Every state in the U.S. will be affected by COVID-19, but some are more vulnerable due to limited ability to mitigate and treat the virus, and to reduce its economic and social impacts, according to a COVID-19 vulnerability index created by the Surgo Foundation.
The Surgo Foundation, a privately funded think tank, created an index that combines indicators specific to COVID-19 with the CDC’s social vulnerability index, which measures the expected negative impact of disasters of any type. The Surgo Foundation’s index takes into account factors that fall into one of several categories, including socioeconomic status, minority status, housing type, epidemiologic factors and health care system factors. Each state and the District of Columbia received a score in each category and an overall score, with a higher score indicating that the state is more vulnerable. Read more about the methodology here.
Here is each state’s ranking and composite score based on the vulnerability index:
Paul Romer estimates that testing every American would cost $100 billion, a hefty sum but less than the $2 trillion Congress has spent so far.
Nobel Prize-winning economist Paul Romer says a return to nearly normal life is possible this summer if the United States does wide-scale testing for the coronavirus.
Romer is calling on the U.S. government to test everyone in the nation once every two weeks and isolate people who test positive for the deadly coronavirus. He estimates that doing so would cost $100 billion, a hefty sum but far less than the $2 trillion Congress has spent so far and less than the cost of keeping the economy partly closed for months to come.
“I’m on the optimistic end of how quickly we can scale testing up,” said Romer, who won the 2018 Nobel Prize for economics. “I do think there’s a way most people could feel safe returning to what feels like normal life this summer if we do this wide-scale testing.”
So far, the nation has tested about 5 million people — or less than 2 percent of the population. Last week, Congress approved an additional $25 billion for testing as part of the latest funding bill, which Romer calls a good start but not enough.
Restarting the U.S. economy isn’t just about government officials clearing certain businesses to reopen. People have to feel safe enough to venture out. Romer says that will happen only when nearly everyone in the country is getting tested on a regular basis and people who are sick are being quarantined.
“It’s totally in our control to fix this,” Romer said in a phone interview. “We should be spending $100 billion on the testing. We should just get it going. It’s just not that hard.”
He advises starting with screening all health-care and front-line workers in the next month and then scaling up the testing to the rest of the nation this summer by using university labs to process tests.
Romer says massive testing is the only viable option for the nation. Otherwise, the economy will limp along, leaving millions of people unemployed and forcing small businesses to shut forever. It could take years to recover from that kind of pain. On the flip side, reopening much of the nation too soon could cause deaths to skyrocket again.
Top White House officials voiced support for more testing over the weekend. Treasury Secretary Steven Mnuchin said on Fox News Sunday that the Trump administration would “balance” reopening the economy with “more testing” to “monitor this very, very carefully.”
As Congress and the White House debate another round of economic relief, it’s unclear how much more money will be allocated for testing. Evidence from China and Germany, which have begun to reopen much of their economies, shows that people remain reluctant to go out and spend again. Subways in China remain half full, big public spaces such as casinos remain nearly empty and economic activity is still way off from normal.
Although some have balked at the cost of testing every American, Romer points out that the United States is losing at least $500 billion a month from the Great Lockdown. His estimate is more modest than some other economists such as St. Louis Federal Reserve President Jim Bullard, who says the nation is losing $25 billion a day right now. Bullard has also endorsed universal testing as the only way to fix the nation’s health — and economic — problems.
“Every month of delay makes the recovery slower — and take longer,” Romer said.
Romer won the Nobel Prize for modeling the U.S. and global economies. A former chief economist at the World Bank, he has built a career thinking through big international problems and what to do about them. But the coronavirus fight is also personal for him. He has a daughter who is an intensive care physician in Philadelphia.
WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.
The measurement of antibodies specific to COVID-19
The development of immunity to a pathogen through natural infection is a multi-step process that typically takes place over 1-2 weeks. The body responds to a viral infection immediately with a non-specific innate response in which macrophages, neutrophils, and dendritic cells slow the progress of virus and may even prevent it from causing symptoms. This non-specific response is followed by an adaptive response where the body makes antibodies that specifically bind to the virus. These antibodies are proteins called immunoglobulins. The body also makes T-cells that recognize and eliminate other cells infected with the virus. This is called cellular immunity. This combined adaptive response may clear the virus from the body, and if the response is strong enough, may prevent progression to severe illness or re-infection by the same virus. This process is often measured by the presence of antibodies in blood.
WHO continues to review the evidence on antibody responses to SARS-CoV-2 infection.2-17 Most of these studies show that people who have recovered from infection have antibodies to the virus. However, some of these people have very low levels of neutralizing antibodies in their blood,4 suggesting that cellular immunity may also be critical for recovery. As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.
Laboratory tests that detect antibodies to SARS-CoV-2 in people, including rapid immunodiagnostic tests, need further validation to determine their accuracy and reliability. Inaccurate immunodiagnostic tests may falsely categorize people in two ways. The first is that they may falsely label people who have been infected as negative, and the second is that people who have not been infected are falsely labelled as positive. Both errors have serious consequences and will affect control efforts. These tests also need to accurately distinguish between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses. Four of these viruses cause the common cold and circulate widely. The remaining two are the viruses that cause Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. People infected by any one of these viruses may produce antibodies that cross-react with antibodies produced in response to infection with SARS-CoV-2.
Many countries are now testing for SARS-CoV-2 antibodies at the population level or in specific groups, such as health workers, close contacts of known cases, or within households.21 WHO supports these studies, as they are critical for understanding the extent of – and risk factors associated with – infection. These studies will provide data on the percentage of people with detectable COVID-19 antibodies, but most are not designed to determine whether those people are immune to secondary infections.
Other considerations
At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.” People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission. As new evidence becomes available, WHO will update this scientific brief.
The good news is that the number of daily coronavirus tests is going up again. The bad news is that it’s still not nearly enough for the country to safely reopen.
Why it matters: If we don’t know who has the virus, we can’t stop it from spreading without resorting to stringent social distancing measures.
Driving the news: On Saturday, Anthony Fauci said that the U.S. is testing roughly 1.5 million to 2 million people a week, but “we probably should get up to twice that as we get into the next several weeks, and I think we will.”
Deborah Birx, the White House coronavirus task force coordinator, said yesterday that “we have to realize that we have to have a breakthrough innovation in testing.” She said we’ll need tests that can detect antigen, or the part of a pathogen that triggers an immune response.
Between the lines: Testing has been hampered by shortages of supplies like swabs and test kits. There has also been a lack of coordination between labs with excess testing capacity and communities struggling to meet testing demand.
What we’re watching: Some major cities and states — including New York and California — have begun to expand testing beyond the sickest patients, which is a good sign.
These are just a few of the two dozen ways robots have been used during the COVID-19 pandemic, from health care in and out of hospitals, automation of testing, supporting public safety and public works, to continuing daily work and life.
The lessons they’re teaching for the future are the same lessons learned at previous disasters but quickly forgotten as interest and funding faded. The best robots for a disaster are the robots, like those in these examples, that already exist in the health care and public safety sectors.
Research laboratories and startups are creating new robots, including one designed to allow health care workers to remotely take blood samples and perform mouth swabs. These prototypes are unlikely to make a difference now. However, the robots under development could make a difference in future disasters if momentum for robotics research continues.
Robots around the world
As roboticists at Texas A&M University and the Center for Robot-Assisted Search and Rescue, we examined over 120 press and social media reports from China, the U.S. and 19 other countries about how robots are being used during the COVID-19 pandemic. We found that ground and aerial robots are playing a notable role in almost every aspect of managing the crisis.
At work and home, robots are assisting in surprising ways. Realtors are teleoperating robots to show properties from the safety of their own homes. Workers building a new hospital in China were able work through the night because drones carried lighting. In Japan, students used robots to walk the stage for graduation, and in Cyprus, a person used a drone to walk his dog without violating stay-at-home restrictions.
Helping workers, not replacing them
Every disaster is different, but the experience of using robots for the COVID-19 pandemic presents an opportunity to finally learn three lessons documented over the past 20 years. One important lesson is that during a disaster robots do not replace people. They either perform tasks that a person could not do or do safely, or take on tasks that free up responders to handle the increased workload.
The majority of robots being used in hospitals treating COVID-19 patients have not replaced health care professionals. These robots are teleoperated, enabling the health care workers to apply their expertise and compassion to sick and isolated patients remotely.
A small number of robots are autonomous, such as the popular UVD decontamination robots and meal and prescription carts. But the reports indicate that the robots are not displacing workers. Instead, the robots are helping the existing hospital staff cope with the surge in infectious patients. The decontamination robots disinfect better and faster than human cleaners, while the carts reduce the amount of time and personal protective equipment nurses and aides must spend on ancillary tasks.
Off-the-shelf over prototypes
The second lesson is the robots used during an emergency are usually already in common use before the disaster. Technologists often rush out well-intentioned prototypes, but during an emergency, responders – health care workers and search-and-rescue teams – are too busy and stressed to learn to use something new and unfamiliar. They typically can’t absorb the unanticipated tasks and procedures, like having to frequently reboot or change batteries, that usually accompany new technology.
Fortunately, responders adopt technologies that their peers have used extensively and shown to work. For example, decontamination robots were already in daily use at many locations for preventing hospital-acquired infections. Sometimes responders also adapt existing robots. For example, agricultural drones designed for spraying pesticides in open fields are being adapted for spraying disinfectants in crowded urban cityscapes in China and India.
Workers in Kunming City, Yunnan Province, China refill a drone with disinfectant. The city is using drones to spray disinfectant in some public areas.Xinhua News Agency/Yang Zongyou via Getty Images
A third lesson follows from the second. Repurposing existing robots is generally more effective than building specialized prototypes. Building a new, specialized robot for a task takes years. Imagine trying to build a new kind of automobile from scratch. Even if such a car could be quickly designed and manufactured, only a few cars would be produced at first and they would likely lack the reliability, ease of use and safety that comes from months or years of feedback from continuous use.
Alternatively, a faster and more scalable approach is to modify existing cars or trucks. This is how robots are being configured for COVID-19 applications. For example, responders began using the thermal cameras already on bomb squad robots and drones – common in most large cities – to detect infected citizens running a high fever. While the jury is still out on whether thermal imaging is effective, the point is that existing public safety robots were rapidly repurposed for public health.
Don’t stockpile robots
The broad use of robots for COVID-19 is a strong indication that the health care system needed more robots, just like it needed more of everyday items such as personal protective equipment and ventilators. But while storing caches of hospital supplies makes sense, storing a cache of specialized robots for use in a future emergency does not.
This was the strategy of the nuclear power industry, and it failed during the Fukushima Daiichi nuclear accident. The robots stored by the Japanese Atomic Energy Agency for an emergency were outdated, and the operators were rusty or no longer employed. Instead, the Tokyo Electric Power Company lost valuable time acquiring and deploying commercial off-the-shelf bomb squad robots, which were in routine use throughout the world. While the commercial robots were not perfect for dealing with a radiological emergency, they were good enough and cheap enough for dozens of robots to be used throughout the facility.
Robots in future pandemics
Hopefully, COVID-19 will accelerate the adoption of existing robots and their adaptation to new niches, but it might also lead to new robots. Laboratory and supply chain automation is emerging as an overlooked opportunity. Automating the slow COVID-19 test processing that relies on a small set of labs and specially trained workers would eliminate some of the delays currently being experienced in many parts of the U.S.
Automation is not particularly exciting, but just like the unglamorous disinfecting robots in use now, it is a valuable application. If government and industry have finally learned the lessons from previous disasters, more mundane robots will be ready to work side by side with the health care workers on the front lines when the next pandemic arrives.
“CAME OUT of nowhere,” President Trump said March 6 of the coronavirus pandemic. “I just think this is something . . . that you can never really think is going to happen.” A few weeks later, he added, “I would view it as something that just surprised the whole world.” Mr. Trump also said, “Nobody knew there would be a pandemic or epidemic of this proportion.”
Of course, no one can pinpoint the exact moment that lightning will strike. But a global pandemic? Experts have predicted it, warned about the preparedness gaps and urged action. Again and again and again.
Just look at 2019. In January, the U.S. intelligence community issued its annual global threat assessment. It declared, “We assess that the United States and the world will remain vulnerable to the next flu pandemic or large-scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support. . . . The growing proximity of humans and animals has increased the risk of disease transmission. The number of outbreaks has increased in part because pathogens originally found in animals have spread to human populations.”
In September, the Johns Hopkins Center for Health Security issued a report titled “Preparedness for a High-Impact Respiratory Pathogen Pandemic.” The report found that if such a pathogen emerged, “it would likely have significant public health, economic, social, and political consequences. . . . The combined possibilities of short incubation periods and asymptomatic spread can result in very small windows for interrupting transmission, making such an outbreak difficult to contain.” The report pointed to “large national and international readiness gaps.”
In October, the Nuclear Threat Initiative, working with the Johns Hopkins center and the Economist Intelligence Unit, published its latest Global Health Security Index, examining open-source information about the state of health security across 195 nations, and scoring them. The report warned, “No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.” The report found that “Fewer than 5 percent of countries scored in the highest tier for their ability to rapidly respond to and mitigate the spread of an epidemic.”
In November, the Center for Strategic and International Studies published a study by its Commission on Strengthening America’s Health Security. It warned, “The American people are far from safe. To the contrary, the United States remains woefully ill-prepared to respond to global health security threats. This kind of vulnerability should not be acceptable to anyone. At the extreme, it is a matter of life and death. . . . Outbreaks proliferate that can spread swiftly across the globe and become pandemics, disrupting supply chains, trade, transport, and ultimately entire societies and economies.” The report recommended: “Restore health security leadership at the White House National Security Council.”
Came out of nowhere? Not even close. The question that must be addressed in future postmortems is why all this expertise and warning was ignored.
By the numbers: The coronavirus has infected over 2.9 million people and killed over 200,000, Johns Hopkins data shows. More than 829,000 people have recovered from COVID-19. The U.S. has reported the most cases in the world (more than 940,000 from 5.1 million tests), followed by Spain (over 223,000).
What’s happening: Australian Health Minister Greg Hunt announced a new coronavirus tracing app on Sunday that the government hopes at least 50 percent of the population will use. A top health official said the app is “only for one purpose, to help contact tracing,” as he sought to reassure Australians on privacy issues.
Argentina is extending a nationwide shelter-in-place order that was due to expire Sunday until May 10, President Alberto Fernandez said on Saturday, per Reuters. The country has confirmed over 3,700 cases, according to Johns Hopkins.
Spain will gradually ease nationwide stay-at-home restrictions starting May 2 if coronavirus cases continue to decline, Prime Minister Pedro Sánchez said Saturday.
The World Health Organization said Saturday there is “no evidence” that people who recover from COVID-19 and have antibodies are protected from a second infection.
India announced it will be easing lockdown measures for its 1.3 billion people in the areas outside of hotspots — providing some relief for locally owned businesses and daily wage workers.
The director of Israel’s foreign intelligence agency, Mossad, said in a briefing to health care officials on Thursday that Iran and its regional allies are intentionally underreporting cases and deaths from the coronavirus.
New Zealand’s level 4 lockdown measures requiring non-essential workers to stay home have been extended to 11:59 p.m next Monday, when the country moves into a still-strict level 3. NZ reported just three cases on Thursday.
Pakistan has decided to keep mosques open during the fasting month of Ramadan, which began Thursday, as cases continue to climb, AP reports.
The big picture: The world faces its gravest challenge in decades, but geopolitical tensions won’t wait until it’s over. Trump’s threat on Wednesday to “destroy” Iranian boats that harass U.S. ships comes amid arrests of Hong Kong pro-democracy activists and clashes in Afghanistan that could further undermine peace there.
By the numbers: The coronavirus has infected over 2.9 million people and killed over 200,000, Johns Hopkins data shows. More than 829,000 people have recovered from COVID-19. The U.S. has reported the most cases in the world (more than 940,000 from 5.1 million tests), followed by Spain (over 223,000).
The coronavirus pandemic is shaking bedrock assumptions about U.S. exceptionalism. This is perhaps the first global crisis in more than a century where no one is even looking for Washington to lead.
As images of America’s overwhelmed hospital wards and snaking jobless lines have flickered across the world, people on the European side of the Atlantic are looking at the richest and most powerful nation in the world with disbelief.
“When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said Henrik Enderlein, president of the Berlin-based Hertie School, a university focused on public policy. “We are all stunned. Look at the jobless lines. Twenty-two million,” he added.
“I feel a desperate sadness,” said Timothy Garton Ash, a professor of European history at Oxford University and a lifelong and ardent Atlanticist.
The pandemic sweeping the globe has done more than take lives and livelihoods from New Delhi to New York. It is shaking fundamental assumptions about American exceptionalism — the special role the United States played for decades after World War II as the reach of its values and power made it a global leader and example to the world.
Today it is leading in a different way: More than 840,000 Americans have been diagnosed with Covid-19 and at least 46,784 have died from it, more than anywhere else in the world.
As the calamity unfolds, President Trump and state governors are not only arguing over what to do, but also over who has the authority to do it. Mr. Trump has fomented protests against the safety measures urged by scientific advisers, misrepresented facts about the virus and the government response nearly daily, and this week used the virus to cut off the issuing of green cards to people seeking to emigrate to the United States.
“America has not done badly, it has done exceptionally badly,” said Dominique Moïsi, a political scientist and senior adviser at the Paris-based Institut Montaigne.
And in the United States, it has exposed two great weaknesses that, in the eyes of many Europeans, have compounded one another: the erratic leadership of Mr. Trump, who has devalued expertise and often refused to follow the advice of his scientific advisers, and the absence of a robust public health care system and social safety net.
“America prepared for the wrong kind of war,” Mr. Moïsi said. “It prepared for a new 9/11, but instead a virus came.”
“It raises the question: Has America become the wrong kind of power with the wrong kind of priorities?” he asked.
Ever since Mr. Trump moved into the White House and turned America First into his administration’s guiding mantra, Europeans have had to get used to the president’s casual willingness to risk decades-old alliances and rip up international agreements. Early on, he called NATO “obsolete” and withdrew U.S. support from the Paris climate agreement and the Iran nuclear deal.
But this is perhaps the first global crisis in more than a century where no one is even looking to the United States for leadership.
In Berlin, Germany’s foreign minister, Heiko Maas, has said as much.
China took “very authoritarian measures, while in the U.S., the virus was played down for a long time,” Mr. Maas recently told Der Spiegel magazine.
“These are two extremes, neither of which can be a model for Europe,” Mr. Maas said.
America once told a story of hope, and not just to Americans. West Germans like Mr. Maas, who grew up on the front line of the Cold War, knew that story by heart, and like many others in the world, believed it.
But nearly three decades later, America’s story is in trouble.
The country that helped defeat fascism in Europe 75 years ago next month, and defended democracy on the continent in the decades that followed, is doing a worse job of protecting its own citizens than many autocracies and democracies.
There is a special irony: Germany and South Korea, both products of enlightened postwar American leadership, have become potent examples of best practices in the coronavirus crisis.
But critics now see America failing not only to lead the world’s response, but letting down its own people as well.
“There is not only no global leadership, there is no national and no federal leadership in the United States,” said Ricardo Hausmann, director of the Growth Lab at Harvard’s Center for International Development. “In some sense this is the failure of leadership of the U.S. in the U.S.”
Of course, some countries in Europe have also been overwhelmed by the virus, with the number of dead from Covid-19 much higher as a percentage of the population in Italy, Spain and France than in the United States. But they were struck sooner and had less time to prepare and react.
The contrast between how the United States and Germany responded to the virus is particularly striking.
While Chancellor Angela Merkel has been criticized for not taking a forceful enough leadership role in Europe, Germany is being praised for a near-textbook response to the pandemic, at least by Western standards. That is thanks to a robust public health care system, but also a strategy of mass testing and trusted and effective political leadership.
Ms. Merkel has done what Mr. Trump has not. She has been clear and honest about the risks with voters and swift in her response. She has rallied all 16 state governors behind her. A trained physicist, she has followed scientific advice and learned from best practice elsewhere.
Not long ago, Ms. Merkel was considered a spent force, having announced that this would be her last term. Now her approval ratings are at 80 percent.
“She has the mind of a scientist and the heart of a pastor’s daughter,” Mr. Garton Ash said.
Mr. Trump, in a hurry to restart the economy in an election year, has appointed a panel of business executives to chart a course out of the lockdown.
Ms. Merkel, like everyone, would like to find a way out, too, but this week she warned Germans to remain cautious. She is listening to the advice of a multidisciplinary panel of 26 academics from Germany’s national academy of science. The panel includes not just medical experts and economists but also behavioral psychologists, education experts, sociologists, philosophers and constitutional experts.
“You need a holistic approach to this crisis,” said Gerald Haug, the academy’s president, who chairs the German panel. “Our politicians get that.”
A climatologist, Mr. Haug used to do research at Columbia University in New York.
The United States has some of the world’s best and brightest minds in science, he said. “The difference is, they’re not being listened to.”
“It’s a tragedy,” he added.
Some cautioned that the final history of how countries fare after the pandemic is still a long way from being written.
A pandemic is a very specific kind of stress test for political systems, said Mr. Garton Ash, the history professor. The military balance of power has not shifted at all. The United States remains the world’s largest economy. And it was entirely unclear what global region would be best equipped to kick-start growth after a deep recession.
“All of our economies are going to face a terrible test,” he said. “No one knows who will come out stronger at the end.”
Benjamin Haddad, a French researcher at the Atlantic Council, wrote that while the pandemic was testing U.S. leadership, it is “too soon to tell” if it would do long-term damage.
“It is possible that the United States will resort to unexpected resources, and at the same time find a form of national unity in its foreign policy regarding the strategic rivalry with China, which it has been lacking until now,” Mr. Haddad wrote.
There is another wild card in the short term, Mr. Moïsi pointed out. The United States has an election in November. That, and the aftermath of the deepest economic crisis since the 1930s, might also affect the course of history.
The Great Depression gave rise to America’s New Deal. Maybe the coronavirus will lead the United States to embrace a stronger public safety net and develop a national consensus for more accessible health care, Mr. Moïsi suggested.
“Europe’s social democratic systems are not only more human, they leave us better prepared and fit to deal with a crisis like this than the more brutal capitalistic system in the United States,” Mr. Moïsi said.
The current crisis, some fear, could act like an accelerator of history, speeding up a decline in influence of both the United States and Europe.
“Sometime in 2021 we come out of this crisis and we will be in 2030,” said Mr. Moïsi. “There will be more Asia in the world and less West.”
Mr. Garton Ash said that the United States should take an urgent warning from a long line of empires that rose and fell.
“To a historian it’s nothing new, that’s what happens,” said Mr. Garton Ash. “It’s a very familiar story in world history that after a certain amount of time a power declines.”
“You accumulate problems, and because you’re such a strong player, you can carry these dysfunctionalities for a long time,” he said. “Until something happens and you can’t anymore.”
It’s entirely understandable that consumers would be reticent to visit in-person care settings right now. Given that doctors’ offices and urgent care facilities are where sick people congregate, a patient might well assume their chances of contracting COVID-19 would be higher there than in almost any other public space. But a story we heard this week from a health system chief strategy officer (CSO) reveals just how frightened patients may be to return.
Last week the system began to reach out to patients who had positive screening mammograms in February, before elective procedures and tests were cancelled, and who now needed to return for more detailed diagnostic images. A full 75 percent of these patients were unwilling to schedule a diagnostic mammogram within the next month, with one patient even saying, “I’ll take my chances with breast cancer over COVID!”.
Women with a concerning mammogram finding are typically among the most motivated patients in seeking follow-up care. If a majority of them are unwilling to pursue in-person follow-up, the same will likely be true of scores of patients with other possible cancers, heart disease, and other serious conditions. As fear delays needed care, patients are likely to end up much sicker, with more advanced disease, when they do return. With rigorous attention to symptom and temperature screening, visiting a doctor’s office should be less risky than going to the grocery store—but providers will have to publicly communicate the steps they are taking to keep patients safe before many will be willing to come in the door.
HENRY KOTULA 