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Coronavirus Today: Plans for a worst-case scenario

Good evening. I’m Diya Chacko, and it’s Tuesday, April 21. Here’s what’s happening with the coronavirus outbreak in California and beyond.

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Five weeks into California’s coronavirus restrictions, several counties are looking to relax their stay-at-home policies. As some more rural counties like San Luis Obispo see virus cases decline more dramatically than areas like Los Angeles and San Diego, officials want the state’s blessing to begin “a science-based, thoughtfully phased reopening of our economy.” But Gov. Gavin Newsom suggested on Tuesday that he won’t allow local rules that are weaker than statewide ones. “I imagine there’ll be some examples of people just getting ahead of that collaborative spirit,” he said. “And we may have to dial a little bit of that back.”

In fact, California public health officials are still planning for a “worst-case scenario.” They have quietly published a sobering set of detailed guidelines to answer the troubling ethical question of who lives and who dies should a new surge of severe cases lead to a shortage of ventilators and supplies. The guidelines prescribe a method to prioritize patients in the event that an outbreak overwhelms hospitals, preserving ventilators and beds in intensive care units for people deemed most likely to survive treatment. If necessary, younger people and workers who are “vital to the acute care response” would receive care before others.

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While doctors have long been given autonomy to decide which patients should be offered coronavirus tests, they faced pressure from hospital administrators — citing guidelines from the federal Centers for Disease Control and Prevention — to save testing tools for the sickest. But now California health officials have partially lifted restrictions on who should get tests, recommending for the first time that asymptomatic people living or working in high-risk settings such as nursing homes, prisons and even some households should now be considered a priority. Some experts see the developments as a major step toward establishing widespread testing to identify and isolate every coronavirus case.

But just as when the diagnostic tests were first rolled out, there’s a shortage of serology tests that look for antibodies in the blood of those suspected to have recovered from COVID-19. And while scientists are hopeful the presence of antibodies brings some immunity, no one yet knows how long it could last or if it’s possible to get the virus more than once. That makes it difficult to know what the antibody tests mean, and how to manage public expectations.

As forensic virologists search to uncover the origins of COVID-19, bats have been fingered as a likely source. But some bat lovers and scientists say there is no proof that the coronavirus jumped from the winged mammals to people. Instead, they are concerned about the reverse — that people could spread the disease to bats.

Wild animals have seemed to be reclaiming territory in urban areas of L.A. as people shelter at home. On message boards, residents are tracking the movements of coyotes hunting for prey along quiet streets; others are sharing snapshots of hawks and owls nesting in city parks and of raccoons and rats raiding trash cans. Wildlife biologists, however, say this rich urban ecosystem has been here all along.

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For nature lovers who miss the outdoors, the National Park Foundation has posted a Parks at Home page to encourage people to “travel” with the aid of real-time webcams, photo galleries, online tours and recorded soundscapes. Here are some of the best places to visit from home, as recommended by Travel editor Mary Forgione.

By the numbers

California cases and deaths as of 5 p.m. PDT Tuesday:

Track the latest numbers and how they break down in California with our graphics.

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Where is the coronavirus spreading?

Confirmed COVID-19 cases by country as of 5 p.m. PDT Tuesday, April 21. Click to see the map from Johns Hopkins CSSE.
Confirmed COVID-19 cases by country as of 5 p.m. PDT Tuesday, April 21. Click to see the map from Johns Hopkins CSSE.
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Across California

County health officers in California have immense power to act in the interest of public health without first securing permission from the governor or mayors or county supervisors. This decades-long arrangement stems from the early days of the AIDS epidemic, and it’s why Bay Area health officers were able to issue the nation’s first lockdown orders that likely saved thousands of lives and charted the course for much of the U.S.

L.A. County officials confirmed 1,400 more coronavirus cases Tuesday, 880 of which were reported by laboratories that had not previously used the county’s electronic case reporting system. And COVID-19 could eventually become the county’s leading cause of death, if the current mortality rate of 50 deaths per day were to continue for the whole year, said the county health department’s chief science officer.

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Los Angeles Mayor Eric Garcetti said ending stay-at-home rules too soon could worsen the number of cases and deaths. The chilling story of an L.A. nurse who watched her father die from COVID-19 in her hospital illustrates what we face losing if we reopen too early.

Garcetti has called on the L.A. garment industry to step up and manufacture personal protective equipment for hospital workers still dealing with shortages. But factory workers, many of whom are undocumented or paid under the table, are facing the same sub-minimum-wage pay and poor working conditions that have been standard in the industry for years. Dozens have said their factories are putting workers at risk of infection.

Cal State Fullerton plans to begin its fall semester with online classes. It’s one of the first universities to make that move. Campuses nationwide are grappling with how long to stay closed, with most reporting staggering revenue hits from canceled housing and dining contracts. Continuing remote learning will have serious ramifications on their finances, and possibly enrollment, if students balk at paying tuition and fees without a full campus experience.

Since the outbreak has shuttered schools, curtailed medical visits and largely hidden children in their homes, reports of suspected child abuse have dropped by as much as 50% in Los Angeles County. The decline began almost immediately after California began its stay-at-home orders. “We usually have a lot of eyes and ears out there making sure children are safe. But right now we don’t know what is happening behind closed doors,” Sheriff Alex Villaneuva said Monday. He plans “to do welfare checks on our most at-risk kids with patrol personnel.”

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How to stay safe

Wash your hands for at least 20 seconds! Here’s a super-fun how-to video.
Stop touching your face, and keep your phone clean.
— Watch for symptoms including fever, cough and shortness of breath. If you’re worried you might be infected, call your doctor or urgent care clinic before going.
— Practice social distancing, such as maintaining a six-foot radius of personal space in public.
Wear a mask if you leave home for essential activities. Here’s how to do it right.
— Here’s how to care for someone with COVID-19, from monitoring their symptoms to preventing the virus’ spread.

How to stay sane

— Was your job affected by the coronavirus? Here’s how to file for unemployment.
— Here are all the ways to stay virtually connected with your friends.
— Visit our free games and puzzles page for daily crosswords, card games, arcade games and more.
— Here are some free resources for restaurant workers and entertainment industry professionals having trouble making ends meet.
— Advice for helping kids navigate pandemic life includes being honest about uncertainties, acknowledging their feelings and sticking to a routine. Here’s guidance from the CDC.

Around the nation and the world

Citing the contagion, President Trump said Tuesday he would suspend green-card applications for 60 days. The ban will cover people seeking green cards, which provide permanent legal status, but not foreign agricultural workers. The announcement after a day of confused messages does not make clear how many people could be affected, and key details could still change. Trump said he expected to sign an executive order Wednesday, but like his other efforts to bypass certain laws to restrict immigration, it is likely to face a legal challenge.

As several Southern governors began to reopen their states, some mayors are pushing back, saying they have yet to see the decline in COVID-19 cases needed to ease stay-at-home orders. After Georgia Gov. Brian Kemp said gyms, salons, tattoo parlors and bowling alleys could reopen Friday as long as customers obey social distancing guidelines, Savannah’s mayor called the order “reckless, premature and dangerous.” Atlanta’s told reporters, “I don’t see that it’s based on anything that’s logical.”

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The Senate has overwhelmingly approved a deal to increase funding for a popular small business loan program that ran out of money last week. Efforts to replenish the Paycheck Protection Program — designed to provide forgivable loans to small businesses if they keep workers on the payroll during the economic shutdown — had stalled as Democrats and Republicans argued over what else to include in the bill. The House is expected to pass the measure on Thursday, and Trump has said he will sign it.

Media reports in Japan estimate that shifting the Tokyo Olympics to the summer of 2021 could cost between $2 billion and $6 billion — unforeseen expenses arising just as Japan’s economy is hit hard by the pandemic. Now Olympic leaders and local organizers are waging a war of words amid uncertainty over who will pay for what.

Your questions answered

Today’s question comes from a reader who want to know: What is happening with the outbreaks of COVID-19 in nursing homes? Times reporters have been looking into this topic.

Nursing homes have become a tragic focal point of the coronavirus outbreak, with their elderly residents, many of whom have underlying health conditions, accounting for a large percentage of COVID-19 deaths nationwide. More than 30% of those who have died in L.A. County were residents of long-term care facilities; more than 70% of the deaths in Long Beach have been nursing home residents.

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A few days ago, California Department of Public Health officials divulged for the first time the names of nursing homes statewide with outbreaks and the number of cases at each facility. The agency’s website lists the names of 261 skilled nursing facilities with more than 3,000 positive cases among residents and staff.

The list, published late Friday, is a snapshot representing 86% of the state’s 1,224 skilled nursing facilities that had reported data within the last 24 hours, officials said. But while officials have promised to update the numbers regularly, the list does not show how many people have died at each facility and doesn’t always specify how many people have tested positive.

The Times has modified its coronavirus case tracker accordingly to include breakout information on nursing homes and assisted living centers. You can see that data here.

Got a question? Our reporters covering the coronavirus outbreak want to hear from you. Email us your questions, and we’ll do our best to answer them. You can find more answers in our Frequently Asked Questions roundup, and in our morning briefing.

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For the most up-to-date coronavirus coverage from The Times, visit our live updates page, visit our Health section and follow us on Twitter and on Instagram.


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