Global coronavirus battle rages on amid 'glimmers of hope'

Scientists say drastic shifts in behaviour appear to be having an effect in the pandemic, though they say the death toll will continue to mount and caution against drawing any sweeping conclusions.

The world began this week to see small but encouraging signs that concerted efforts to drastically change human behaviour — to suspend daily routines by staying at home — are slowing the insidious spread of the novel coronavirus, which has killed tens of thousands and sickened more than 1 million others across several continents.

But — a simple word that epidemiologists say cannot be emphasised enough — these early indications, while promising, must not be interpreted to mean that all will be well by summer's first days. Although President Donald Trump tweeted Monday about a light at the end of a tunnel, the cautions of scientists and other government officials conjure one very, very long tunnel.

In the Chinese city of Wuhan, where the coronavirus publicly emerged in December, the end to a monthslong lockdown has residents taking baby steps toward some version of normality. In Italy, where the next viral wave has killed more than 17,000, a delayed but committed resolve to stay inside has greatly decreased the rate of contagion.

And in the United States, the death toll, now growing by well more than 1,000 a day, has continued to mount, with the past few days the country's deadliest so far in this pandemic. Yet Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Wednesday on Fox News that he was starting to see "some glimmers of hope," so much so that he expected that previous projections of 100,000 to 200,000 virus-related deaths would be lowered.

Even in New York City, now the ghastly epicentre where hundreds continue to die every day, officials cite a slowdown in hospitalisations as evidence that social distancing and other modifications — not least the shutdown of the city's vibrancy and economy — are working.

"We are flattening the curve," Governor Andrew Cuomo of New York said Wednesday, a day when the state reported more than 700 deaths. "Thank God. Thank God. Thank God."

Without doubt, frightening developments continue to emerge in many places across the United States, and scientists and political leaders warn that the picture is shifting by the day. Amid cause for tempered optimism were new flashes of misery.

In Wayne County, Michigan, which includes Detroit, 192 deaths have been announced this week. In Mahoning County, Ohio, which includes Youngstown, the death toll grew Wednesday, to 28 from 19. In Illinois, state officials reported 82 additional deaths, many in the Chicago area. And near St. Louis, where cases and deaths have been increasing rapidly, the Missouri National Guard was converting a hotel into a treatment site ready to accept patients next week.

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Still, experts said, there were tentative signals of reassurance. The reason is fairly elemental, according to Ashish Jha, the director of the Harvard Global Health Institute: "On a very simple level, you can't give the virus to someone else if you're not physically near them."

Stay-at-home orders nearly halted travel for most Americans by late March, an analysis of anonymous cellphone location data by The New York Times found. Americans in much of the Northeast, Midwest and West complied with orders from state and local officials to stay home, the data suggests, but delays in enacting such orders in other areas, including parts of the Southeast, potentially dampened the impact of social distancing measures.

"It's just math," Natalie Dean, an assistant professor of biostatistics at the University of Florida, said. "If people dramatically reduce the number of people they're interacting with, that will reduce the spread of the disease."

"These types of strategies have worked," she added.

Pike Place Market in Seattle in March. It could be months before Americans can return to their pre-pandemic lifestyles of unrestricted movement. Photo / Grant Hindsley, The New York Times

But the many variables at play — beginning with the unpredictable nature of the virus — demand that the efficacy of these strategies be placed in context.

In the United States, there are the decisions by some states not to impose stay-at-home orders; the fears that warmer weather will lure people into socialising; and, especially, the low and inconsistent availability of testing, a fundamental tool in tracking the disease and preventing spread.

"What we've seen in the short term is that very stringent measures, that have a lot of societal impact, have been effective at reducing the rate of growth," said Joseph Lewnard, an assistant professor of epidemiology at the University of California, Berkeley.

"Unfortunately, the flattening of the curve we see now does not necessarily paint a rosy picture about reopening society as it was before the epidemic," he said.

Without a vaccine, any progress is fragile, temporary. The social distancing measures cannot continue forever. And if they are relaxed without meticulous testing and the isolation of new patients, researchers say, the numbers of infections and fatalities are likely to soar again.

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Lewnard and Jha said months could pass before Americans would be able to return to their pre-pandemic lifestyles of unrestricted movement. Even then, they said, such a return would best take place in stages, with the government remaining vigilant for signs of outbreak.

"I can imagine May into June, we might see things opening up by 25 to 50 per cent," Jha said. "We might be up to 70 to 80 per cent by the summer but no large gatherings, no baseball games, no super-crowded beaches.

"We'll have to experiment."

What Jha envisions for the United States in a couple of months is where the city of Wuhan essentially is now — mostly because of the draconian measures taken by China's authoritarian government, including the requirement that people with even mild symptoms be remanded to mass quarantine sites.

In Italy, where the next viral wave has killed more than 17,000, a delayed but committed resolve to stay inside has decreased the rate of contagion. Photo / Alessandro Grassani, The New York Times

In December, doctors in Wuhan's hospitals sounded the alarm about a mysterious pneumonia like illness, only to be reprimanded for spreading rumours. The Chinese government eventually took action but only after significant delays in addressing the virus and informing the public about the possibility of human-to-human transmission.

Wuhan, a city of 11 million, was locked down, as was the surrounding Hubei province, with nearly 60 million residents. About the only hives of human activity were the overwhelmed hospitals, where there were too few test kits for too many patients, who in turn were infecting others, including health care workers.

Across the country, the enactment of Mao-era social controls limited the movement of citizens and slowed the economy to a near standstill. The most severe measures, though, were applied to Wuhan, where the sick and potentially exposed were separated from their families and sent to mass quarantine centers and isolation sites.

"The most important thing was not the lockdown," said Xihong Lin, a professor of biostatistics at Harvard University who recently took part in a paper examining the government's epidemic response in Wuhan. "The most important thing was to take the source of infections out of the network so that family members could be protected."

As of Wednesday, the coronavirus had officially sickened 81,865 and killed 3,335 in China, although the country has been accused by US intelligence officials of vastly underreporting its epidemic statistics. In addition, the government's extreme measures were by no means flawless; mismanagement cost lives, and the impact on the economy and mental health has yet to be determined.

Still, experts agree that China's swift if ruthless actions stemmed the invisible tide. "Each country can use Wuhan's experience and adapt it to its own situation and culture," Lin said.

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On Wednesday, as an unfettered Wuhan stepped hesitantly into its altered future, a commentary published by Xinhua, the state-run news agency, celebrated the city's determination and hard work through the epidemic — but noted that "cautious unblocking is far from a final victory over the health threat."

From Wuhan, the coronavirus moved in greatest intensity to Italy. Once again, delays in carrying out a full-throated form of social distancing had deadly consequences.

By the time a man in Italy's Lombardy region had tested positive for the virus, on February 20, he had likely infected many, including those in a local hospital. Three days later, health officials found an apparently unrelated outbreak.

The country's northern region began closing schools and museums and putting a curfew on bars, while at the same time some politicians in Rome were assuring the world that Italy was safe to visit and that only a very small percentage of Italians had the virus.

A hospital was under construction in Milan last month to help alleviate the waves of infections swamping northern Italy's health system. Photo / Alessandro Grassani, The New York Times

That soon changed. While some in charge argued and dithered, the virus became a wildfire, with hundreds of cases multiplying into thousands. By the time the government closed the entire country — an unprecedented lockdown for a Western democracy — on March 10, waves of infection were swamping northern Italy's overwhelmed health system, forcing doctors to make godlike decisions about which patients to try saving and which to remove from breathing equipment.

For the most part, Italians stayed at home, as deaths mounted daily by the hundreds. And by early April, its restrictive measures seemed to be slowing the rate of contagion. On Tuesday, officials reported the fewest number of new infections since the first days after the national lockdown.

Now the Italian government is preparing a slow, measured reopening. Schools will likely remain closed until September, and leaving home may be contingent on test results.

"This is an extraordinary result," Italy's health minister, Roberto Speranza, said on television Tuesday evening, after the latest statistics showed that the rate of contagion had decreased from one person infecting around three people to one person infecting just one. "The measures have worked, and we can finally start planning the future."

But he emphasised that Italy could not afford to let down its guard. "It takes little to spoil the work we have done so far," Speranza said. "It only takes wrong timing, wrong behavior, some lightness — excessive optimism."

A field hospital in Detroit, where illnesses and deaths have mounted. Photo / Brittany Greeson, The New York Times

After Italy, the world's coronavirus hot spot became New York state, where 6,268 have died in the pandemic, including 779 in one day this week. While most of the deaths — more than 4,000 — have been in an unnaturally quiet New York City, hundreds more have been reported in suburban Westchester and on Long Island, and officials say that others are probably dying at home, uncounted as victims of the virus.

Normally, workers from the city's Office of Chief Medical Examiner arrive within a few hours to collect a body. Now the wait can be as long as 24 hours, according to Lt. Edwin Raymond, a police officer who works in northern Brooklyn and who has responded to nine 911 calls involving dead bodies in six days.

The ambulance siren has become the soundtrack of the city as deaths have soared, Raymond said. "This thing — from a cough to a fever to pronounced within a week."

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Among the likely reasons for the high numbers, experts say, are the city's high population density and the protracted time before stay-at-home orders were put into place. "You just got a bad hand to start with," George Rutherford, a professor of epidemiology at the University of California, San Francisco, said to a reporter calling him from New York City.

During his daily news conference Wednesday, Cuomo in no way minimised the horror of death at such a scale, at a time when even the basic rituals of mourning have been upended. That is why he said he had "mixed emotions" over the news that the number of hospitalisations had fallen in recent days, indicating that social distancing measures, at least for now, were flattening the upward arc of infections.

"If we stop what we are doing, you will see that curve change," Cuomo said.

The governor's very qualified sense of progress is shared by Jeffrey Shaman, a professor of environmental health sciences at Columbia University who is advising New York City.

"There's some room for some optimism on this front," Shaman said. But he also warned that "we should not be exuberant and not get ahead of ourselves," and said that another two weeks may tell whether New York's curve is undeniably flattening.

The professor searched for the right term to describe his state of mind before settling on "patiently optimistic."

Elsewhere in the country, where communities are either grappling with or bracing for their pandemic moment, government officials are emphasising the necessity of social distancing by citing statistics that are simultaneously upsetting and reassuring.

After Italy, the world's coronavirus hot spot became New York State. Photo / Kirsten Luce, The New York Times

In Washington state, where in February the virus rampaged through a nursing home in Kirkland, eventually killing 37 people, the rate of spread has started to level off, and some comfort is taken that the number of deaths is not rising as quickly as in other states.

Over the weekend, Governor Jay Inslee reported that the state was returning ventilators provided by the federal government. And on Wednesday, he announced that an Army field hospital the federal government had built next to CenturyLink Field in Seattle would be removed, now that concerns about hospital capacity have waned.

"These soldiers uprooted their lives to help Washingtonians when we needed them most," Inslee said. "Since then, it's become apparent that other states need them more than we do."

Further evidence of the impact of social distancing is found in California, where many counties moved early to impose stay-at-home orders and where researchers have reduced their death toll projections. The state is now lending hundreds of ventilators to other places in need.

Governor Gavin Newsom on Tuesday even referred to a "sense of optimism" that the state had kept its rate of infections below the levels that would strain hospitals.

Tempering that optimism are the sheer numbers in California — 17,000 coronavirus cases and at least 440 deaths — as well as the prediction by state officials that waves of infection will continue. Dr. Mark Ghaly, the secretary of the California Health and Human Services Agency, said the state's peak would come in late May.

A joint operation of the Italian army and the Carabinieri to transport coffins in Bergamo. Photo / Fabio Bucciarelli, The New York Times

With so many uncertainties about the course of the coronavirus at play — in good measure because so little actual testing has been conducted — city and state leaders have seized on the apparent effects of social distancing as a way to raise hopes and rally their communities to stay the course.

In Detroit, which has reported more than 5,800 cases and more than 250 deaths, hospitals cannot handle the number of sick and a convention center has been converted into a field hospital. Hundreds of public employees have been quarantined, and thousands of health care workers have tested positive for the virus. Fear pulsates through the empty streets of the city.

But Mayor Mike Duggan on Tuesday reported what he called "the first glimmer of light" — indications that social distancing was slowing the city's death rate.

He seemed to channel Winston Churchill in both his candour and reassurance.

"We're going to lose a lot of our neighbours in the coming days," Detroit's mayor said. "It's going to get worse before it gets better. But we can beat this if we keep doing what we're doing."

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Written by: Dan Barry
Photographs by: Demetrius Freeman, Alessandro Grassani, Grant Hindsley, Brittany Greeson, Kirsten Luce, Fabio Bucciarelli
© 2020 THE NEW YORK TIMES