Can blood from coronavirus survivors treat the newly ill?


By LAURAN NEERGAARD March 24, 2020

FILE - In this Feb. 18, 2020, file photo, Dr. Zhou Min, a recovered COVID-19 patient who has passed his 14-day quarantine, donates plasma in the city's blood center in Wuhan in central China's Hubei province. Plasma from recovered COVID-19 patients contains antibodies that may help reduce the viral load in patients that are fighting the disease. (Chinatopix via AP, File)


WASHINGTON (AP) — Hospitals are gearing up to test if a century-old treatment used to fight off flu and measles outbreaks in the days before vaccines, and tried more recently against SARS and Ebola, just might work for COVID-19, too: using blood donated from patients who’ve recovered.

Doctors in China attempted the first COVID-19 treatments using what the history books call “convalescent serum” -- today, known as donated plasma -- from survivors of the new virus.

Now a network of U.S. hospitals is waiting on permission from the Food and Drug Administration to begin large studies of the infusions both as a possible treatment for the sick and as vaccine-like temporary protection for people at high risk of infection.

There’s no guarantee it will work.

“We won’t know until we do it, but the historical evidence is encouraging,” Dr. Arturo Casadevall of Johns Hopkins University’s school of public health told The Associated Press.

Casadevall drew on that history in filing the FDA application. The FDA is “working expeditiously to facilitate the development and availability of convalescent plasma” a spokesman said.

Here are some questions and answers about this latest quest for a treatment.

WHAT EXACTLY IS THIS POSSIBLE THERAPY?

It may sound like “back to the Stone Age,” but there’s good scientific reason to try using survivors’ blood, said Dr. Jeffrey Henderson of Washington University School of Medicine in St. Louis, who coauthored the FDA application with Casadevall and another colleague at the Mayo Clinic.

When a person gets infected by a particular germ, the body starts making specially designed proteins called antibodies to fight the infection. After the person recovers, those antibodies float in survivors’ blood -- specifically plasma, the liquid part of blood — for months, even years.

One of the planned studies would test if giving infusions of survivors’ antibody-rich plasma to newly ill COVID-19 patients would boost their own body’s attempts to fight off the virus. To see if it works, researchers would measure if the treatment gave patients a better chance of living or reduced the need for breathing machines.

One caution: While regular plasma transfusions are a mainstay of medicine, very rarely they can cause a lung-damaging side effect.

COULD IT ALSO ACT LIKE A VACCINE?

Sort of, but unlike a vaccine, any protection would only be temporary.

A vaccine trains people’s immune systems to make their own antibodies against a target germ. The plasma infusion approach would give people a temporary shot of someone else’s antibodies that are short-lived and require repeated doses.

Still, if FDA agrees, a second study would give antibody-rich plasma infusions to certain people at high risk from repeated exposures to COVID-19, such as hospital workers or first responders, said Dr. Liise-anne Pirofski of New York’s Montefiore Health System and Albert Einstein College of Medicine. That also might include nursing homes when a resident becomes ill, in hopes of giving the other people in the home some protection, she said.

“We need both things desperately,” Pirofski said. “We need to be able to break the cycle of transmission and we also need to be able to help people who are ill.”
Full Coverage: Understanding the Outbreak

WHAT’S THE HISTORY?

These plasma infusions were used most famously during the 1918 flu pandemic, and against numerous other infections, such as measles and bacterial pneumonia, before vaccines and modern medicines came along. Long-ago research is sketchy. But in the Journal of Clinical Investigation earlier this month, Casadevall and Pirofski cited evidence that 1918 flu patients given the infusions were less likely to die. And a 1935 medical report detailed how doctors stopped a measles outbreak from sweeping through a boarding school using “serum” from prior patients.

The old-fashioned approach still is dusted off every so often to tackle surprise outbreaks such as SARS in 2002, and in 2014 when Ebola survivors’ plasma was used to treat other patients during the West Africa epidemic. Even during those recent outbreaks, strict studies of the technique were not done, but Casadevall said there were clues that the plasma helped.

Casadevall thinks that when it didn’t work, it may have been used too late. “Somebody at the end of their lives, it’s very hard to affect” any disease at that point, he cautioned.

A more modern approach is to brew this type of antibody in the lab, something Regeneron Pharmaceuticals and other companies are working on. Using blood from COVID-19 survivors is a decidedly more labor-intensive approach — but researchers could start banking the plasma as soon as regulators give the OK.

HOW WOULD DOCTORS GET THE PLASMA?

Blood banks take plasma donations much like they take donations of whole blood; regular plasma is used in hospitals and emergency rooms every day. If someone’s donating only plasma, their blood is drawn through a tube, the plasma is separated and the rest infused back into the donor’s body. Then that plasma is tested and purified to be sure it doesn’t harbor any blood-borne viruses and is safe to use.

For COVID-19 research, the difference would be who does the donating -- people who have recovered from the coronavirus. Scientists would measure how many antibodies are in a unit of donated plasma — tests just now being developed that aren’t available to the general public — as they figure out what’s a good dose, and how often a survivor could donate.

Researchers aren’t worried about finding volunteer donors but caution it will take some time to build up a stock.

“I get multiple emails a day from people saying, ‘Can I help, can I give my plasma?’” Pirofski said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Virus test results in minutes? Scientists question accuracy

By ARITZ PARRA, CIARÁN GS and JILL LAWLESS 3/27/2020

FILE - This undated electron microscope image made available by the U.S. National Institutes of Health in February 2020 shows the virus that causes COVID-19. The sample was isolated from a patient in the U.S. Some political leaders are hailing a potential breakthrough in the fight against COVID-19: simple pin-prick blood tests or nasal swabs that can determine within minutes if someone has, or previously had, the virus. But some scientists have challenged their accuracy. (NIAID-RML via AP)


MADRID (AP) — Some political leaders are hailing a potential breakthrough in the fight against COVID-19: simple pin-prick blood tests or nasal swabs that can determine within minutes if someone has, or previously had, the virus.

The tests could reveal the true extent of the outbreak and help separate the healthy from the sick. But some scientists have challenged their accuracy.

Hopes are hanging on two types of quick tests: antigen tests that use a nose or throat swab to look for the virus, and antibody tests that look in the blood for evidence someone had the virus and recovered. The tests are in short supply, and some of them are considered unreliable.

“The market has gone completely mad,” Spanish Health Minister Salvador Illa said Thursday, lamenting the l ack of face masks, personal protection equipment and rapid tests “because everybody wants these products, and they want the good ones.”

The Spanish government on Friday said it already sent back a batch of 58,000 rapid antigen tests from a Chinese producer because the first 8,000 proved flawed. It said the producer agreed to replace the returned tests and another 582,000 tests ordered with kits that would meet requirements.

Chinese authorities said Thursday that the manufacturer did not have a license to sell the products. But Spain said the company did have permission to do so in Europe and the kits came with European Union certificates.

The Spanish government initially said 9,000 tests, not 8,000, had proved unreliable.

British Prime Minister Boris Johnson this week called the rapid tests a “game changer” and said his government had ordered 3.5 million of them.

The U.K. hopes the tests will allow people who have had COVID-19 and recovered to go back to work, safe in the knowledge that they are immune, at least for now. That could ease the country’s economic lockdown and bring back health care workers who are being quarantined out of fears they may have the virus.

Many scientists have been cautious, saying it’s unclear if the rapid tests provide accurate results.

In the past few months, much of the testing has involved doctors sticking something akin to a long cotton swab deep into a patient’s nose or throat to retrieve cells that contain live virus. Lab scientists pull genetic material from the virus and make billions of copies to get enough for computers to detect the bug. Results sometimes take several days.

Rapid antigen tests have shorter swabs that patients can use themselves to gather specimens. They are akin to rapid flu tests, which can produce results in less than 15 minutes. They focus on antigens — parts of the surface of viruses that trigger an infected person’s body to start producing antibodies.

Health authorities in China, the United States and other countries have offered few details on the rates of false positive and false negative results on any coronavirus tests. Experts worry that the rapid tests may be significantly less reliable than the more time-consuming method.


Lower accuracy has been a concern with rapid flu tests. Spanish scientists said the rapid tests for coronavirus they reviewed were less than 30% accurate. The more established lab tests were about 84% accurate.

Those results “would prevent its routine introduction,” according to a report by the Spanish Society of Infectious Disease and Clinical Microbiology that triggered the alarms in Spain and spurred the government’s rejection of the 58,000 antigen tests.

Similar questions swirl around new antibody tests involving blood samples. Some versions have been described as finger-prick tests that can provide important information in minutes.

Antibody tests are most valuable as a way of seeing who has been infected in the recent past, who became immune to the disease and — if done on a wide scale — how widely an infection has spread in a community.

The antibody tests also will allow scientists to get a better understanding of how deadly coronavirus is to all people, because they will provide a better understanding of how many people were ever infected, ranging from those who never showed symptoms to those who became fatally ill. The results will also guide vaccine development.

But so much is unknown, including how long antibodies — and immunity — lasts, and who the blood tests should be used on.

“We don’t have all the answers,” said Dr. Robin Patel, president of the American Society for Microbiology.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death. Most people recover.

More than 15 companies have notified the U.S. Food and Drug Administration that they have developed antibody tests, the agency said. The companies are permitted to begin distributing the tests to hospitals and doctors’ offices, provided they carry certain disclaimer statements, including: “This test has not been reviewed by the FDA.”

In Spain, the government sought the rapid tests for use first in hospitals and nursing homes, where efforts to halt the spread of the virus have been hampered by widespread infections among health workers.

Hopes about the transformative power of the tests have been raised, then partially dashed, in the U.K. Sharon Peacock, director of the national infection service at Public Health England, told lawmakers this week that the tests would be available in the “near future” for purchase through Amazon for use at home or to have completed in a pharmacy.

“We need to evaluate them in the laboratory to be clear, because these are brand-new products,” she said, explaining that the evaluation should be completed this week. She said “further millions” were being ordered on top of the 3.5 million the government had already bought.

Full Coverage: Virus Outbreak

But England’s chief medical officer, Chris Whitty, urged caution.

“I do not think, and I want to make this clear, that this is something you will suddenly be ordering on the internet next week,” Whitty told a news conference Wednesday. “The one thing worse than no test is a bad test.

“If they are incredibly accurate, we will work out the quickest way to release them. If they are not accurate, we will not release any of them,” he said.

The prime minister’s spokesman was unable to say Thursday how much the U.K. had paid for the tests, which come from several suppliers, or whether the money would be refunded if they turned out to be unreliable.

The chief scientist at the World Health Organization said wider testing would allow health officials to pinpoint infections in people who appear healthy but may be carrying the virus.

“We know that if you really go out and test everyone in the community, you’re going to find people walking around with this virus in their nose who do not feel at all ill,” Dr. Soumya Swaminathan said in an interview.

WHO believes most transmissions of the virus occur through people who already show symptoms, but “the question is still open” about how asymptomatic people may spread infection, Swaminathan said.

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Jill Lawless reported from London. Jamey Keaten in Geneva and Mike Stobbe in New York contributed to this report.

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Follow AP coverage of the virus outbreak at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

Brazil’s governors rise up against Bolsonaro’s virus stance

By MAURICIO SAVARESE and DAVID BILLER March 26, 2020

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A man rides his bicycle along an empty Arpoador beach in Rio de Janeiro, Brazil, Thursday, March 26, 2020, as many people stay home to help contain the spread of the new coronavirus. (AP Photo/Leo Correa)


SAO PAULO (AP) — Brazil’s governors are defying President Jair Bolsonaro over his call to reopen schools and businesses, dismissing his argument that the “cure” of widespread shutdowns to contain the spread of the new coronavirus is worse than the disease.

Bolsonaro contends that the clampdown already ordered by many governors will deeply wound the already beleaguered economy and spark social unrest. In a nationally televised address Tuesday night, he urged governors to limit isolation only to high-risk people and lift the strict anti-virus measures they have imposed in their regions.

“What needs to be done? Put the people to work. Preserve the elderly, preserve those who have health problems. But nothing more than that,” said Bolsonaro, who in the past has sparked anger by calling the virus a “little flu.”

The country’s governors protested on Wednesday that his instructions run counter to health experts’ recommendations and endanger Latin America’s largest population. They said they would continue with their strict measures and, in a joint letter, nearly all of them begged the federal government join forces with states. The rebellion even included traditional allies of Brazil’s president.

Gov. Carlos Moisés of Santa Catarina state, which gave almost 80% of its votes to Bolsonaro in the 2018 presidential runoff, complained he was “blown away” by the president’s instructions. Moisés said he would insist that all residents stay home during the pandemic despite the president’s stand.

In a videoconference Wednesday between Bolsonaro and governors from Brazil’s southeast region, Sao Paulo Gov. João Doria threatened to sue the federal government if it tried to interfere with his efforts to combat the virus, according to video of their private meeting reviewed by The Associated Press.

Aerial view of the almost empty Paulista Avenue in Sao Paulo (AP Photo/Andre Penner)

“We are here, the four governors of the southeast region, in respect for Brazil and Brazilians and in respect for dialogue and understanding,” said Doria, who supported Bolsonaro’s 2018 presidential bid. “But you are the president and you have to set the example. You have to be the representative to command, guide and lead this country, not divide it.”

Bolsonaro responded by accusing Doria of riding his coattails to the governorship, then turning his back.

“If you don’t get in the way, Brazil will take off and emerge from the crisis. Stop campaigning,” the president said.

The governors weren’t the only defiant ones. Virus plans challenged by Bolsonaro were upheld by the Supreme Court. The heads of both congressional houses criticized his televised speech. Companies donated supplies to state anti-virus efforts.

Gloria Maria cleans the shore of an unusually empty Copacabana beach backdropped by the Sugar Loaf Mountain in Rio de Janeiro, Brazil, Thursday, March 26, 2020, as people stay indoors to help contain the spread of the new coronavirus. The 41-year-old city worker said that in her 10 years of work cleaning the beach, she never saw an empty beach on a sunny Thursday. "It's terrible, people are dying in Europe due this virus," she added. (AP Photo/Leo Correa)

Bolsonaro on Wednesday told reporters in the capital, Brasilia, that he has listened to his U.S. counterpart, Donald Trump, and found their perspectives to be similar. On Thursday, he issued a decree to allow religious services, despite states’ quarantine orders, then ridiculed journalists for gathering outside the presidential residence while their outlets prescribe social distancing.

“Look, people of Brazil: they say I’m wrong, and that you have to stay home,” he said with a grin, then turned to face the press. “So I ask, what are you doing here?”

He has found some support among his base — #BolsonaroIsRight trended atop Brazilian Twitter on Wednesday — though that backing has been countered by a week of nightly protests from many Brazilians respecting the self-isolation rules who lean from their windows to bang pots and pans.

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, though, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.

As of Thursday, Brazil had 2,915 confirmed cases and 77 deaths related to the outbreak, with nearly 200 people in intensive care units. Experts say the figures could soar in April, intensifying pressure on the country’s stretched health care system. There is particular concern about the virus’ potential damage in the ultra-dense, low-income neighborhoods known as favelas.

Bolsonaro’s administration has also faced criticism from economists, including Armínio Fraga, a former central bank governor, and Claudio Ferraz, a professor at Rio de Janeiro’s Pontifical Catholic University.

“Brazil is seeing something unique, an insurrection of governors,” Ferraz wrote on Twitter. “This will become a new topic in political science: checks and balances by governors in a Federal System.”

Rio de Janeiro Gov. Wilson Witzel, another former ally of Bolsonaro, also told the president in the videoconference that he won’t heed the call to loosen social distancing protocols.


A boy peaks from the dilapidated doorway of his home as his mother receives soap and detergent distributed by volunteers as an effort to avoid the spread of the new coronavirus, in the Rocinha slum of Rio de Janeiro, Brazil, Tuesday, March 24, 2020. (AP Photo/Leo Correa)

Last week, Witzel announced he would shut down airports and interstate roads, which Bolsonaro annulled by decree contending that only the federal government can adopt such measures. By the time the president took to the airwaves Tuesday evening, a Supreme Court justice had ruled in favor of Witzel.

Two days earlier Brazil’s top court issued another ruling allowing Sao Paulo state to stop repaying federal government debt amounting to $400 million so that it can beef up its health sector. The decision may set a precedent for other states.

Sao Paulo, Brazil’s economic engine, is home to the majority of the coronavirus cases. It has been under partial lockdown since Tuesday, and schools, universities and non-essential businesses have mostly been closed for more than 10 days. Rio state has adopted similar measures, including closing its beaches.

Gov. Ronaldo Caiado of Goiás state, a physician who had been a close Bolsonaro ally, participated in a meeting late Wednesday of nearly all Brazilian governors to coordinate their efforts. The federal government wasn’t invited.

Caiado told reporters he is redefining his relationship with Bolsonaro.

“I cannot allow the president to wash his hands and hold others responsible for the coming economic collapse and loss of jobs,” Caiado said. “That is not the behavior of a leader.”

Soldiers stand in formation before disinfecting wagons for the new coronavirus at the central train station in Rio (AP Photo/Leo Correa)
Soldiers disinfect wagons parked at the central train station in Rio de Janeiro, Brazil, where trains connect cities within the state, as a measure to stop the spread the new coronavirus, Thursday, March 26, 2020. COVID-19 causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Leo Correa)

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Biller reported from Rio de Janeiro.

https://plawiuk.blogspot.com/2020/03/mutual-aid-solidarity-and-humor-in.html

Fears for civil rights mount amid fight against coronavirus

By MICHAEL TARM March 25, 2020

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A traveler walks through the security line at the Salt Lake City International Airport Wednesday, March 25, 2020, in Salt Lake City. Many airline flights are nearly empty as virus undercuts travel. The Salt Lake City International Airport is expecting to screen about 5,000 passengers Wednesday, March 25, 2020, which is down from about 24,000 daily passengers. Earlier this year during the ski season, the airport was seeing record-breaking days with 30,000 passengers. (AP Photo/Rick Bowmer)

CHICAGO (AP) — The orders seem prudent in the bid to thwart the spread of the novel coronavirus: Don’t go out, don’t gather with others and keep your stores closed. But growing segments of the U.S. population say state and federal governments are trampling on freedoms central to American life in the name of protecting public health.

The case is already being made. A church-goer in New Hampshire says prohibitions against large gatherings violate her religious rights. A Pennsylvania golf course owner argues that gubernatorial edicts shuttering his business amount to illegal seizure of his private property.

If civil libertarians aren’t yet sounding alarms, many have their hands hovering over the button.

“So far, we haven’t had draconian methods, like armed police blocking people’s movement in the streets, surveillance and phone tapping,” said Larry Gostin, a public health lawyer at Georgetown University. “But we are seeing lockdowns of millions of citizens like we have never seen before.”

He added: “We are on the precipice of something that could transform American values and freedoms.”

Questions about the extent of governmental power to impose restrictions haven’t been fully resolved since New York cook Mary Mallon, a typhoid carrier, defied public health department orders to isolate. Mallon, better known as Typhoid Mary, lost her legal battle for freedom and ended up effectively imprisoned for 28 years on an island cottage, dying there in 1938.

Responses are no longer as severe. But thousands of Americans are already confined to their homes under threat of fines and even jail. Businesses are losing thousands of dollars. Workers are laid off.

One man infected with the coronavirus in Kentucky recently left a hospital and refused to quarantine; an armed county deputy was posted outside his home to ensure the 53-year-old stayed put.

“It’s a step I hoped I’d never have to take, but we can’t allow one person who we know has the virus to refuse to protect their neighbors,” Kentucky Gov. Andy Beshear told reporters.

Authority to order shutdowns and quarantines inside states rests almost entirely with states under provisions in the U.S. Constitution ceding power not explicitly delegated to the federal government to states.

The federal government itself can’t order nationwide quarantines or business closures, courts have ruled over the years. It does, however, have clear power under constitutional clauses regulating commerce to quarantine international travelers or those traveling state to state who are suspected of carrying an infectious disease.


At least some legal scholars believe the Constitution’s Commerce Clause may vest President Donald Trump with powers to impose a national lockdown, but he’d likely have to resort to persuading all 50 states to agree to uniform restrictions if he ever seriously contemplated such a move.

That doesn’t appear to be his inclination. He said this week he was hoping to lift restrictions in a bid to boost the plummeting U.S. economy as early as Easter Sunday, April 12, setting up a standoff with state officials who have said they can’t risk it.

“The federal government has done guidelines. And then states can follow the guidelines, states can fashion the guidelines to fit their specific circumstances,” New York Gov. Andrew Cuomo said. “What works for New York isn’t necessarily going to work for Tulsa or San Antonio. The federal government isn’t saying we mandate anything.”

Laws spelling out what steps a state can take during a pandemic can be complex and difficult for judges to sort through. Some haven’t been updated in decades, according to a report by the Congressional Research Service.

And they also differ state to state. The maximum penalty in most states if someone violates mandatory quarantines — often backed by a court order — is no more than a year in jail. In Mississippi, it can be 10 years in some circumstances, according to the National Conference of State legislatures.

A few Americans are already fed up and have taken their grievances to court by suing their respective states. But a relative trickle of legal challenges will likely become a flood if lockdowns drag on for weeks and frustrations mount. The number of dead in the U.S. has reached 1,042 with more than 69,000 infections, and scientists warn the peak has not happened.

The Pennsylvania lawsuit filed on behalf of the Blueberry Hill Golf Club says Gov. Tom Wolf’s power to close businesses under state law is limited to man-made or natural disasters such as oil spills, tornadoes and mudslides. The coronavirus, it argues, doesn’t fall into those categories. The state has more than 1,280 cases.

For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

The state-court filing says the golf course has a short window that starts with an influx of golfers in spring to recoup costs of maintaining greens and fairways. With cash flow now cut, it may not be able to make vital bank payments, the lawsuit says.
Full Coverage: Virus Outbreak

The owner would undertake COVID-19 prevention protocols if permitted to re-open, the lawsuit said, including but not limited to “requiring golfers to walk, or if golfers wish to ride in carts, require golfers to use individual carts for each golfer.”

So far, judges have rejected the few legal challenges to state restrictions. Pennsylvania’s Supreme Court refused to freeze Wolf’s sweeping shutdown orders. In response to complaints, Wolf did ease restrictions on some businesses.

A New Hampshire court issued a similar ruling in the lawsuit by the church-goer. It upheld Gov. Chris Sununu’s ban on large gatherings, the court’s written ruling saying it couldn’t imagine a more critical public objective “than protecting the citizens of this state and this country from becoming sick and dying from this pandemic.” New Hampshire reports more than 130 cases.

But courts have never been asked whether the unprecedented lockdowns are constitutional “and in violation of individual rights,” Gostin said.

A battle all the way to the U.S. Supreme Court on that issue, he says, may be looming.

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Follow Michael Tarm on Twitter at http://twitter.com/mtarm

Aid group says Mideast lockdowns hinder humanitarian efforts

By SAMY MAGDY and JOSEPH KRAUSSMarch 25, 2020

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Medical workers oversee the disinfection of the streets to prevent the spread of coronavirus in Qamishli, Syria, Tuesday, March 24, 2020. (AP Photo/Baderkhan Ahmad)


CAIRO (AP) — An international aid group said Wednesday that closures aimed at containing the coronavirus pandemic are preventing it from reaching 300,000 people in conflict zones across the Middle East, as the virus arrived in war-torn Libya and case counts rose in Syria and the Gaza Strip, among the world’s most vulnerable places.

The Norwegian Refugee Council said it was unable to reach people in Syria, Yemen and the Gaza Strip, where authorities have imposed strict measures to halt the spread of the virus. All have fragile health care systems that could be overwhelmed by an outbreak, and only Yemen has yet to report any cases.

“While governments are taking tough and much-needed measures to prevent the spread of coronavirus, millions of refugees and displaced people still depend on humanitarian assistance,” said Jan Egeland, head of the aid group.

In northwestern Syria, hundreds of thousands of people are crammed into unsanitary tent camps, sheltering from the government offensive on the war-torn country’s last rebel stronghold. On Wednesday, the U.S. urged the Syrian government to halt its campaign so those displaced can access humanitarian aid. The U.S. also urged the Assad government to release thousands of civilians arbitrarily detained in crowded jails who are especially vulnerable to the virus. On Wednesday, Syria’s tally of cases rose to five and testing began after weeks of obstacles in the rebel-held province.

The crowded Gaza Strip reported seven new coronavirus late Wednesday among security workers, raising the total to nine and stoking concerns about the capacity of its weakened health system to manage coronavirus patients. Gaza has been under Israeli-Egyptian blockade since the Hamas militant group took power in 2007.

For most people, the new coronavirus causes mild or moderate symptoms that clear up in two weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness. The virus is highly contagious and can be spread by those showing no symptoms.

Countries across the Middle East have imposed sweeping measures to prevent its spread, including closing their borders, canceling flights and in some cases imposing round-the-clock curfews.

In Syria, an open-ended nightly curfew took effect Wednesday at 6 p.m. local time (1600 GMT). State TV showed police patrolling the empty streets of Damascus and other main cities.

The Israeli government Wednesday approved new restrictions, including the closure of all synagogues. Many in Israel’s insular ultra-Orthodox communities have defied restrictions on public gatherings, fueling tension with authorities.

Twenty-nine percent of those who contracted the virus in Israel were infected in a synagogue or a yeshiva, according to an analysis by the National Information and Knowledge Center for the Fight Against the Coronavirus, which has been advising the Health Ministry.

The new restrictions in Israel will bar most people from venturing more that 100 meters (yards) from their homes. More than 2,369 Israelis have been infected, with 39 in serious condition. Five elderly Israelis with pre-existing medical conditions have died. In a televised address, Israeli Prime Minister Benjamin Netanyahu urged citizens to obey the stringent guidelines and warned of the need for a total lockdown if the outbreak doesn’t slow.

The Palestinian Authority, which governs parts of the Israeli-occupied West Bank, has ordered a full lockdown and halted travel between cities, towns and villages. Sixty-two cases have been reported in the West Bank along with the nine in Gaza. A 60-year-old woman became the West Bank’s first fatality Wednesday. She was infected by her son, who caught the virus while working in Israel, according to the Palestinian Authority.

At least 3,000 workers came home to the West Bank on Wednesday, said Shahir Saed, head of the workers union, after the Palestinian leadership ordered all 65,000 Palestinian workers to return to the West Bank from Israel. Wages in Israel are much higher than in the Palestinian territories, where decades of Israeli military rule has hindered economic development.

In Libya, authorities tracked down and quarantined dozens of people who had come into contact with the country’s first confirmed case, a 73-year-old man who entered from neighboring Tunisia on March 5 after traveling to Saudi Arabia. Health officials said he was in stable condition.

Libya has been mired in chaos since the 2011 uprising that overthrew and killed longtime dictator Moammar Gadhafi. It is governed by rival authorities based in Tripoli and eastern Libya whose forces have been battling over the capital for nearly a year. The capital’s suburbs came under heavy fire even as the United Nations appealed for a truce so authorities could focus on the pandemic.

Meanwhile, the eastern city of Benghazi began a two-week lockdown Wednesday, although authorities have allowed residents to buy food and medicine for two hours each morning.

Streets in Egypt, the Arab world’s most populous country, emptied Wednesday at 7 p.m. as a nationwide nighttime curfew took effect. President Abdel Fattah el-Sissi appealed to citizens on social media to stay inside and “preserve our safety.” Egypt has confirmed 456 cases and 22 fatalities, including two senior military officers who were involved in efforts to disinfect public places.

Iran is battling the worst outbreak in the region, with over 27,000 confirmed cases and a death toll of at least 2,077. Authorities have advised people to stay at home but have not imposed the kinds of lockdowns seen elsewhere. State television aired footage of people thronging the streets Monday night, ignoring social-distancing warnings. President Hassan Rouhani imposed new restrictions on parks, saying he was left with “no other choice.”

War-ravaged Afghanistan imposed a lockdown on its western Herat province, which borders Iran and where the largest number of cases has been detected. Afghan authorities have reported 76 cases and two deaths. The NATO-led coalition in Afghanistan has reported four cases among soldiers who recently arrived in Kabul.

Saudi Arabia, meanwhile, expanded its curfew hours in the cities of Mecca and Medina, home to Islam’s holiest sites, as well as the capital, Riyadh. Residents now must remain inside their homes from 3 p.m. to 6 a.m. The kingdom, which has reported 900 cases, also banned travel between three governorates.

As community transmission appears to take off in Pakistan, which has confirmed 1,000 cases and seven deaths, the country halted all domestic passenger flights beginning Thursday.

Abu Dhabi’s Etihad carrier, one of the biggest in the Middle East, said it has had to cut salaries by 25-50% due to the grounding of its passenger flights.

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Associated Press writer Samy Magdy reported this story in Cairo and AP writer Joseph Krauss reported from Jerusalem. AP writers Aron Heller in Jerusalem; Munir Ahmed in Islamabad; Jon Gambrell and Aya Batrawy in Dubai, United Arab Emirates; Jan M. Olsen in Copenhagen, Denmark; Mohammed Daraghmeh in Ramallah, West Bank; Nasser Karimi in Tehran, Iran; and Tameem Akhgar in Kabul, Afghanistan, contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

As offerings dwindle, some churches fear for their future

By DAVID CRARY March 21, 2020

The Rev. Alvin J. Gwynn Sr., of Friendship Baptist Church in Baltimore, sits in his church's sanctuary, Thursday, March 19, 2020. He bucked the cancellation trend by holding services the previous Sunday. But attendance was down by about 50%, and Gwynn said the day’s offering netted about $5,000 compared to a normal intake of about $15,000. “It cuts into our ministry,” he said. “If this keeps up, we can’t fund all our outreach to help other people.” (AP Photo/Steve Ruark)


NEW YORK (AP) — As in-person worship services are canceled or downsized amid the coronavirus outbreak, some churches across the U.S. are bracing for a painful drop in weekly contributions and possible cutbacks in programs and staff.

One church leader, Bishop Paul Egensteiner of the Evangelical Lutheran Church in America’s Metropolitan New York Synod, said some of the 190 churches in his region were unlikely to survive because of a two-pronged financial hit. Their offerings are dwindling, and they are losing income from tenants such as preschools which can no longer afford to rent church venues.

“As much as I’d like to help them, everybody’s reserves are taking a hit because of the stock market,” Egensteiner said,

At Friendship Baptist Church in Baltimore, a mostly African American congregation of about 1,100, the Rev. Alvin Gwynn Sr. bucked the cancellation trend by holding services last Sunday. But attendance was down by about 50%, and Gwynn said the day’s offering netted about $5,000 compared to a normal intake of about $15,000.

“It cuts into our ministry,” he said. “If this keeps up, we can’t fund all our outreach to help other people.”

There was a brighter outcome at the Church of the Resurrection, a large United Methodist Church congregation that operates out of five locations in the Kansas City area.

Cathy Bien, the church’s communications director, said about 25,700 people logged in to join online worship last Sunday after in-person services were canceled. That compared to normal Sunday participation of 14,000 worshippers -– 8,000 in person and 6,000 online.

“It blew our minds,” Bien said. “They were coming from all over the country -– a lot of Methodists from other churches.”

The huge turnout didn’t translate into a larger than normal offering, although the church is still processing checks that were sent by some of the worshippers, Bien said. She expressed hope that financial support will remain robust as the church stresses the need to bolster food pantries and other community programs in the face of COVID-19.

At Trinity Presbyterian Church in Charlottesville, Virginia, giving was down modestly last weekend as the church cancelled in-person worship and made the service available online.

The pastor, Walter Kim, said some of his roughly 1,000 congregants have grown accustomed to online giving in recent years, but many worshippers still give in person at the services - an option not available for now.


“We’ll be asking them to sign up (for online giving) or mail a check,” said Kim. He will be urging congregants to bolster the church’s “mercy fund” for use assisting hard-up members of the community as job losses multiply.

In addition to his pastoral duties Kim is president of the National Association of Evangelicals, which represents more than 45,000 evangelical churches. The NAE will be co-hosting a two-day digital summit next week featuring videos from church leaders advising other pastors nationwide how to respond creatively and effectively to the virus outbreak.

The co-host is the Humanitarian Disaster Institute at Wheaton College in Illinois, which already has offered resources to churches in response to COVID-19.

“Some changes are going to be required,” Kim said. “The church is a very creative institution. In the end it will find ways of fulfilling its mission.”

In Western Massachusetts, the Roman Catholic Diocese of Springfield has indefinitely cancelled all public Masses, and recently rescinded permission for parishioners to pray individually at their churches.

Funeral Masses were still allowed with a maximum attendance of 25; the diocese said the times of those Masses were not to be shared in the media,

“Lack of access to the churches and Eucharist is particularly difficult for many older parishioners whose entire daily routine is built around getting up, out of the house, and going to Mass,” said the Rev. Mark Stelzer, who has served in the diocese as a parish priest and college chaplain.

The Rev. William Tourigny, pastor of Ste. Rose de Lima Church in Chicopee, Massachusetts, said his parish had a solid financial foundation and expected it could maintain all programs and staff payroll for the time being.

“For smaller faith-based communities with little or no reserved funds, difficult decisions will need to be made,” he said.

Joe Wright, executive director of the Bivocational and Small Church Leadership Network in Nashville said many pastors in the network have been holding regular in-person services, while monitoring the spread of the virus.

“Once the coronavirus rises to the level where it starts hitting smaller groups, then we’ll see even the smaller groups back away and seek ways to gather, probably electronically,” he said.

When that happens, Wright said, financial giving will depend on the church, especially the age of the congregations.

“Some churches with older congregations do not give electronically so the transition to that will be a little bit harder,” he said.

Ron Klassen, executive director of Rural Home Missionary Association, said it’s too early to say how the rural churches he represents are being impacted.

“My sense is that in the past, people rise up and, if anything, the giving might increase,” he said. “People are going to give. They’ll take care of their church and their community.”

In Baltimore, pastor Gwynn worries that tensions might rise past the point that church outreach programs can help.

“With all the uncertainty, I’m afraid this could turn into anarchy,” he said. “Not everybody’s patient. Not everybody’s law abiding.”

He even envisioned the possibility of a stampede toward the goods being doled out after church’s annual food drive.

“My biggest fear right now is what’s happening to the minds of our people,” Gwynn said. “How long can we hold them together?’

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AP Religion Editor Gary Fields contributed.

Ethanol plants seek rule changes to resupply hand sanitizer

By DAVID PITT March 26, 2020

FILE— In this Jan. 28, 2014 file photo a jar of ethanol fuel sits on display during the Iowa Renewable Fuels Association meeting in Altoona, Iowa. As hospitals and nursing homes run out of hand sanitizer to fight off the coronavirus, struggling ethanol producers are eager to help. They could provide alcohol to make millions of gallons of the germ-killing sanitizer, but the U.S. Food and Drug Administration has put up a roadblock, frustrating both the health care and ethanol industries with its inflexible regulations during a national health care crisis. (AP Photo/Charlie Neibergall, file)

DES MOINES, Iowa (AP) — As hospitals and nursing homes desperately search for hand sanitizer amid the coronavirus outbreak, federal regulators are preventing ethanol producers from providing millions of gallons of alcohol that could be transformed into the germ-killing mixture.

The U.S. Food and Drug Administration’s roadblock has been frustrating the health care and ethanol industries, which have been calling for a relaxed regulation to deal with the public health care emergency.

“Hand sanitizer is a big part of our lives,” said Eric Barber, CEO of Mary Lanning Healthcare, a hospital in Hastings, Nebraska. “We can’t get any. We order it and it’s just not available.”

The problem for the ethanol industry is that most plants make food-grade ethanol, one step below the highest pharmaceutical grade. But since the plants aren’t certified to comply with stringent production standards designed to protect quality of medicines, food ingredients and dietary supplements, the FDA doesn’t want the alcohol used for a product to be applied to the skin.
FILE - In this Jan. 6, 2015 file photo steam blows over the Green Plains ethanol plant in Shenandoah, Iowa. As hospitals and nursing homes run out of hand sanitizer to fight off the coronavirus, struggling ethanol producers are eager to help. They could provide alcohol to make millions of gallons of the germ-killing sanitizer, but the U.S. Food and Drug Administration has put up a roadblock, frustrating both the health care and ethanol industries with its inflexible regulations during a national health care crisis. (AP Photo/Nati Harnik, file)

In addition, the alcohol is not denatured or mixed with a bitter additive to make it undrinkable. The FDA insists this step is “critical” because of cases of poisoning, sometimes fatal, among young children who have accidentally ingested hand sanitizers.

An FDA spokesman said Thursday that regulators have already seen a rise in poisonings linked to hand sanitizers in recent weeks, “heightening this public concern.”

The FDA is also skeptical of industry claims that undenatured sanitizers could be distributed in a way that would keep them away from children.

“It is unclear what, if any, measure could be instituted to ensure that the product does not make its way into consumer hands, where children could have access,” FDA’s Jeremy Kahn said in an emailed statement.

Facing a nationwide shortage, Barber said the FDA should temporarily relax regulations to allow alternative production.

“You’re talking about alcohol. Does it matter if it’s fuel grade or whatever the stuff is they’re trying to price gouge now? I think its common sense,” he said.

The American Hospital Association encouraged flexibility to help protect patients and caregivers, without directly weighing in on the sanitizer dispute.

“We may need to consider a range of possible solutions that were not on the table before the pandemic,” said Nancy Foster, a vice president with the group, in an emailed statement to the AP.


The Consumer Brands Association, formerly the Grocery Manufacturers Association, has had conversations with the FDA to push the agency to reconsider its guidelines. The group, which represents branded food, consumer products and beverage companies, said that hand sanitizer supplies are running so low that its members have had to ration it out to workers in stores, distribution centers and manufacturing plants.

“We need a temporary solution,” said Mike Gruber, vice president of regulatory and technical affairs at the trade association. “This goes toward ensuring basic food safety practices.”

Distillers that produce vodka, whisky and other alcoholic drinks have been given some regulatory waivers by the Alcohol and Tobacco Tax and Trade Bureau allowing them to produce hand sanitizer. Many have done that, but they produce much smaller volumes of alcohol than an ethanol plant could produce. They also receive a benefit in the Senate-passed stimulus bill.

The Distilled Spirits Council of the United States, which represents dozens of large and small distillers, applauded Congress for easing taxes on distillers who make hand sanitizer.

Under the stimulus package passed late Wednesday, distillers don’t have to pay federal excise taxes on alcohol used for hand sanitizer through Jan. 1, 2021.

“Hundreds of U.S. distillers are stepping up to produce hand sanitizer and they should not be hit with a huge tax bill for producing this much-needed item, especially at a time when so many of them are struggling,” said Chris Swonger, the group’s president and CEO.

But the council said it’s urging the FDA to update its guidance and let distillers use undenatured alcohol for hand sanitizer. The stimulus bill requires distillers to follow the FDA’s guidance if they want to receive the tax breaks.

The FDA has waived dozens of regulations in recent weeks to boost production of key medical supplies, including coronavirus tests, ventilators, gloves and hand sanitizers.

Under the latest FDA guidelines, regulators maintain standards for alcohol, requiring new producers to use alcohol that meets federal or international standards for use in either drugs or food products.

The regulatory hurdles are especially frustrating for Midwest ethanol producers who are facing plunging fuel demand and a petroleum fight between Saudi Arabia and Russia that caused prices to plummet. The factors are forcing more plants to curtail production and close.

For ethanol producers relaxed rules, including a requirement of the hard-to-acquire denaturant, would allow them to step in an help in a national emergency.

“If we could get the FDA to say yes you can use the beverage grade and for the duration of this emergency at least for some point in time here for the next two weeks you can waive the denaturant we would literally have millions of gallons of hand sanitizer available within a matter of days,” said Monte Shaw, CEO of Iowa Renewable Fuels Association, an ethanol trade group. “Every one of our plants has gotten contacted by people who want this stuff and we can’t send it to them.”

Andrew Vrbas owner of Pacha Soap, a boutique soap shop in Hastings, Nebraska, had just finished renovating a 100,000-square-foot former bread factory as a project to boost the community. Now, he’s preparing to set up hand sanitizer production there to supply to hospitals. He’s received calls from hospitals in Nebraska, Florida and New York City seeking hand sanitizer.

“We are literally three miles from a plant that has as much ethanol as you could imagine,” he said. “We’re sitting on millions of gallons of alcohol. If we could rally the federal government to say look if you just let us work with local ethanol producers we have the expertise, we have the ability to provide hand sanitizer to hospitals not only in Nebraska but all across the country that are just reaching out through my network saying if you could send us hand sanitizer, we’re out.”

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Retail Writer Anne D’Innocenzio contributed from New York City, Health Writer Matthew Perrone from Washington and Auto Writer Dee-Ann Durbin from Ann Arbor, Michigan.

Giant Hawaii telescope cost estimate increases to $2.4B
By JENNIFER SINCO KELLEHER March 17, 2020

FILE - In this July 19, 2019, file photo, protesters continue their opposition vigil against the construction of the Thirty Meter Telescope at Mauna Kea in Hawaii The cost to build a giant telescope that's unpopular among many Native Hawaiians is now estimated to have ballooned by a billion dollars. "While an exact updated project cost will depend on when and where on-site construction begins for the Thirty Meter Telescope, the latest estimate for the TMT project is in the range of $2.4 billion in 2020 dollars," Gordon Squires, TMT vice president, said in a statement this week. Construction of one of the world's largest telescopes on Hawaii's tallest mountain, Mauna Kea, has been stalled by foes of the embattled project who say the telescope will desecrate land held sacred to some Native Hawaiians. (Bruce Asato/Honolulu Star-Advertiser via AP, File)

HONOLULU (AP) — The cost to build a giant telescope that’s unpopular among many Native Hawaiians is now estimated to have ballooned by a billion dollars.

“While an exact updated project cost will depend on when and where on-site construction begins for the Thirty Meter Telescope, the latest estimate for the TMT project is in the range of $2.4 billion in 2020 dollars,” Gordon Squires, TMT vice president, said in a statement this week.

Construction of one of the world’s largest telescopes on Hawaii’s tallest mountain, Mauna Kea, has been stalled by foes of the embattled project who say the telescope will desecrate land held sacred to some Native Hawaiians.

Protesters have stopped construction from going forward since mid-July.

“The increase of nearly one billion dollars is due to the delay in starting on-site construction in Hawaii, as well as inflation and world market cost increases for some construction items,” Squires said. “We will not know the true cost of the project until we finalize a construction site and do an analysis.”

Telescope officials have selected an alternate location in Spain’s Canary Islands if it can’t be built in Hawaii.

Hawaii is still the preferred site, regardless of the cost increase, Squires’ statement said.

TMT International Observatory Executive Director Edward Stone said each of the project’s partners, which includes Canada, India, Japan and China, would have to agree to go to the Canary Islands, the New York Times reported last week.

“We’re not there yet,” he said, though some partners were already willing to move while others wanted to wait and see what happens in Hawaii.

A final decision on the site was a few months away, said Gary Sanders, project manager for the telescope, according to the newspaper.

Japan suspended its yearly funding for the project. But it isn’t pulling out of participation.



Hawaii telescope protesters leave camp due to virus concern


FILE - In this Sunday, July 14, 2019, file photo, the sun sets behind telescopes at the summit of Mauna Kea. Opponents of the Thirty Meter Telescope project on Hawaii island have left their camp because of concerns over the spread of the coronavirus. The Honolulu Star-Advertiser reports the move came after more than eight months of nonviolent protests at the base of the Mauna Kea Access Road. (AP Photo/Caleb Jones, File)


HONOLULU (AP) — Opponents of the Thirty Meter Telescope project on Hawaii’s Big Island have pulled out of their camp due to concerns over the spread of the coronavirus.

The move came after more than eight months of nonviolent protests at the base of the Mauna Kea Access Road, The Honolulu Star-Advertiser reported Thursday.

Construction of one of the world’s largest telescopes on Hawaii’s tallest mountain, Mauna Kea, has been stalled by project opponents who say the telescope will desecrate land considered sacred by some Native Hawaiians.

The large tents erected last year as a warehouse, kitchen and instructional area were removed and protest supporters were asked to leave, protest leader Andre Perez said Wednesday.

“Because of the concern for human health and safety, we’ve decided to leave,” Perez said. “We feel that there’s no imminent threat from TMT, that’s our assessment, and so human health and safety is paramount for us.”

Protesters posted videos on social media saying medical professionals advised them to reduce travel and “stay in our bubbles and remain home” until the coronavirus threat passes.

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.

Protesters successfully blocked the access road for more than five months. Law enforcement officials arrested 39 protesters on July 17 for obstructing the road during nonviolent demonstrations but never made another attempt to clear the road.

FILE - In this July 14, 2019, file photo, native Hawaiian activists gather at the base of Hawaii's Mauna Kea. Opponents of the Thirty Meter Telescope project on Hawaii island have left their camp because of concerns over the spread of the coronavirus. The Honolulu Star-Advertiser reports the move came after more than eight months of nonviolent protests at the base of the Mauna Kea Access Road. (AP Photo/Caleb Jones, File)

Hawaii County Mayor Harry Kim pledged in December there would be no police effort to remove protesters from the mountain and convinced telescope opponents to move tents and other equipment off the road.

Construction has not advanced since then because protesters continued to camp near the road and hold demonstrations.

Perez does not expect the departure of protesters will prompt officials to restart the project in the near future, although no promises were made.

“We have not gotten any pledges or any confirmation or agreement with them at all,” Perez said.

He added: “We’re confident that they’re not going to move with TMT during this time of pandemic crisis.”

AP NEWS

Plague as art: Over the centuries, many kinds of stories
By HILLEL ITALIE March 22, 2020

This combination of photos shows, from left, "The End of October," by Lawrence Wright, "The Red Lotus," by Chris Bohjalian and "Afterland" by Lauren Beukes. Novels coming out now and written before the coronavirus pandemic use plagues to explore everything from gender roles to our own failure to anticipate the worst. (Knopf, from left, Doubleday, Mulholland Books via AP)


NEW YORK (AP) — Lauren Beukes, a script and fiction writer, is drawn to narratives that allow her to probe themes of gender and power. For her upcoming novel, “Afterland,” she imagined a plot twist in which a disease wipes out virtually the entire male population.

“I wanted to explore what a world without men would look like and how it wouldn’t necessarily be a better place with everyone making friendship bracelets and growing communal gardens and walking at night,” says Beukes, who began her book years before the current coronavirus pandemic.

Lawrence Wright, the Pulitzer Prize-winning author and journalist, says his new novel was inspired by a question the filmmaker Ridley Scott asked him years ago after reading Cormac McCarthy’s dystopian “The Road”: How could social order break down so completely when we’re struck by sudden disaster? His upcoming thriller “The End of October” describes, uncannily, a global pandemic originating in Asia. He had meant his new book as a cautionary tale.


“Our society has grown blind about dealing with natural hazards because we were so worried about terrorism. Hurricane Harvey caused far more damage than a terrorist attack,” says Wright, known for his nonfiction book “The Looming Tower: Al-Qaeda and the Road to 9/11.”

Plagues have been with us for at least as long as people have been able to record them. But among those who create art, their meaning has changed profoundly according to the time and the teller.

Once regarded as divine punishment, they have served as parables of greed, tyranny and scientific hubris. They have underscored narratives of escapism, vulnerability and save-the-world heroism. They have been treated as catalysts for what we never imagined becoming — and for confirmation of what we were all along.

—For the ancient Greek historian Thucydides, the plague that devastated Athens affirmed his view that prayers were “useless” and his dire belief that laws and codes of honor were easily abandoned.

—Edgar Allan Poe condemned a heartless prince and his foolish belief that he was immune from disease in “The Masque of the Red Death.”

—In Stephen King’s “The Stand,” biowarfare and a careless military are central villains.

—Stephen Soderbergh rejected any political interpretation of his film “Contagion,” saying that the virus in it “was just a virus.” Yet he told The Guardian in 2011 that he did want to “convey the feeling” he sensed worldwide “that the fabric of society really is stretched thin.”


This combination of photos shows the cover of the novel "Afterland," left, and a portrait of author Lauren Beukes. Novels coming out now and written before the coronavirus pandemic use plagues to explore everything from gender roles to our own failure to anticipate the worst. (Mulholland Books, left, and Tabitha Guy via AP)

In some eras, little imagination was needed to picture the worst — and hope for the best. Tony Kushner’s epic play “Angels in America” was a defining chronicle of the wreckage of AIDS. The Black Plague of the Middle Ages inspired both terrifying art of ravaged bodies and dancing skeletons and images of Saint Sebastian and Saint Roch intended to console.

“Saint Sebastian had survived being shot with arrows, and Saint Roch was believed to have survived an episode of the plague, so you often see them appearing in art,” says C. Griffith Mann, who curates the Department of Medieval Art at the Metropolitan Museum of Art.

A classic work of literature from the Middle Ages, Boccaccio’s “The Decameron,” reads in some ways as a guide to social distancing and self-isolation. Seven young women and three young men escape from the plague in Florence and live together in a villa, where they entertain each other by telling stories.

“I think Boccaccio anticipated what we would/could do in the time of the plague: We need to escape from our ‘real’ world in which our misery has no explicable cause, no identifiable beginning, and no end in sight,” says Wayne A. Rebhorn, who chairs the English department at the University of Texas at Austin.

“Many of the stories include stories within them — stories used by characters to get out of jams, persuade others to do their bidding, and, at the simplest level, entertain those who read or listen to them. If the plague shows just how desperate and fragile human life can be, stories offer a way to cope with that desperation.”

This combination of photos shows a portrait of Lawrence Wright, left, and the cover of his novel "The End of October." Novels coming out now and written before the coronavirus pandemic use plagues to explore everything from gender roles to our own failure to anticipate the worst. (Kenny Braun, left, and Knopf via AP)

Plague books can be a way of tracking other changes in society. The 1665 plague in London was the basis for Daniel Defoe’s “A Journal of the Plague Year,” which was published decades later and was noted for its detailed account of the city’s ordeal. Defoe scholar and Auburn University professor Paula Backscheider notes that his book came out at a time when the Renaissance had challenged religious beliefs, and that for the author the London plague was a way of looking beyond religious reasons for human suffering.

“He is grippingly driven to try to decide if the plague is the will of God,” Backscheider says, “or if there are scientific explanations that would explain how it started and spread, how people could protect themselves from it, and how it might be treated humanely and effectively.”

In the 20th century, Albert Camus’ “The Plague” was widely seen as a parable for the Nazi occupation of France and the eventual liberation — and as a statement on the randomness of fate. Katherine Anne Porter’s “Pale Horse, Pale Rider” was inspired by the flu epidemic of 1918-1919 that killed millions at the same time that World War I, which killed millions more, was ending. She published the short novel in 1939, as a new world war began.

“Her illness is grounded in a real influenza pandemic, but because her illness is associated with the war (it ends with the Armistice), it symbolizes the spiritual malaise of the 20th century,” says Dorothy Unrue, a Porter scholar who edited a volume of her work for the Library of America.

(Doubleday, left, and Victoria Blewer via AP)

Chris Bohjalian’s new novel, “The Red Lotus,” has just been published. The author looks for stories about “heartbreak and dread” and thought of a pandemic — an idea he developed after reading an article about mice carrying viruses resistant to treatment. In his book, rats are the carriers of diseases, although people are the real villains.

“I don’t view the possible pandemic in the novel as a metaphor,” he says. “(But) a pathogen doesn’t attack a human with conscious malice. But humans? We are all too conscious of the carnage we can inflict on one another.”

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Follow AP National Writer Hillel Italie on Twitter at @hitalie.

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Follow AP coverage of the virus outbreak at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

Virus coordinator Birx is Trump’s data-whisperer

By RICARDO ALONSO-ZALDIVAR and AAMER MADHALAN



FILE - In this March 20, 2020, file photo President Donald Trump listens as White House coronavirus response coordinator Dr. Deborah Birx speaks during a coronavirus task force briefing at the White House in Washington. Birx has emerged as one of the most important voices in the administration’s response to the coronavirus pandemic, spelling out the implications of the virus in personal terms while attempting to reassure Americans that it is centering its response to the pandemic with a data-driven mindset. (AP Photo/Evan Vucci, File)


WASHINGTON (AP) — For many in the public health and political worlds, Dr. Deborah Birx is the sober scientist advising an unpredictable president. She’s the data whisperer who will help steer President Donald Trump as he ponders how quickly to restart an economy that’s ground to a halt in the coronavirus pandemic.

Others worry that Birx, who stepped away from her job as the U.S. global AIDS coordinator to help lead the White House coronavirus response, may be offering Trump cover to follow some of his worst instincts as he considers whether to have people packing the pews by Easter Sunday.


In coming days, immunologist Birx will be front and center in that debate along with the U.S. government’s foremost infection disease expert, Dr. Anthony Fauci, as well as Vice President Mike Pence. Birx will bring to the discussion what she fondly refers to as her sheet music — data on testing, mortality, demographics and much more.

“What the president has asked us to do is to assemble all the data and give him our best medical recommendation based on all the data,” Birx told reporters. “This is consistent with our mandate to really use every piece of information that we can in order to give the president our opinion that’s backed up by data.”

But will Trump listen?

The president has sent mixed messages on that. He plans to meet with the two doctors and Pence on Monday to review the latest data on the spread of the disease. His administration’s original 15-day guidelines promoting social distancing expire Tuesday.

Over a matter of weeks, Trump has veered from playing down the virus threat to warning Americans it could be summer before the pandemic is under control. And in more recent days, he’s talked eagerly about having parts of the country raring back by Easter in two weeks.

As the president’s message has vacillated, Birx has emerged as one of the most important voices laying out the administration’s pandemic response. She has a way of spelling out the implications of the virus to Americans in personal terms while offering reassurances that the administration is approaching the pandemic with a data-driven mindset.

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death.

Former Health and Human Services Secretary Kathleen Sebelius, who helped shepherd Birx’s ambassadorial nomination through the Senate in the Obama administration, said it’s like Birx and Fauci have become a tag team for science in the midst of calamity.

“I can’t imagine how complicated it is to have a boss –- if you will — who insists on saying things on a regular basis that are just not true and aren’t based on any science,” Sebelius said.


In her public comments, Birx has taken pains to avoid publicly contradicting Trump when he’s offered some decidedly unscientific riffs, unlike Fauci, a professional mentor, who has been known to push back pointedly.

Instead, her messaging has toggled between providing digestible interpretations of what the data is saying about the spread of the virus and offering relatable pleas to the American public to practice social distancing to help stem the disease.

In recent days, Birx has received praise from Trump backers and pushback from some fellow scientists after she minimized what she called “very scary” statistical modeling by some infectious disease experts.

One study, published this month by Harvard University epidemiologists, found that the need to maintain social distancing remains crucial in the weeks ahead to prevent the American healthcare system from becoming overwhelmed by new cases.

“The scenario Dr. Birx is ‘assuring’ us about is one in which we somehow escape Italy’s problem of overloaded healthcare system despite the fact that social distancing is not really happening in large parts of the US,” Marc Lipsitch, a co-author of the study, wrote on Twitter.

Birx also has drawn criticism for asserting that there are still beds in intensive care units and a “significant” number of ventilators available in hospitals around New York City -- the area hardest hit by virus. That message doesn’t jibe with the dire warnings of city hospital workers, who in recent days have said they’re ill-equipped and in danger of being overwhelmed by patients stricken with the virus.

Birx’s friends and colleagues say she is one of the adults in the room who is providing the president with clear-headed advice and giving Americans the information they need to stay safe.

“She’s a tough cookie,” said Michael Weinstein, who heads the AIDS Healthcare Foundation and got to know Birx professionally after she was named the global AIDS coordinator in 2014. “She’s 100% about the data.”

In the sea of men in dark suits who have been appearing with Trump for daily briefings, the 63-year-old mother of two with a fondness for colorful scarves stands out. Her seemingly endless scarf collection was even fodder for comedian Paula Poundstone recently on the NPR quiz show “Wait Wait...Don’t tell me!”

Birx’s resume is impressive: She is a U.S. Army physician and recognized AIDS researcher who rose to the rank of colonel, head of the global AIDS program at the Centers for Disease Control and Prevention, and a rare Obama administration holdover as the State Department’s ambassador-at-large leading a U.S. taxpayer-funded worldwide campaign to stop the spread of HIV/AIDS.

Birx has also developed a reputation as a tough boss. Some who fall under her watch at the global effort known as PEPFAR have complained that the leadership of her office has been“dictatorial” and “autocratic,” according to a State Department Office of Inspector General audit released earlier this year.

“She has somewhat of a reputation of being a hard task-master,” said John Auerbach, head of the nonprofit Trust for America’s Health.. “She is incredibly hard-working, someone who was driven and would drive other people to work really hard and to do their best work.”

Birx has also been perhaps the most outspoken in calling for Americans to be mindful in how they are interacting with others. And she’s made the case in personal terms.

The doctor says she’s avoided visiting with her young grandchildren as she practices social distancing, and she’s spoken in admiring tones of her two millennial daughters when making the case that younger Americans’ actions will play a key role in determining how quickly the country can contain the virus.

She also has spoken of her grandmother living with a lifetime of guilt, because she caught the flu at school as a girl and, in turn, infected her mother — one of an estimated 50 million people worldwide who died in the 1918 influenza epidemic.

“She never forgot that she was the child that was in school that innocently bought that flu home,” Birx said of her grandmother.

Birx, who declined to be interviewed for this article, told a Christian TV network popular with Trump’s evangelical base that she’s confident that the president is, like her, a student of data.

“He’s been so attentive to the scientific literature and the details and the data,” Birx told CBN. “I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues because in the end, data is data.”


SEE https://plawiuk.blogspot.com/2020/03/she-drank-kool-aid-viewers-baffled-as-dr.html