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RVs Become Temporary Homes For Doctors Caring For COVID-19 Patients

Physician Aliea Herbert administers a test for coronavirus disease (COVID-19) to a patient at Interbay Village, a village of tiny houses managed by the Low Income Housing Institute, at a mobile testing site run by Swedish Medical Center in Seattle, Washington, U.S. April 29, 2020. REUTERS/David Ryder

Doctors caring for COVID-19 patients at hospitals across the United States have taken up temporary residence in donated recreational vehicles, parked outside their homes, as a way to keep them near to their families yet isolated.

Dr. Nick Astras, an emergency room doctor who works at Long Island Community Hospital is now living in an RV just outside his suburban home of Brookhaven, where his children can see their father from their window.

The Grey Wolf camper was donated by a Long Island resident after the doctor’s wife, Kalpana Astras, saw a Facebook post asking for unused recreational vehicles to be donated to front-line medical workers, police and firefighters.

After registering, Kalpana Astras said she was notified within days that the Facebook group had located a vehicle the family could use for free.

The vehicle’s owner, Bernard ‘Bud’ Conway, said he kept it in storage for camping and fishing. He said with New York campgrounds closed, and a family of medical providers in need, the decision was easy.

“I just figured let me do something good and maybe some good will come of it,” he said.

The idea for the Facebook group originated in Texas, where Emily Phillips, wife of emergency room physician Dr. Jason Phillips, said she was concerned about her husband infecting her or their three children.

“I was scared to live in my own house. So my mom actually came up with the idea and she said, ‘Why don’t you see if somebody has an RV that you could rent?'” Phillips explained, saying she posted on Facebook to see if anyone in her own network knew of someone who would rent a vehicle to her.

“Within five minutes, a friend of mine called and said, ‘My friend, Holly Haggard, wants to give you her RV.’ And I just couldn’t believe it. I was flabbergasted that somebody would give me their home.”

Days later, Haggard and Phillips founded the group and started matching owners of recreational vehicles with medical and emergency workers treating patients with COVID-19. With over 1,000 volunteers, the group has now expanded internationally.

(Reporting by Andrew Hofstetter, Angela Moore and Arlene Eiras; Writing by Diane Craft; Editing by Rosalba O’Brien)

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As Virus Advances, Doctors Rethink Rush To Ventilate

A CT scan picture shows lungs of 48-year-old coronavirus disease (COVID-19) patient Andre Bergmann, in this screen grab released on April 14, 2020 by the Bethanien Hospital lung clinic in Moers, Germany. HOSPITAL BETHANIEN MOERS/THOMAS VOSHAAR/Handout via REUTERS

By Silvia Aloisi, Deena Beasley, Gabriella Borter, Thomas Escritt and Kate Kelland

BERLIN (Reuters) – When he was diagnosed with COVID-19, Andre Bergmann knew exactly where he wanted to be treated: the Bethanien hospital lung clinic in Moers, near his home in northwestern Germany.

The clinic is known for its reluctance to put patients with breathing difficulties on mechanical ventilators – the kind that involve tubes down the throat.

The 48-year-old physician, father of two and aspiring triathlete worried that an invasive ventilator would be harmful. But soon after entering the clinic, Bergmann said, he struggled to breathe even with an oxygen mask, and felt so sick the ventilator seemed inevitable.

Even so, his doctors never put him on a machine that would breathe for him. A week later, he was well enough to go home.

Bergmann’s case illustrates a shift on the front lines of the COVID-19 pandemic, as doctors rethink when and how to use mechanical ventilators to treat severe sufferers of the disease – and in some cases whether to use them at all. While initially doctors packed intensive care units with intubated patients, now many are exploring other options.

Machines to help people breathe have become the major weapon for medics fighting COVID-19, which has so far killed more than 183,000 people. Within weeks of the disease’s global emergence in February, governments around the world raced to build or buy ventilators as most hospitals said they were in critically short supply.

Germany has ordered 10,000 of them. Engineers from Britain to Uruguay are developing versions based on autos, vacuum cleaners or even windshield-wiper motors. U.S. President Donald Trump’s administration is spending $2.9 billion for nearly 190,000 ventilators. The U.S. government has contracted with automakers such as General Motors Co and Ford Motor Co as well as medical device manufacturers, and full delivery is expected by the end of the year. Trump declared this week that the U.S. was now “the king of ventilators.”

However, as doctors get a better understanding of what COVID-19 does to the body, many say they have become more sparing with the equipment.

Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them – mechanical ventilators – too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

Medical procedures have evolved in the pandemic as doctors better understand the disease, including the types of drugs used in treatments. The shift around ventilators has potentially far-reaching implications as countries and companies ramp up production of the devices.

“BETTER RESULTS”

Many forms of ventilation use masks to help get oxygen into the lungs. Doctors’ main concern is around mechanical ventilation, which involves putting tubes into patients’ airways to pump air in, a process known as intubation. Patients are heavily sedated, to stop their respiratory muscles from fighting the machine.

Those with severe oxygen shortages, or hypoxia, have generally been intubated and hooked up to a ventilator for up to two to three weeks, with at best a fifty-fifty chance of surviving, according to doctors interviewed by Reuters and recent medical research. The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs. 

This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.

In China, 86% of 22 COVID-19 patients didn’t survive invasive ventilation at an intensive care unit in Wuhan, the city where the pandemic began, according to a study published in The Lancet in February. Normally, the paper said, patients with severe breathing problems have a 50% chance of survival. A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88% of 320 mechanically ventilated COVID-19 patients had died.

More recently, none of the eight patients who went on ventilators at the Cleveland Clinic Abu Dhabi hospital had died as of April 9, a doctor there told Reuters. And one ICU doctor at Emory University Hospital in Atlanta said he had had a “good” week when almost half the COVID-19 patients were successfully taken off the ventilator, when he had expected more to die.

The experiences can vary dramatically. The average time a COVID-19 patient spent on a ventilator at Scripps Health’s five hospitals in California’s San Diego County was just over a week, compared with two weeks at the Hadassah Ein Kerem Medical Center in Jerusalem and three at the Universiti Malaya Medical Centre in the Malaysian capital Kuala Lumpur, medics at the hospitals said.

In Germany, as patient Bergmann struggled to breathe, he said he was getting too desperate to care.

“There came a moment when it simply no longer mattered,” he told Reuters. “At one point I was so exhausted that I asked my doctor if I was going to get better. I was saying, if I had no children or partner then it would be easier just to be left in peace.”

Instead of putting Bergmann on a mechanical ventilator, the clinic gave him morphine and kept him on the oxygen mask. He’s since tested free of the infection, but not fully recovered. The head of the clinic, Thomas Voshaar, a German pulmonologist, has argued strongly against early intubation of COVID-19 patients. Doctors including Voshaar worry about the risk that ventilators will damage patients’ lungs.

The doctors interviewed by Reuters agreed that mechanical ventilators are crucial life-saving devices, especially in severe cases when patients suddenly deteriorate. This happens to some when their immune systems go into overdrive in what is known as a “cytokine storm” of inflammation that can cause dangerously high blood pressure, lung damage and eventual organ failure.

The new coronavirus and COVID-19, the disease the virus causes, have been compared to the Spanish flu pandemic of 1918-19, which killed 50 million people worldwide. Now as then, the disease is novel, severe and spreading rapidly, pushing the limits of the public health and medical knowledge required to tackle it.

When coronavirus cases started surging in Louisiana, doctors at the state’s largest hospital system, Ochsner Health, saw an influx of people with signs of acute respiratory distress syndrome, or ARDS. Patients with ARDS have inflammation in the lungs which can cause them to struggle to breathe and take rapid short breaths. 

“Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” said Robert Hart, the hospital system’s chief medical officer. “Over time what we learned is trying not to do that.”

Instead, Hart’s hospital tried other forms of ventilation using masks or thin nasal tubes, as Voshaar did with his German patient. “We seem to be seeing better results,” Hart said.

CHANGED LUNGS

Other doctors painted a similar picture.

In Wuhan, where the novel coronavirus emerged, doctors at Tongji Hospital at the Huazhong University of Science and Technology said they initially turned quickly to intubation. Li Shusheng, head of the hospital’s intensive care department, said a number of patients did not improve after ventilator treatment.

“The disease,” he explained, “had changed their lungs beyond our imagination.” His colleague Xu Shuyun, a doctor of respiratory medicine, said the hospital adapted by cutting back on intubation.

Luciano Gattinoni, a guest professor at the Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen in Germany, and a renowned expert in ventilators, was one of the first to raise questions about how they should be used to treat COVID-19.

“I realised as soon as I saw the first CT scan … that this had nothing to do with what we had seen and done for the past 40 years,” he told Reuters.

In a paper published by the American Thoracic Society on March 30, Gattinoni and other Italian doctors wrote that COVID-19 does not lead to “typical” respiratory problems. Patients’ lungs were working better than they would expect for ARDS, they wrote – they were more elastic. So, he said, mechanical ventilation should be given “with a lower pressure than the one we are used to.”

Ventilating some COVID-19 sufferers as if they were standard patients with ARDS is not appropriate, he told Reuters. “It’s like using a Ferrari to go to the shop next door, you press on the accelerator and you smash the window.”

The Italians were swiftly followed by Cameron Kyle-Sidell, a New York physician who put out a talk on YouTube saying that by preparing to put patients on ventilators, hospitals in America were treating “the wrong disease.” Ventilation, he feared, would lead to “a tremendous amount of harm to a great number of people in a very short time.” This remains his view, he told Reuters this week.

When Spain’s outbreak erupted in mid-March, many patients went straight onto ventilators because lung X-rays and other test results “scared us,” said Delia Torres, a physician at the Hospital General Universitario de Alicante. They now focus more on breathing and a patient’s overall condition than just X-rays and tests. And they intubate less. “If the patient can get better without it, then there’s no need,” she said.

In Germany, lung specialist Voshaar was also concerned. A mechanical ventilator itself can damage the lungs, he says. This means patients stay in intensive care longer, blocking specialist beds and creating a vicious circle in which ever more ventilators are needed.

Of the 36 acute COVID-19 patients on his ward in mid-April, Voshaar said, one had been intubated – a man with a serious neuro-muscular disorder – and he was the only patient to die. Another 31 had recovered.

“IRON LUNGS”

Some doctors cautioned that the impression that the rush to ventilate is harmful may be partly due to the sheer numbers of patients in today’s pandemic.

People working in intensive care units know that the mortality rate of ARDS patients who are intubated is around 40%, said Thierry Fumeaux, head of an ICU in Nyon, Switzerland, and president of the Swiss Intensive Care Medicine Society. That is high, but may be acceptable in normal times, when there are three or four patients in a unit and one of them doesn’t make it.

“When you have 20 patients or more, this becomes very evident,” said Fumeaux. “So you have this feeling – and I’ve heard this a lot – that ventilation kills the patient.” That’s not the case, he said. “No, it’s not the ventilation that kills the patient, it’s the lung disease.”

Mario Riccio, head of anaesthesiology and resuscitation at the Oglio Po hospital near Cremona in Lombardy, Italy’s worst-hit region, says the machines are the only treatment to save a COVID-19 patient in serious condition. “The fact that people who were placed under mechanical ventilation in some cases die does not undermine this statement.”

Originally nicknamed “iron lungs” when introduced in the 1920s and 1930s, mechanical ventilators are sometimes also called respirators. They use pressure to blow air – or a mixture of gases such as oxygen and air – into the lungs.

They can be set to exhale it, too, effectively taking over a patient’s entire breathing process when their lungs fail. The aim is to give the body enough time to fight off an infection to be able to breathe independently and recover.

Some patients need them because they’re losing the strength to breathe, said Yoram Weiss, director of Hadassah Ein Kerem Medical Center in Jerusalem. “It is very important to ventilate them before they collapse.” At his hospital, 24 of 223 people with COVID-19 had been put on ventilators by April 13. Of those, four had died and three had come off the machines.

AEROSOLS

Simpler forms of ventilation – face masks for example – are easier to administer. But respirator masks can release micro-droplets known as aerosols which may spread infection. Some doctors said they avoided the masks, at least at first, because of that risk.

While mechanical ventilators do not produce aerosols, they carry other risks. Intubation requires patients to be heavily sedated so their respiratory muscles fully surrender. The recovery can be lengthy, with a risk of permanent lung damage.

Now that the initial wave of COVID-19 cases has peaked in many countries, doctors have time to examine other ways of managing the disease and are fine-tuning their approach.

Voshaar, the German lung specialist, said some doctors were approaching COVID-19 lung problems as they would other forms of pneumonia. In a healthy patient, oxygen saturation – a measure of how much oxygen the haemoglobin in the blood contains – is around 96% of the maximum amount the blood can hold. When doctors check patients and see lower levels, indicating hypoxia, Voshaar said, they can overreact and race to intubate.

“We lung doctors see this all the time,” Voshaar told Reuters. “We see 80% and still do nothing and let them breathe spontaneously. The patient doesn’t feel great, but he can eat and drink and sit on the side of his bed.”

He and other doctors think other tests can help before intubation. Voshaar looks at a combination of measures including how fast the patient is breathing and their heart rate. His team are also guided by lung scans.

“HAPPY HYPOXICS”

Several doctors in New York said they too had started to consider how to treat patients, known as “happy hypoxics,” who can talk and laugh with no signs of mental cloudiness even though their oxygen might be critically low.

Rather than rushing to intubate, doctors say they now look for other ways to boost the patients’ oxygen. One method, known as “proning,” is telling or helping patients to roll over and lie on their fronts, said Scott Weingart, head of emergency critical care at Stony Brook University Medical Center on Long Island.

“If patients are left in one position in bed, they tend to desaturate, they lose the oxygen in their blood,” Weingart said. Lying on the front shifts any fluid in the lungs to the front and frees up the back of the lungs to expand better. “The position changes have radically impressive effects on the patient’s oxygen saturations.”

Weingart does recommend intubating a communicative patient with low oxygen levels if they start to lose mental clarity, if they experience a cytokine storm or if they start to really struggle to breathe. He feels there are enough ventilators for such patients at his hospital.

But for happy hypoxics, “I still don’t want these patients on ventilators, because I think it’s hurting them, not helping them.”

QUALITY, SKILL

As governments in the United States and elsewhere are scrambling to raise output of ventilators, some doctors worry the fast-built machines may not be up to snuff.

Doctors in Spain wrote to their local government to complain that ventilators it had bought were designed for use in ambulances, not intensive care units, and some were of poor quality. In the UK, the government has cancelled an order for thousands of units of a simple model because more sophisticated devices are needed.

More important, many doctors say, is that the additional machines will need highly trained and experienced operators.

“It’s not just about running out of ventilators, it’s running out of expertise,” said David Hill, a pulmonology and critical care physician in Waterbury, Connecticut, who attends at Waterbury Hospital.

Long-term ventilation management is complex, but Hill said some U.S. hospitals were trying to bring non-critical care physicians up to speed fast with webinars or even tip sheets. “That is a recipe for bad outcomes.”

“We intensivists don’t ventilate by protocol,” said Hill. “We may choose initial settings,” he said, “but we adjust those settings. It’s complicated.”

(Escritt reported from Berlin, Aloisi from Milan, Beasley from Los Angeles, Borter from New York and Kelland from London. Additional reporting: Alexander Cornwell in Abu Dhabi, Panu Wongcha-um in Bangkok, Maayan Lubell in Jerusalem, A. Ananthalakshmi and Rozanna Latif in Kuala Lumpur, Kristina Cooke in Los Angeles, Sonya Dowsett in Madrid, Jonathan Allen and Nicholas Brown in New York, John Mair in Sydney, Costas Pitas in London, David Shepardson in Washington DC, Brenda Goh in Wuhan and John Miller in; Zurich. Writing by Andrew RC Marshall and Kate Kelland; Edited by Sara Ledwith and Jason Szep)

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Coronavirus Came To NY From Europe, Not China, Cuomo Says

FILE PHOTO: New York Governor Andrew Cuomo speaks to the media while visiting the Jacob K. Javits Convention Center which will be partially converted into a hospital for patients affected by the coronavirus disease (COVID-19) in Manhattan in New York City, New York, U.S., March 23, 2020. REUTERS/Mike Segar

By Nathan Layne and Jessica Resnick-Ault

(Reuters) – New York Gov. Andrew Cuomo on Friday pointed to research showing that strains of the novel coronavirus entered his state from Europe, not China, and said that travel bans enacted by U.S. President Donald Trump were too late to halt its spread.

Cuomo cited research from Northeastern University estimating that more than 10,000 New Yorkers may have contracted the disease by the time the state had its first confirmed case on March 1. He said he believed Italy was the likely source.

The governor noted that Trump ordered a ban on travel from China on Feb. 2, more than a month after news reports had emerged about an outbreak in the city of Wuhan, and decided to restrict travel from Europe the following month. By that time, the virus had spread widely in the United States, he said.

“We closed the front door with the China travel ban, which was right,” Cuomo told a briefing. “But we left the back door open because the virus had left China by the time we did the China travel ban.”

With his comments, Cuomo thrust himself into a heated and politically fraught debate about when and how the virus first entered the United States and whether officials like Trump and himself could have saved more lives if they had acted sooner.

Cuomo defended his own actions by pointing to the 19 days between New York’s first confirmed case and his lockdown order, arguing that he had moved faster than any other state.

He also said Trump, who last week halted U.S. contributions to the World Health Organization after accusing it of promoting China’s “disinformation” about the outbreak, was right to question whether the WHO responded properly to the crisis.

But Cuomo took aim at what he described as a slow reaction by the country’s leaders, even as increasingly disturbing reports emerged out of China in January and February about how quickly the virus was spreading and killing people.

Cuomo said as many as 2.2 million people took flights from Europe to New York and New Jersey airports in those two months, many of them likely carrying the highly contagious respiratory illness COVID-19.

“We acted two months after the China outbreak. When you look back, does anyone think the virus was still in China waiting for us to act two months later?” Cuomo said. “The horse had already left the barn by the time we moved.”

Cuomo said it was important that the country learns from the mistakes that were made because the virus could surge again in autumn or a new virus could emerge. “It will happen again. Bank on it. Let’s not put our head in the sand,” he said.

He said it was too early to reopen his state, which is in lockdown until at least May 15. He said the three-day rolling average for people newly admitted for COVID-19 was holding stubbornly around 1,300 per day, a worrisome sign.

But on a positive note, he said hospitalizations for COVID-19 totaled 14,258 on Thursday, declining for the tenth straight day. He reported 422 additional deaths, the lowest daily total since March 31.

(Reporting by Nathan Layne in Wilton, Connecticut and Jessica Resnick-Ault in New York; Editing by Chizu Nomiyama, Dan Grebler and Marguerita Choy)

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Oh Brother! Coronavirus Calls Split Family Fortunes on Wall Street

A combination photograph shows (L) an undated handout photo of Andrew Sandler, managing director and head of hedge funds at Sandler Capital Management, and a file image of Ricky Sandler, Founder, CEO and Chief Investment Officer, Eminence Capital, speaking at the Milken Institute's 21st Global Conference in Beverly Hills, California, U.S. May 1, 2018. Sandler Capital Management/Handout via REUTERS (L) and REUTERS/Lucy Nicholson/File Photo

By Lawrence Delevingne

BOSTON (Reuters) – After a calamitous two week plunge in stocks as the coronavirus spread globally, Ricky Sandler called into a midday CNBC show on March 16 with a brash, bullish prediction.

“People are totally missing what is happening here. Every new headline, every new hysteria is making people more nervous and it’s actually very, very positive,” he said, recommending that viewers borrow against their mortgages to buy stocks.

Andrew Sandler, holed up with family, dogs and pet fish on New York’s Long Island, couldn’t resist a shot at his little brother on Facebook.

“I think he’s wrong,” Andrew posted immediately after the TV appearance.

The depth and duration of COVID-19’s economic impact is a subject of debate among families the world over. But for Ricky and Andrew Sandler, their diverging views have broader implications: both run multi-billion dollar stock-focused hedge funds.

Their different outlooks — time to buy or stay cautious — have meant double-digit losses for Ricky’s $7.6 billion Eminence Capital LP and double-digit gains for Andrew’s nearly $2 billion unit of Sandler Capital Management.

It’s a scenario playing out across Wall Street. The coronavirus killed off the longest-running bull market in equities, meaning most hedge funds are nursing losses, with the average stock-focused fund down about 9.5% in March and 13% lower for the first quarter, according to data tracker HFR.

A small number of hedge fund managers who positioned in time for the fallout have profited, few more than Andrew Sandler. The elder Sandler brother was one of the best performing hedge fund managers in the world for the first quarter, according to a ranking by HSBC.

To be sure, when markets recover, investors who held or added to their stock holdings may generate large gains, but the timing of such a payoff is uncertain.

Representatives for Andrew and Ricky declined to comment and would not make them available for interview.

DOWNSIDE RISKS

The Sandler brothers followed their late father, Harvey, into investment management in the 1990s. Andrew joined the family firm while Ricky set up his own fund. Until recently the brothers, now in their early 50s, worked a few blocks apart in midtown Manhattan offices.

Ricky, a cycling enthusiast who alternates between athletic apparel and power neckties, is comfortable in the spotlight. He routinely appears at gatherings of Wall Street’s elite, such as the Milken Institute’s annual confab in Beverly Hills and Allen & Co’s Sun Valley conference, and sometimes mounts public campaigns against companies.

Self-described as risk averse, Andrew is more low-key, avoiding the hedge fund speaking circuit in favor of tending to a 17,000 gallon basement aquarium.

In contrast to his younger brother, Andrew’s caution meant he missed out on the full market surge of recent years. His Sandler Plus fund gained just 2.75% in 2019, according to an investor letter, compared to a gain of nearly 14% by the average stock focused fund.

That all changed this year. Andrew had positioned his funds defensively, writing to investors on January 16 that “we remain concerned about valuations and downside risks the market seems to be ignoring.”

Andrew was soon reducing market exposure even further, in part because of a rapidly spreading virus in China.

“The Coronavirus could serve as a catalyst for disappointing global growth as well as specifically disrupt certain supply chains and consumer businesses,” the firm noted in a January 28 Lyxor/Sandler U.S. Equity Fund report.

Andrew’s positioning was ideal when stocks started their rapid decline in late February: his funds had more bets on stocks declining than on them rising that month, according to a February 25 Lyxor report.

It also noted increased bets on healthcare stocks and a reduction in consumer discretionary businesses, which have been particularly hard hit as governments curtailed economic activity to prevent the spread of the virus.

Andrew’s Sandler Plus funds surged approximately 9.5% in March, putting its year-to-date performance at nearly 15%, according to an investor update reviewed by Reuters.

‘TAKE HEED’

On March 16, the same day that Ricky took to CNBC to talk up the markets, Andrew warned a friend that he was not surprised by 1,000 point single day declines for major stock indexes. “Going to be more. Stay liquid my man. This is fucked up,” he wrote on Facebook.

Ricky came out of 2019 optimistic. As U.S. stocks surged, Eminence’s main hedge fund gained 21% in 2019 with a bullish net portfolio exposure of 47% in July, according to Institutional Investor.

Eminence’s exact positioning in late February was not available, but by the time Ricky went on CNBC in mid-March, his fund had suffered losses of more than 30%, according to an investor with direct knowledge of the performance.

Eminence’s top holdings at yearend, according to the most recent regulatory filing, included Versace apparel parent Capri Holdings Limited <CPRI.N>, chemical maker Ashland Global Holdings Inc. <ASH.N> and motorsports giant Liberty Media Formula One <FWONA.O>; those stocks suffered first quarter price declines of between 35% and 72%.

Ricky told clients on a call in late March that he was leaning into his positions and remained bullish on the portfolio, according to the investor. Eminence performance rebounded slightly by the end of the month, putting the fund down 19% for the first quarter, according to the investor.

Reuters could not determine if Eminence has changed its investment strategy since the end of the first quarter; a representative for the firm declined to comment on that or recent performance.

Ricky was still bullish and predicted a 10% stock market rise from current levels by the yearend in an April 7 video discussion hosted by the University of Wisconsin.

Major U.S stock indices have risen between 7% and 12% since the beginning of April.

It’s not clear how much the Sandler brothers discuss the markets. But on March 20, a long-dormant Twitter account under the name Ricky Sandler responded to criticism of his CNBC appearance earlier in the week.

“Those who think I am an idiot take heed,” he wrote. “This is the buying opportunity of a lifetime.”

(Reporting by Lawrence Delevingne. Editing by Carmel Crimmins)

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Cuomo Says Trump Agrees To Help Expand Coronavirus Testing

New York Governor Andrew Cuomo speaks in front of stacks of medical protective supplies during a news conference at the Jacob K. Javits Convention Center which will be partially converted into a temporary hospital during the outbreak of the coronavirus disease (COVID-19) in New York City, New York, U.S., March 24, 2020. REUTERS/Mike Segar

By Doina Chiacu and Steve Holland

WASHINGTON (Reuters) – President Donald Trump and New York Governor Andrew Cuomo, two prominent figures in the U.S. coronavirus crisis who are often at odds, emerged from a White House meeting on Tuesday with mostly positive things to say and an apparent deal on testing.

Cuomo, a Democrat whose state is the epicenter of the U.S. coronavirus epidemic with nearly 20,000 deaths, said the Republican president agreed on a plan for doubling New York’s coronavirus screening capacity to 40,000 tests per day.

Under that plan, Cuomo said, the federal government will procure and furnish the test kits and related materials, including the chemical reagents that have sometimes been in short supply.

The state will be responsible for expanding the capacity of some 300 laboratories conducting the tests and hiring the necessary staff.

“That is an intelligent division of labor – let each layer of government do what it does best,” Cuomo told a news briefing after his rare face-to-face encounter with Trump, a man with whom the governor has had a testy relationship at best in the media.

He said the testing would mix diagnostic screenings used to determine if someone is carrying the virus, and serology tests in which blood samples are analyzed for the presence of antibodies, an indication of exposure even after an individual is no longer infected.

Cuomo said it will “take several weeks at best” to implement the plan.

“It’s in some ways an outrageous goal, but this is New York, and we’re used to outrageous,” he said, adding that the state’s current level of 20,000 tests a day marked the highest per-capita rate for diagnostic coronavirus screening in the world.

As of Tuesday, New York state had tallied more than 257,000 cases of COVID-19, the highly contagious respiratory illness caused by the novel coronavirus. That accounts for more than a quarter of the 809,000-plus known infections nationwide.

BUDGET SHORTFALL

Health experts say a massive expansion in both kinds of tests is essential before stay-at-home orders and mandatory business shutdowns, which were ordered to slow the spread of the virus, can be safely lifted.

Cuomo, who said he also stressed the severity of the state’s budget problems brought on by the pandemic, described his conversation with Trump as “honest and open.”

At a separate White House briefing, Trump called his meeting with Cuomo productive and said he was proud of the relationship his administration has forged with New York.

With social distancing and lockdowns showing results, Cuomo has said he could begin to consider how to reopen a state that ranges from New York City, with more than 8 million people, to farm country and sparsely populated towns.

Trump said the federal government will work with New York to help secure additional capacity for testing, the importance of which the president has at times minimized.

Cuomo also told Trump New York City no longer needed the U.S. Naval Ship Comfort hospital ship to help with overflow patients.

Along with other governors, Cuomo has called on the federal government to provide direct cash assistance to the states, a request that has gone unanswered in the stimulus packages passed by Congress.

New York, facing a $10 billion to $15 billion budget shortfall, needs a cash infusion to pay teachers, police officers, healthcare workers, Cuomo said.

The governor said Trump indicated he understood and promised to “work hard” to obtain funding for states in the next round of legislation.

(Reporting by Doina Chiacu and Steve Holland in Washington; Additional reporting by Steve Gorman in Los Angeles and Nathan Layne in Wilton, Connecticut; Editing by Dan Grebler and Howard Goller)

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How a Long Island Pediatrician is Dealing With The Coronavirus Outbreak

Dr Greg Gulbransen performs a follow up visit on a baby whose family had tested positive for the coronavirus disease (COVID-19) in early March while at his pediatric practice in Oyster Bay, New York, U.S., April 13, 2020. Picture taken April 13, 2020. REUTERS/Lucas Jackson

NEW YORK (Reuters) – When a 3-year-old patient of New York pediatrician Dr. Greg Gulbransen dislocated her arm, he told her parents not to take her to the emergency care center, fearing that could put the family at risk of contracting COVID-19, the disease caused by the new coronavirus.

Instead, he said, he met them on their front lawn, where he popped the girl’s joint back in.

“It is a very easy thing to do, but it made a huge difference for them,” he said.

Gulbransen has had to rethink how he runs his pediatric practice on Long Island since the coronavirus crisis started.

“We’re in the heart of the storm,” said Gulbransen. His practice remains open and now also welcomes some non-pediatric patients who have had trouble being seen by a doctor.

He said his practice has been physically rearranged to keep sick patients away from those who are well.

Other recent adjustments include doing telemedicine, although he is unsure how insurance reimbursements will work with such consultations.

He said he was worried about his pediatric patients picking up on their parents’ anxieties, as well as the health and financial welfare of his staff.

“The anxiety level is palpable,” said Gulbransen.

“But it’s a privilege,” he said, adding, “you’re here for your patients. You gotta push and do whatever it takes.”

New York state, the epicenter of the pandemic in the United States, had a coronavirus death toll exceeding 10,000 as of Tuesday, out of more than 28,000 across the country.

The disease looks different in children than it tends to with adults, said Gulbransen.

“We had a 6-week-old with COVID, and really (the infant had) no other symptom than a runny nose,” said Gulbransen.

He has also treated “quite a few toddlers and plenty of schoolage children,” who were all doing well.

Cases of the illness involving children are “dwarfed by adult cases, although some of the (child) cases can be quite severe,” according to Dr. Lorry Rubin, director of pediatric infectious diseases at Cohen Children’s Medical Center, part of the Northwell Health network.

Sometimes previously healthy children, often adolescents, develop pneumonia “and that can be severe and possibly lead to them needing oxygen or ventilatory support,” Rubin said.

Still, most pediatric COVID-19 patients do well. Rubin said he was aware of only one child who had died, who also had a terminal congenital illness. Among infants under 60 days old in whom COVID had been detected, “all of them have done quite well,” he added.

“The frequency of pediatric illness requiring hospitalization is low,” Rubin said. “No question, it’s not as bad in children and less common than in adults.”

But with New York’s healthcare system at full throttle treating coronavirus patients, Gulbransen wants to take no risks. His motto is: “Whatever you do, don’t send someone from this office to the ER.”

(Reporting by Lucas Jackson; Writing by Bernadette Baum; Editing by Rosalba O’Brien)

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Physician Assistant From Floral Park Who Died of Coronavirus Remembered As ‘Supermom’

Minnoli Aya poses with her parents Raj and Madhvi on her graduation day in this undated handout photo provided by the family to Reuters on April 13, 2020. Courtesy of Minnoli Aya/Handout via REUTERS

By Gabriella Borter and Kristina Cooke

NEW YORK (Reuters) – “Home soon,” Madhvi Aya texted from her hospital bed. “Love you.”

It was the last exchange she had with her only daughter, 18-year-old Minnoli. Three days later, Madhvi Aya died of COVID-19.

Aya, 61, was a physician assistant who had treated patients with the coronavirus. Then she became a patient herself.

She was admitted to the Long Island Jewish Medical Center on March 18 after being infected and died 11 days later. Her family believes she contracted the respiratory illness at her workplace the emergency room at Woodhull Hospital in Brooklyn.

She told her husband and daughter that she had treated infected patients while wearing only a surgical mask, which offers little protection from airborne infection. Woodhull hospital declined to comment on Aya’s case or whether it had been able to provide its staff with enough protective gear amid widespread shortages nationally.

Aya is among 51 U.S. healthcare workers identified by Reuters as having died after being diagnosed with or showing symptoms of the virus. They include nurses, doctors and technicians who have died in the United States after contracting the disease, according to interviews with hospitals, union representatives and families and a Reuters review of local media reports and obituaries.

There’s no official tally of the deaths among U.S. healthcare workers, and the total could be much higher than the number counted by Reuters.

Minnoli is a freshman at the State University of New York at Buffalo with hopes of becoming a trauma cardiothoracic surgeon. She continued texting her mother for days after her death.

“I kept texting her wanting to believe it wasn’t true,” Minnoli said. “She deserved to live and see me graduate, and become a doctor, and get married and have kids.”

Aya became a physician assistant because she was determined to create a good life for her daughter. The job entailed 12-hour shifts in the emergency room of her Brooklyn hospital.

Since March 1, when the first coronavirus case was confirmed in New York, 28,183 people have tested positive in Brooklyn, and 1,869 people have died, accounting for more than 28% of New York City’s confirmed coronavirus deaths.

RISKING THEIR LIVES

More than 28,440 people in the United States have died from COVID-19 so far.

Of the 51 deaths among healthcare workers identified by Reuters, at least 16 were in New York, one of the hardest-hit states. At least seven were in Michigan, six in Florida, and six in New Jersey.

At least 27 were nurses.

They include Patrick Cain, 52, an intensive care nurse in Flint, Michigan, originally from Canada. When he died, the hospital played “Oh Canada,” the national anthem, over the loudspeakers, according to another nurse at the hospital.

“Everyone knew then,” the nurse said.

His obituary in the Flint Journal describes him as a passionate nurse who always advocated for patients. “He tended to those in need who were exposed to the coronavirus, which eventually took his life,” his obituary reads.

At least 10 of those who died were physicians or resident doctors. Florida doctor Alex Hsu’s daughter Dria described him as calm and reassuring, and said he made others feel heard and important. The 67-year old was the “epitome of self-sacrifice and selflessness,” Dria told Reuters.

“He is our hero,” she said.

Emergency medicine doctor Frank Gabrin, who worked at two New York area hospitals and died from COVID-19 last month, said he believed he contracted the virus while he was forced to reuse the same n-95 mask because of a shortage, according to his best friend Debra Lyons.

“He said it was from having to wear the mask four shifts in a row,” Lyons said in a phone interview. “He got the kit the first night of his first shift, and he used the same kit for all four shifts, 12-hour shifts.”

At least five of the deaths identified by Reuters were hospital technicians, and at least four were EMTs.

The youngest deceased healthcare worker Reuters found was just 20: Valeria Viveros, a nursing assistant in Riverside, California. At least 15 people were in their sixties, and 12 in their fifties.

A KISS BEFORE WORK

If Madhvi Aya was anxious about treating coronavirus patients without the recommended N-95 respirator mask, she never expressed it, said her husband Raj, a retired accountant.

She was an optimist who rarely called in sick or took a day off, Raj told Reuters.

Aya, who immigrated with her husband from India in 1993, awoke at 4 a.m. and would kiss her daughter on the forehead before she left for work.

Shifts in the emergency room were grueling. When Raj picked up his wife from work in the evening, she was usually quiet on the drive home. She would need to close her eyes for 15 minutes before they talked.

“The emergency room is like a war zone,” Raj said. “Even though I was very close to her, she would never discuss it.”

She developed a cough and fever in mid-March. Raj convinced her to call in sick on March 14 and took her to Woodhull Hospital to get a coronavirus test.

At home, she soon needed Raj’s help to get dressed. She was too weak to get out of bed. Her fever persisted.

On March 18, she asked Raj to take her to Long Island Jewish Medical Center, the hospital closest to their home in Floral Park. He waited outside in the car, unable to enter because of the hospital’s no-visitor policy.

She was admitted. She got the coronavirus test result from Woodhull the same day: positive.

Minnoli returned home on March 20 after classes were moved online. She tried calling her mother for a week, but Aya was too weak to answer.

“I’m still praying for you to come home safely to me. I need you Mommy,” Minnoli texted on March 25. “None of us can live without you. I believe in you, please fight back. You’re so strong mommy. I love so much more than you can imagine.”

“Love you,” her mother wrote back. “Mom be back.”

‘MR. AYA, WE ARE SORRY’

Raj called the hospital every day for updates. He learned that Aya was getting intravenous fluids and oxygen. As the days passed, she began having more trouble breathing.

On March 28, the doctor treating Aya raised the possibility of intubation as a final attempt to raise her oxygen levels, Raj said.

In her last texts to Raj on Saturday, she asked her husband to consult her brother, a doctor in India, on whether she should agree to being intubated. Raj read about intubation on the internet, contacted her family and consulted friends.

They told him he needed to say yes, that intubation is a last resort.

The medical team tried to intubate her on Sunday, March 29. But during the process of inserting the breathing tube, doctors discovered blood clots in her lungs, Raj said. They tried to remove them but they were unsuccessful.

“Mr. Aya, we are sorry,” said the person who called from the hospital to tell him his wife had died.

Aya’s death was reported earlier today by The New York Times.

Woodhull Hospital spokeswoman Michelle Hernandez said Aya was one of three hospital staff members who had recently died, but she declined to say if the others had succumbed to COVID-19.

Two weeks after Aya’s death, Minnoli sleeps downstairs in the living room to avoid her mother’s bedroom upstairs. She and Raj have lost the “supermom” who kept the family together, Minnoli said. They have also lost their health insurance and income.

A friend has raised more then $46,000 for Raj and Minnoli through a GoFundMe campaign to cover their expenses. Several of Aya’s coworkers and friends have contributed.

“Madhvi was more than just a colleague to me. She was a great friend and mentor,” one wrote on the campaign page.

“I will always remember you,” said another.

Each night in New York City, neighborhoods around hospitals cheer for healthcare workers to express gratitude for the risks they are taking to save lives. Minnoli watches videos of the applause on social media.

“I can’t help but think, what about the ones who have fallen? What about the ones who are already dead?” Minnoli said. “She was a hero unnoticed.”

(This story refiles to correct the job title “physician assistant”)

(Reporting by Gabriella Borter and Kristina Cooke; Editing by Ross Colvin and Brian Thevenot)

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Masks May Be ‘New Normal’ As U.S. Preps Reopening

A United States Postal Service (USPS) mail carrier pushes his cart while delivering mail in the rain on Manhattan's Upper West Side during the outbreak of the coronavirus disease (COVID-19) in New York City, New York, U.S., April 13, 2020. REUTERS/Mike Segar

By Maria Caspani and Jessica Resnick-Ault

NEW YORK (Reuters) – The death toll from the coronavirus pandemic in the United States approached 31,000 on Wednesday as governors began cautiously preparing Americans for a post-virus life that would likely include public face coverings as the “new normal.”

The governors of Connecticut, Maryland, New York and Pennsylvania each issued orders or recommendations that residents wear face masks as they emerge from isolation in the coming weeks.

“If you are going to be in public and you cannot maintain social distancing, then have a mask, and put that mask on,” said New York Governor Andrew Cuomo, a Democrat.

Similar orders were imposed in New Jersey and Los Angeles last week and face coverings were recommended by Kansas Governor Laura Kelly on Tuesday.

California Governor Gavin Newsom has said residents across the nation’s most-populous state would likely be wearing masks in public for some time to come.

“We are going to be getting back to normal; it will be a new normal,” Connecticut Governor Ned Lamont said, echoing a phrase used by at least two of his fellow governors in recent days.

U.S. Midwest governors were also making plans together to restart their economies, said Jordan Abudayyeh, a spokeswoman for Illinois Governor J.B. Pritzker.

In Michigan, hundreds of cars flooded the streets around the state Capitol in Lansing on Wednesday to protest Democratic Governor Gretchen Whitmer’s stay-at-home orders, some of the strictest in the country.

Some protesters, in the demonstration organized by conservative and pro-President Donald Trump groups, left their cars to gather on the lawn in front of the Capitol building, many of them not wearing masks or practicing social distancing.

TOLL ON HEALTHCARE STAFF

As of Wednesday night, 30,885 people in the United States had died of COVID-19, the respiratory illness caused by the novel coronavirus, according to a Reuters tally.

That includes more than 4,000 deaths newly attributed to the disease in New York City after health officials revised their counting methods to include “probable,” but unconfirmed, cases.

Healthcare workers have faced unique health threats while working on the front lines trying to tackle the pandemic.

Reuters has identified more than 50 nurses, doctors and medical technicians who have died after being diagnosed with COVID-19 or showing symptoms of it. At least 16 were in New York state.

“The emergency room is like a war zone,” said Raj Aya, whose wife, Madhvi Aya – a physician’s assistant in Brooklyn – was one of the healthcare workers who died in New York.

As the outbreak begins to slow, political leaders have bickered over how and when to begin the process of unwinding unprecedented lockdowns that have damaged the economy and largely confined Americans to their homes.

Washington state Governor Jay Inslee told an afternoon news conference the largest obstacle to a return to normalcy was a shortage of coronavirus tests.

“We simply haven’t had enough test kits – they simply do not exist anywhere in the United States right now,” Inslee said, adding the state had purchased about a million swabs, along with vials and test medium but they were just starting to arrive.

At his daily White House briefing hours later, Trump boasted that the United States had “the most expansive testing system anywhere in the world.” But, he said, testing was a problem for the states and not the federal government.

“We can’t be thinking about a Walmart parking lot,” where some testing is being done, but the states and cities should do that, he said.

Senate Democrats on Wednesday unveiled a $30 billion plan to vastly increase nationwide testing for the coronavirus.

‘ALMOST IN FREE FALL’

Trump, citing data suggesting the peak of new infections had passed, said he would announce guidelines on Thursday for reopening the economy.

The sweeping closures of businesses have left millions of Americans unemployed and store owners struggling to pay rent.

Government data released on Wednesday showed that retail sales dropped by 8.7% in March, the biggest decline since tracking began in 1992. Consumer spending accounts for more than two-thirds of U.S. economic activity.

In addition, output at U.S. factories declined by the most since 1946 as the pandemic fractured supply chains.

“The economy is almost in free fall,” said Sung Won Sohn, a business economics professor at Loyola Marymount University in Los Angeles.

The United States, with the world’s third-largest population, has now suffered the greatest number of reported fatalities from the coronavirus, ahead of Italy and Spain.

Globally, the number of infections has crossed the 2 million mark and over 136,000 people have died, a Reuters tally shows.

The pathogen emerged last year in China.

Trump said on Wednesday his government was trying to determine whether the coronavirus emanated from a lab in Wuhan, China, and Secretary of State Mike Pompeo said Beijing “needs to come clean” on what they know. The official death toll released by the Chinese government stands at about 3,600.

The source of the virus remains a mystery. General Mark Milley, chairman of the Joint Chiefs of Staff, said on Tuesday that U.S. intelligence indicated the coronavirus likely occurred naturally, as opposed to being created in a laboratory in China, but there was no certainty either way.

(Reporting by Nathan Layne, Lucia Mutikani, Doina Chiacu, Susan Heavey, Maria Caspani, Lisa Shumaker, Gabriella Borter, Peter Szekely, Kristina Cooke, Jessica Resnick-Ault, Sharon Bernstein, Steve Gorman and Dan Whitcomb; Writing by Dan Whitcomb; Editing by Bill Tarrant, Cynthia Osterman, Peter Cooney and Himani Sarkar)

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With Cheers, NY Nurses Greet Reinforcements From Across U.S.

Manhasset-Lakeville Fire Department staff clap to show appreciation to doctors and nurses from Northwell Health, for fighting the spread of the coronavirus disease (COVID-19), in New York City, New York, U.S. in this still image obtained from a social media video. Manhasset-Lakeville Fire Department/via REUTERS

With loud cheers and applause, medical staff at New York’s Northwell Health network greeted 46 nurses on Tuesday who had arrived from all over the United States to reinforce hospitals as they battle the coronavirus pandemic.

U.S. deaths from the novel coronavirus topped 24,000 on Tuesday, according to a Reuters tally. There were nearly 583,000 confirmed cases, over 200,000 of which were in New York state alone.

Treating the large number of patients with COVID-19, the disease caused by the new coronavirus, has challenged hospitals in its U.S. epicenter. They have scrambled to find enough ventilators and other equipment, as well as beds and staff.

Northwell, the largest healthcare provider in New York, said it had contracted medical staffing companies to help it buttress efforts to treat patients at 18 hospitals across New York City, Long Island and Westchester county.

The “clap-in,” with dozens of staff cheering loudly and holding signs saying “Nurses are the heart of healthcare” and “Welcome, healthcare heroes,” was a surprise for the nurses who arrived on Tuesday afternoon for a half-day training session. Hailing from states including California, South Carolina, and Indiana, they are undergoing training in subjects ranging from operating ventilators to dealing with electronic medical records.

“It’s so heartwarming to see so many nurses come from so far away to assist us in our time of need,” said Maureen White, executive vice president and chief nurse executive at Northwell.

About 300 nurses from other areas have been enlisted over the past three weeks, said Launette Woolforde, Northwell’s registered nurse and vice president for nursing education.

Marybella Cole, who had arrived in New York from Lewiston, Idaho, said community was important to her.

“There’s no bigger calling than something like this,” she said.

Raymond Woods said he had left kids and grandchildren behind in Indiana so he could help.

“I have never been more proud to be a nurse. This is by far the most rewarding career I’ve had in my life,” he said.

(Reporting by Andrew Hofstetter; Writing by Bernadette Baum; Editing by Rosalba O’Brien)

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NY, 8 Other States To Collaborate on Reopening Plan

insider trading

NEW YORK (Reuters) – A total of nine states on the U.S. East and West coasts said on Monday they had begun planning for the slow reopening of their economies and lifting of strict stay-at-home orders amid signs the worst had passed in the U.S. coronavirus pandemic.

The Northeast states of New York, New Jersey and Connecticut will work with Delaware, Pennsylvania and Rhode Island in coordinating to gradually reopen their economies together, New York Governor Andrew Cuomo said.

“Nobody has been here before, nobody has all the answers,” Cuomo said during an open conference call with his five counterparts. “Addressing public health and the economy: Which one is first? They’re both first.”

The governors of California, Oregon and Washington said they also had reached an agreement on a shared approach to restarting businesses, although they gave no firm timeline and said they would be guided by the health of residents first.

U.S. President Donald Trump said earlier on Monday that any decision on restarting the economy was his to make.

Tensions between state governors and Trump have bubbled up since the outbreak worsened a month ago and emerged in the debate about when and how to restart economic activity.

Legal experts say a U.S. president has limited power under the U.S. Constitution to order citizens back to their places of employment, or cities to reopen government buildings, transportation, or local businesses to reopen.

“It is the decision of the president, and for many good reasons,” Trump wrote on Twitter on Monday. He went on to write that his administration was working closely with the governors.

“A decision by me, in conjunction with the governors and input from others, will be made shortly!” Trump’s tweet said.

Political leaders said a reopening of the economy may hinge on more widespread testing and cautioned that lifting of stay-at-home restrictions too early could reignite the outbreak. The Trump administration has signaled May 1 as a potential date for easing the restrictions.

DEATH TOLL TOPS 23,000

The U.S. death toll from COVID-19 topped 23,000 on Monday, according to a Reuters tally with a total of nearly 570,000 U.S. cases. The United States, with the world’s third-largest population, has recorded more fatalities from COVID-19 than any other country.

But fatalities reported on Sunday numbered 1,513, the smallest increase since 1,309 died on April 6. The largest number of fatalities, over 10,000, was in New York state with the concentration in and around New York City.

Cuomo said on Monday that “the worst is over” for his state but warned that gains achieved through social distancing could be undone if “we do something stupid” and relax those restrictions too quickly.

Wyoming reported its first death from the coronavirus on Monday, the final U.S. state to report a fatality.

Official statistics, which exclude deaths outside of hospitals, have understated the actual number of people who have succumbed to COVID-19, the respiratory disease caused by the new coronavirus, health experts said. (Graphic: https://tmsnrt.rs/2w7hX9T)

New York City Health Commissioner Dr. Oxiris Barbot acknowledged a “tightening” of the supply chain for swabs needed in coronavirus testing, and said it was part of a “national and international challenge” to ramp up testing.

Chris Sununu, the Republican governor of New Hampshire, said testing for the coronavirus had improved “but we don’t have enough. Nobody has enough.”

“There’s just a limited supply for a massive amount of demand,” Sununu told CNN.

To ease the impact of the shutdown on the U.S. economy, the two top Democrats in the U.S. Congress urged Republicans on Monday to authorize more funding for national testing. An effort to rush fresh assistance to U.S. small businesses stalled in Congress as the health emergency failed to overcome partisan differences between Republicans and Democrats.

(Reporting by Maria Caspani and Jessica Resnick-Ault in New York, Doina Chiacu and Lisa Lambert in Washington, Nathan Layne in Wilton, Connecticut and Dan Whitcomb in Los Angeles; Writing by Grant McCool; Editing by Frank McGurty and Howard Goller)

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