases in the city. Just days after public schools around Indiana reopened their doors, at least one student and one school staff member in districts around Indianapolis have tested positive for the virus.The debate over school openings came as Dr. Anthony Fauci dismissed a tweet by President Donald Trump claiming the U.S. global lead in coronavirus cases is because of increased testing.Fauci ‘Cautiously Optimistic’ About Coronavirus VaccineTop US infectious-disease expert tells lawmakers vaccine could be available in coming monthsFauci said the scale of the U.S. outbreak is the result of multiple factors, including some states opening up too quickly and disregarding federal guidelines.On Friday, the head of the World Health Organization predicted the effects of the pandemic will be felt for “decades to come.””Most of the world’s people remain susceptible to this virus, even in areas that have experienced severe outbreaks,” Tedros Adhanom Ghebreyesus said in London. “Although vaccine development is happening at record speed, we must learn to live with this virus.”
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A pair of NASA astronauts face the final and most important part of their SpaceX test flight: returning to Earth with a rare splashdown.Doug Hurley and Bob Behnken took part in a farewell ceremony Saturday at the International Space Station, several hours ahead of their planned departure on a SpaceX Dragon capsule.  Despite approaching Hurricane Isaias, NASA said the weather looks favorable for a Sunday afternoon splashdown in the Gulf of Mexico near Panama City, Florida. It will be the first splashdown for astronauts in 45 years. The last time was following the joint U.S.-Soviet mission in 1975 known as Apollo-Soyuz.The astronauts’ homecoming will cap a two-month mission that ended a prolonged launch drought in the U.S., which has relied on Russian rockets to ferry astronauts to the space station since the end of the shuttle era.  In launching Hurley and Behnken from NASA’s Kennedy Space Center on May 30, SpaceX became the first private company to send people into orbit. Now SpaceX is on the verge of becoming the first company to bring people back from orbit.  “The hardest part was getting us launched, but the most important is bringing us home,” Behnken said.  A successful splashdown, Behnken said, will bring U.S.-crew launching capability “full circle.”This photo provided by NASA shows, from left, front, astronauts Bob Behnken and Doug Hurley on the International Space Station, Aug. 1, 2020. Behnken and Hurley are scheduled to leave the station in a SpaceX capsule Saturday and splashdown Sunday.Space station commander Chris Cassidy, who will remain on board with two Russians until October, presented Hurley with the small U.S. flag left behind by the previous astronauts to launch to the space station from U.S. soil, in July 2011. Hurley was the pilot of that final shuttle mission.The flag — which also flew on the first shuttle flight in 1981 — became a prize for the company that launched astronauts first.  Elon Musk’s SpaceX easily beat Boeing, which isn’t expected to launch its first crew until next year and will land in the U.S. Southwest. The flag has one more flight after this one: to the moon on NASA’s Artemis program in the next few years.”We’re a little sad to see them go,” Cassidy said, “but very excited for what it means to our international space program to add this capability” of commercial crew capsules. The next SpaceX crew flight is targeted for the end of September.Hurley and Behnken also are bringing back a sparkly blue and purple dinosaur named Tremor. Their young sons chose the toy to accompany their fathers on the historic mission.
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There are more than 17.6 million worldwide COVID-19 cases, according to Johns Hopkins statistics.  The U.S. continues to lead in the number of infections with more than 4.5 million, followed by Brazil with 2.6 million cases, and India with almost 1.7 million.Mexico has replaced Britain as the country with the third largest number of deaths from COVID-19. Johns Hopkins says Mexico now has reported 46,688 deaths.The U.S. leads the world in the number of deaths from the virus with more than 153,000, followed by Brazil with more than 92,000.Where Has the New Coronavirus Spread?New virus, denoted 2019-nCoV by the WHO, has caused alarm because of its similarity to SARS in 2002-2003Russia is gearing up to launch a mass vaccination campaign against the coronavirus in September or October.  News media reports quote sources as saying the vaccine was developed at a state research facility.   Scientific data about the vaccine or test results have not been released.In South Korea, the leader of a secretive religious sect linked to more than 5,200 of the country’s more than 14,000 COVID cases has been arrested. Lee Man-hee has denied allegations that he hid members and underreported the sect’s activities in an effort to avoided quarantines.The coronavirus has burned through a summer sleep-away camp in the U.S. state of Georgia, perhaps providing a cautionary tale for school districts currently weighing the pros and con of reopening in the COVID era.  The Centers for Disease Control and Prevention reported in a study that the camp observed the suggestions the agency provided but did not require the children to wear masks.  Only the staff members were required to wear masks.   A teenage staffer fell ill shortly after the camp opened.
A COVID diagnosis was confirmed the next day and the camp began sending the children home that day.  The CDC had tests results for only 344 of the 597 campers and 76% of them were positive.  The infection rate could have been higher since the CDC did not have results for everyone.The nation’s top infectious disease expert, Dr. Anthony Fauci, told lawmakers Friday on Capitol Hill he is “cautiously optimistic” a coronavirus vaccine would be available in the coming months, as infectious continue to rise at an alarming rate in the U.S.”We hope at the time we get into the late fall and early winter, we will have in fact a vaccine that we can say will be safe and effective,” Fauci said before the House Select Subcommittee on the Coronavirus Crisis. “One can never guarantee the safety and effectiveness unless you do the trial, but we are cautiously optimistic.”Fauci ‘Cautiously Optimistic’ About Coronavirus VaccineTop US infectious-disease expert tells lawmakers vaccine could be available in coming monthsFauci said a Phase 3 trial, the last phase of the vaccine approval process, recently got underway.Fauci also cautioned against importing vaccines made in Russia or China due to concerns over safety.At the hearing’s open, panel chairman Democrat James Clyburn and the subcommittee’s ranking Republican, Steve Scalise, clashed over whether the Trump administration has a national strategy to contain the coronavirus crisis.”The administration’s approach to deferring to states, sidelining experts and rushing to reopen has prolonged this virus and led to thousands of preventable deaths,” Clyburn said. “In fact, the United States response stands out as among the worst of any country in the world.”Scalise dismissed Clyburn’s assessment, arguing with a stack of documents in hand that the administration has, indeed, issued guidance to the country about how to contain the pandemic.”These are just a few of the documents that your agencies have published to show states how to safely reopen, to show schools how to safely reopen, to show nursing homes how to care for their patients,” Scalise said to Fauci and the other government experts at the hearing.”If all governors would have followed those guidelines, thousands more seniors in nursing homes would be alive today, if just five governors would have followed your plan that was developed President Trump,” Scalise added.Robert Redfield, director of the Centers for Disease Control and Prevention (CDC) also testified Friday, saying it was in the “public health best interest” for K-12 schools to reopen.He also discussed a decision by the Trump administration to direct all hospitals to send all coronavirus data to a database in Washington and thus passing the CDC. Redfield said he did not know of the decision until after it was made.US Health Experts: COVID-19 Vaccine Could be Ready by 2021US has topped 150,000 deaths from COVID-19In Britain, Prime Minister Boris Johnson said Friday he was delaying plans to ease lockdown measures by at least two weeks after the country reported its highest number of new COVID cases since late June.British Minister for Health and Social Care Matt Hancock said a second wave of the virus is rolling across Europe and that Britain must defend against it.British authorities added Luxembourg to the country’s quarantine list, meaning travelers from there must isolate for 14 days after entering Britain. Spain, which had been dropped from the list, has been reinstated and other countries may be added.Botswana’s capital, Gaborone, reimposed a two-week lockdown on Thursday after a surge in new confirmed COVID-19 cases. The increase came as the WHO warned against easing coronavirus restrictions throughout Africa. The WHO says the number of infections on the continent has doubled in the past month.”We are concerned that … we will see an increase in cases as we have seen in [other] countries” where restrictions have been eased too soon,” WHO Regional Director for Africa Matshidiso Moeti said.She said more than 20 African countries have recorded more new cases than in the previous weeks, with South Africa accounting for the most but increases also reported in Kenya, Madagascar, Nigeria, Zambia and Zimbabwe.Moeti said Uganda, Seychelles and Mauritius are doing well in controlling the virus.
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Amid the chaos of the pandemic’s early days, doctors who faced the first coronavirus onslaught reached across oceans and language barriers in an unprecedented effort to advise colleagues trying to save lives in the dark.With no playbook to follow and no time to wait for research, YouTube videos describing autopsy findings and X-rays swapped on Twitter and WhatsApp spontaneously filled the gap.When Stephen Donelson arrived at the University of Texas Southwestern Medical Center in mid-March, Dr. Kristina Goff was among those who turned to what she called “the stories out of other places that were hit before.”Donelson’s family hadn’t left the house in two weeks after COVID-19 started spreading in Texas, hoping to shield the organ transplant recipient. Yet one night, his wife found him barely breathing, his skin turning blue, and called 911.In New York or Italy, where hospitals were overflowing, Goff thinks Donelson wouldn’t even have qualified for a then-precious ventilator. But in Dallas, “we pretty much threw everything we could at him,” she said.Like doctors everywhere, Goff was at the beginning of a huge and daunting learning curve.”It’s a tsunami. Something that if you don’t experience it directly, you can’t understand,” Italian Dr. Pier Giorgio Villani said in a series of webinars on six straight Tuesday evenings to alert other intensive care units what to expect. They started just two weeks after Italy’s first hospitalized patient arrived in his ICU, and 10 days before Donelson fell ill in Texas.Villani, who works in the northern city of Lodi, described a battle to accommodate the constant flow of people needing breathing tubes. “We had 10, 12, 15 patients to intubate and an ICU with seven patients already intubated,” he said.The video sessions, organized by an Italian association of ICUs, GiViTI, and the non-profit Mario Negri Institute and later posted on YouTube, constitute an oral history of Italy’s outbreak as it unfolded, narrated by the first doctors in Europe to fight the coronavirus.
Italian friends spread the word to doctors abroad and translations began for colleagues in Spain, France, Russia and the U.S., all bracing their own ICUs for a flood of patients.
They offered “a privileged window into the future,” said Dr. Diego Casali of Cedars-Sinai Medical Center in Los Angeles, who is from northern Italy and was directed to the webinars when he sought advice from a front-line friend about how to prepare.Dr. Jane Muret of the French Society of Anesthesia-Resuscitation also heard by word-of-mouth and, impressed by the breathing-tube lessons, posted a translation when France had only a handful of diagnosed COVID-19 cases.”Now we can recognize our COVID patients” when they start showing up, she said.
Every tidbit about the newest baffling symptom, every trick to try, served as clues as the virus bore down on the next city, the next country. By the time Donelson arrived, Goff’s hospital was adjusting ventilator care based on that early advice.But while grateful for the global swirl of information, Goff also struggled to make sense of conflicting experiences.”You have no idea how to interpret what went right or what went wrong,” she said, “or was it just the native course of the disease?”Even now, months into a pandemic first wave that’s more like constantly shifting tides, Goff is humbled at how difficult it remains to predict who will live and who will die. She can’t explain why Donelson, finally home after a 90-day ordeal, was ultimately one of the lucky ones.COVID-19 patient Stephen Donelson is applauded by family and health care professionals as he departs the Zale Hospital on the UT Southwestern Campus in Dallas, June 19, 2020.Doctors in Italy were confused: Reports from China were suggesting a death rate of about 3% among those infected. But for the first 18 days, only the dead left the ICU at Bergamo’s large Pope John XXIII Hospital.While the toll eventually dropped, 30% of the hospital’s initial 510 COVID-19 patients died.After decades in practice, ICU chief Dr. Luca Lorini thought he knew how to treat the dangerous kind of respiratory failure — called ARDS, or acute respiratory distress syndrome — first thought to be the main threat.”Every night, I would go home, and I had the doubt that I had gotten something wrong,” Lorini said. “Try to imagine: I am all alone and I can’t compare it with France because the virus wasn’t there, or Spain or the U.K. or America, or with anyone who is closer to me than China.”Only later would it become clear that for patients sick enough to need the ICU, death rates were indeed staggeringly high.By February, China had filed only a limited number of medical journal reports on how patients were faring. Lorini’s hospital tried to fill the data gap by dividing patients into small groups to receive different forms of supportive care and comparing them every three or four days — not a scientific study, but some real-time information to share.
The first lessons: The coronavirus wasn’t causing typical ARDS, and patients consequently needed gentler ventilation than normal. They also needed to stay on those ventilators far longer than usual.”We made big errors,” Villani said, weaning patients off machines too soon.
Then mid-March brought another startling surprise: In a training video for U.S. cardiologists, Chinese doctors warned that the virus causes dangerous blood clots, and not just in the lungs.Dr. Bin Cao of the China-Japan Friendship Hospital in Beijing explained that as the virus sneaks past the lungs into the bloodstream, it damages the lining of blood vessels, forming clots in the heart, kidneys, “all over the body.” He urged American doctors to use blood thinners protectively in the severely ill.In Italy’s epicenter, doctors were making the same discovery. Lorini described a scramble to get the word out via Skype and email. “This is a vascular sickness more than a pulmonary one and we didn’t know that,” he said.In the U.S., the finding about blood thinners made biological sense to Dr. Tiffany Osborn, a critical care physician at Washington University School of Medicine in St. Louis.”It means at least you’re not shooting in the dark. You’re trying something that from a physiologic standpoint makes sense,” said Osborn, who was living in a camper in her driveway to avoid bringing the virus home to her family after her long ICU shifts.By April, many doctors were bowing to pressure to try a malaria drug named hydroxychloroquine that obsessed President Donald Trump. Osborn never understood why such a drug would work and, sure enough, it eventually failed when put to a real test.But what else might be effective?”We’re learning as we go,” Osborn said. “You could talk to me in two weeks and I might be telling you something that’s really different.”FILE – In this March 12, 2020 photo, medical staff work at one of the emergency structures that were set up to ease procedures at the Brescia hospital, northern Italy.When Stephen Donelson arrived in the emergency room, “we had very little hope for him,” Goff said.The Midlothian man had undergone an organ transplant two years earlier, and the immune-suppressing drugs that prevent rejection of his new lungs and liver meant his body couldn’t fight the coronavirus. Goff’s first challenge: how to scale back those medicines just enough for Donelson to battle the virus without endangering his transplant.Her second: He was fighting against the ventilator’s artificial breaths. So Goff deeply sedated Donelson, paralyzing his muscles to let the machine do all the work.Hospital after hospital struggled with balancing how to get enough air into oxygen-starved coronavirus patients without further damaging fragile lungs.Ventilation is like “blowing air into a sponge and all the little holes are opening up. Walls between the holes can be very thin. If you’re putting in a lot of air, it can damage the lining of those little holes,” explained Osborn, the St. Louis critical care specialist.A trick the doctors shared with each other: Flip patients over from their backs to their stomachs — a procedure called proning that takes pressure off the lungs, which lie closer to the back. It also helps lower fluid accumulation in the lungs.It’s not a one-time fix. Donelson stayed on his belly about 16 hours a day early on, as his doctors watched his oxygen levels improve. It’s also hot and heavy work: Every turn took five or six health workers, in full safety garb, working in slow synchrony to avoid dislodging his breathing tube.Italy’s Alessandro Manzoni Hospital set a schedule: Start turning patients onto their bellies at 2 p.m. — it took more than three hours to work through them all — and then put them on their backs again at 8 a.m., when fresh nurses arrived.Hospitals that specialize in treating ARDS knew how to prone before COVID-19 hit. For many others, it was a brand-new skill their workers had to learn. Fast.”We’ve never had to prone anyone here before the pandemic, but now it’s like second nature,” Kevin Cole, a respiratory therapist at Fort Washington Medical Center in Maryland, said four months into the U.S. outbreak.And some hospitals now are asking patients not yet on ventilators to simply roll over periodically, in hopes it might prevent them from needing more invasive care.”What have we got to lose? That’s something that’s not going to hurt anybody,” Osborn said.Molly Gough, a speech therapist at the Zale Hospital on the UT Southwestern Campus speaks with patient Stephen Donelson as he departs the hospital in Dallas, June 19, 2020.Even in normal times, critical-care specialists know they can’t save all their patients. But they’re used to more hand-holding. With this virus, even garbed in spacesuit-like protective gear, health workers must minimize time with infectious patients to avoid getting sick themselves. And family members are largely barred, too.”My general way of doing things is, no one dies alone,” said Osborn, who holds her phone in front of dying patients so loved ones can say goodbye.She paused to compose herself, and added: “If this is going to happen, and you can provide some comfort that maybe they wouldn’t have gotten if you weren’t there, that’s important.”The newest lesson: Recovery takes a lot longer than surviving.Back in Dallas, Donelson spent 17 days on a ventilator. When it was removed, he was too weak to even sit without support and the breathing tube had taken away his ability to swallow.”He would try to pick his head up off the pillow and it would lob to the side just like a newborn baby,” said his wife, Terri Donelson, who for the first time since his hospital admission finally was allowed to connect with her husband through a videoconferencing app.For days after waking up, Donelson had tremendous delirium, a dangerous state of mental confusion and agitation. He didn’t know where he was or why, and would try to pull out his IV tubes. Then a bacterial infection hit his lungs.Then one morning, worried that Donelson suddenly was too quiet, his doctor donned what she calls her “full-helmet, Darth Vader-style mask, which cannot possibly help anyone’s delirium,” and went in to check on him.”I rubbed his arm,” Goff recalled, asking him to wake up. “I said, ‘Hey are you OK, are you with me?'” and Donelson started trying to talk, at first too raspy to understand.Eventually, she made out that he was wishing her a happy Easter. She can only guess he heard the date on TV.Doctor and patient cried together.That was Donelson’s turning point. He still wasn’t deemed virus-free but physical therapists cautiously spent a little more time helping him gain strength and learn to swallow. His first bite: chocolate pudding.Terri Donelson countered the long periods of isolation by keeping the video app running non-stop, talking to her husband and giving him quizzes to stimulate his memory.”Little by little, with each day, he gains something new, something else reawakens,” she said.Finally, on June 19, 90 days after the frantic ambulance ride, Donelson — still weak but recovering — went home. His doctor is humbled by his survival, and anxiously awaiting better science to help guide care as the pandemic continues.”If you have one patient who leaves a really strong impression on you, you may interpret that patient’s experience to be hallmark. Until we have large, population-based studies of actual outcomes, it’s really hard to know what’s real and what’s not real,” Goff said.
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