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SANTA FE, N.M. — As the coronavirus rages across the United States, mainly in large urban areas, more than a third of U.S. counties have yet to report a single positive test result for COVID-19 infections, an analysis by The Associated Press shows.

Data compiled by Johns Hopkins University shows that 1,297 counties have no confirmed cases of COVID-19 out of 3,142 counties nationwide. The number of counties without a positive coronavirus case has declined rapidly, dropping from over half as the AP was preparing to publish. Of the counties without positive tests, 85% are in rural areas — from predominantly white communities in Appalachia and the Great Plains to majority Hispanic and Native American stretches of the American Southwest — that generally have less everyday contact between people that can help transmit the virus.

At the same time, counties with zero positive tests for COVID-19 have a higher median age and higher proportion of people older than 60 — the most vulnerable to severe effects of the virus — and far fewer intensive care beds should they fall sick. Median household income is lower, too, potentially limiting health care options.

The demographics of these counties hold major implications as the Trump administration develops guidelines to rate counties by risk of the virus spreading, empowering local officials to revise social distancing orders that have sent much of the U.S. economy into free fall. President Donald Trump on Sunday extended the country's voluntary national shutdown for a month, significantly changing his tone on the coronavirus pandemic.

Experts in infectious disease see an opportunity in slowing the spread of coronavirus in remote areas of the country that benefit from "natural" social distancing and isolation, if initial cases are detected and quarantined aggressively. That can buy rural health care networks time to provide robust care and reduce mortality.

But they also worry that sporadic testing for coronavirus could be masking outbreaks that -- left unattended -- might overwhelm rural health networks.

In this photo taken March 20, 2020, Mike Johnston, a clerk at the Maupin Market in tiny Maupin, Oregon, helps a customer while wearing a latex glove to protect himself from the new coronavirus. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus)
In this photo taken March 20, 2020, a sign outside a fly fishing shop in tiny Maupin, Oregon, advises customers of new policies to limit the spread of the new coronavirus in rural areas. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus)

"They'll be later to get the infection, they'll be later to have their epidemics," said Christine K. Johnson, a professor of epidemiology at the University of California, Davis. "But I don't think they're going to be protected because there's nowhere in the U.S. that's isolated."

Counties that have zero confirmed COVID-19 cases could raise a red flag about inadequate testing, she said.

"I hope the zeros are really zeros — I worry that they're not doing enough testing in those regions because they're not thinking they're at risk," she said.

In New Mexico, a state with 2 million residents spanning an area the size of Italy, Democratic Gov. Michelle Lujan Grisham has moved aggressively to contain the coronavirus' spread with a statewide school shutdown and prohibition on most gatherings of over five people.

Nearly half of the state's 33 counties are free of any positive coronavirus cases. New Mexico is among the top five states in coronavirus testing per capita, though some virus-free counties aren't yet equipped with specialized testing sites beyond samplings by a handful of doctor offices.

Torrance County Manager Wayne Johnson said plans are being made for the first three dedicated COVID-19 testing sites in the high-desert county of 15,000 residents that spans an area three times the size of Rhode Island.

A statewide stay-at-home order is keeping many residents from commuting to jobs in adjacent Bernalillo County, the epicenter of the state's COVID-19 infections, with 93 confirmed cases out of a state government tally of 208 as of Saturday night.

"We don't have any test sites open, and part of that is that we don't have any needs for the test yet," Johnson said. Still, Johnson said he worries that an outbreak could overwhelm the county's sole medical clinic and an all-volunteer corps of emergency medical technicians.

The state´s first of two coronavirus-related deaths occurred March 22 within a southern oil-producing region in Eddy County, where two other positive tests have surfaced. A man in his late-70s died shortly after arriving at a hospital in Artesia, and tested positive postmortem. He had previously visited two health clinics, and at the hospital five staff were quarantined for possible exposure even though they wore face masks.

State Deputy Epidemiologist Chad Smelser said health officials have continued to painstakingly retrace the steps of infected patients and notify people who came into contact with them. There are dozens of connections per infection on average.

"We know the details of his prior visits in the health care system," Smelser said of the deceased Eddy County patient. "We've worked with those physicians to assess their exposure. And we do not believe that he acquired it in the health care setting."

State health officials say it is unclear how many people have been tested for coronavirus in each county.

Medical experts say uneven testing patterns across the country make it difficult to gauge whether remote areas are really better off.

"It's a fundamental unknown," said Benjamin Neuman, a virologist at Texas A&M University in Texarkana. "I think there is some truth to that notion that there are lower infection rates out there" in rural areas.

He said he fears for homeless populations and undocumented migrants.

¨We hope they stay safe. Those would be hard places to get rid of the coronavirus,¨ Neuman said.

Complaints that testing is not readily available extend to the crossroads town of Crossett in southern Arkansas, where surrounding Ashley County has no confirmed coronavirus cases.

Disabled veteran Marty Zollman, 42, of Crossett says his wife, a clothing store clerk, and teenage daughter sought coronavirus testing this week for fever and flu-like symptoms at a local health clinic and were turned away.

"We might be contagious, but no one will test her," Zollman said of his wife, Janet, who was awaiting surgery for breast cancer. "They keep turning her down. They don't have a source of testing."

He lashed out at Trump for indicating that testing is readily available. "Now it's time for me to call his bluff. If he's got the equipment ... he's got to provide it," Zollman said.

In New Mexico, along the southernmost finger of the Rocky Mountains, Mora Valley Community Health Services and a companion agency attend to elderly patients living in extreme poverty in Mora County, where there have been no confirmed COVID-19 infections and few if any people tested.

With a population of 4,500 that is more than 80% Latino, the county is among the economically poorest in the nation. Average combined household income is $27,000.

"There's elderly out there that have dementia, who don't have a family ... who eat out of cans," said Julián Barela, CEO of Community Health Services, which ordinarily provides a steady stream of Medicaid and Medicare patients with health, dental and behavior health services.

Under new state directives, the clinic has scuttled all non-emergency appointments — most of its caseload — to comply with a measure designed to conserve dwindling supplies of protective gear such as masks, gloves and gowns for health care workers, Barela said. The clinic has yet to see a patient with telltale symptoms of coronavirus worth testing.

Barela said it has been alarming to turn away patients who feel they need attention as new federal grant money arrives.

“We don’t have an emergency backlog, it doesn’t seem reasonable that we’re just shut down,� he said. “We should not operate the same as New York. There is no reason for it.�


Counties without coronavirus are mostly rural, poor
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:14

In this photo taken March 20, 2020, cattle rancher Joe Whitesell rides his horse in a field near Dufur, Oregon, as he helps a friend herd cattle. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus)
In this photo taken March 20, 2020, cattle rancher Joe Whitesell rides his horse in a field near Dufur, Oregon, as he helps a friend herd cattle. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus) (Gillian Flaccus/)In this photo taken March 20, 2020, Mike Johnston, a clerk at the Maupin Market in tiny Maupin, Oregon, helps a customer while wearing a latex glove to protect himself from the new coronavirus. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus) (Gillian Flaccus/)In this photo taken March 20, 2020, a sign outside a fly fishing shop in tiny Maupin, Oregon, advises customers of new policies to limit the spread of the new coronavirus in rural areas. Tiny towns tucked into Oregon's windswept plains and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus yet, but their residents fear the spread of the disease to areas with scarce medical resources, the social isolation that comes when the only diner in town closes its doors and the economic free fall that's already hitting them hard. (AP Photo/Gillian Flaccus) (Gillian Flaccus/)

The ability of the Seattle-based Destination to stay afloat in the harsh conditions of a Bering Sea winter was seriously compromised before it set out on its final, fatal voyage, according to a Coast Guard report released Sunday that blamed the captain and the owner of the crab boat for failing to ensure safety.

The Marine Board of Investigation detailed a series of missteps the Coast Guard found led to the deaths of all six crew on Feb. 11, 2017, just off the Bering Sea island of St. George. The panel also uncovered weaknesses in a safety-oversight system set up to prevent such fishing-industry disasters.

Among the conclusions:

-- The Destination, when it left port, was overloaded and did not meet minimum stability standards required by a federal regulation.

-- The captain set out in freezing spray with a fatigued crew that failed to remove a heavy buildup of ice on the hull and gear.

-- A hatch was believed to have been left open, a situation that would have allowed rapid flooding when disaster struck after 6 a.m., after the boat left the lee of an island and encountered rough seas.

"Within a [matter] of minutes, the vessel started to capsize and sink ... the crew had very little time, if any, to react," the report states. "It would be a challenge for any crewmember or fisherman to conduct emergency broadcast radio calls, don a survival/immersion suit and deploy the liferaft in this short period of time."

Captain Jeff Hathaway, Kai Hamik, Charles Glen Jones, Larry O’Grady, Darrik Seibold and Raymond Vincler died in the worst Alaska crab-boat disaster in more than a decade. Their bodies have not been found.

[Related - No Return: The final voyage of the crab boat Destination]

The sinking stunned many in the Bering Sea crab fleet, which had substantially improved its safety record from the 1990s, when the deaths of more than 70 crew members gave momentum to reforms. It prompted the Coast Guard to form the three-person marine board -- the highest level of marine-casualty inquiry -- to understand what happened and to make recommendations to advance safety.

The 138-page document was made public Sunday after a private Saturday meeting that Coast Guard officials scheduled in Seattle for the families of the lost crew.

The board found that the Destination's problems resulted, in part, from a load of 200 crab pots that were heavier than indicated in an out-of-date 1993 stability booklet that offers crucial safety information about how to load the boat. The board recommended that the Coast Guard determine if civil penalties should be assessed against the boat's owner for failing to provide the captain -- as required by federal regulation -- with accurate stability instructions.

The board also noted that a 2016 dockside safety exam conducted by a surveyor failed to scrutinize the boat's stability. The exam was accepted by the Coast Guard but the board recommended -- and the commandant agreed- that it should now be rejected so that surveyor does not conduct any more exams until he receives "remedial training. "

The boat is owned by Destination Inc., a company formed by David Wilson, who lives north of Seattle, and his brother Louis Bernsten. The alleged violations of the regulations will be referred to the Coast Guard's Anchorage sector for a possible enforcement action, wrote Rear Admiral J.P. Nadeau, the Coast Guard's assistant commandant.

The report also says Hathaway, the captain, added to the stability problems by improperly putting bait atop the pots, which was not allowed in the loading instructions that also required the boat's hatch to be secured.

The findings led in the marine board to make 15 recommendations. Nadeau accepted seven, partially concurred with two and did not agree with six.

Recommendations Nadeau rejected called for updating federal safety regulations to specify the weight of crab pots and the risks of ice.

He also turned down recommendations that called for regulations to require boat owners to maintain records of weight changes to their vessels, notify the Coast Guard when major changes are made on a boat, and to require owners and captains to develop policies to address crew fatigue.

Capt. Lee Boone, who spoke Sunday to reporters, said the commandant's position was that existing regulations were sufficient to prevent the tragedy. The "missing piece was compliance."

Nadeau also rejected a suggestion for a broader audit of the nation's fishing fleets to look for stability problems that could put boats at risk.

"There is not sufficient evidence in this report to conclude additional oversight is needed across the entire fleet of commercial vessels," Nadeau wrote.

Family members said their Saturday meeting with the Coast Guard was somber, at times tense, stretching from morning to deep in the afternoon.

Some questioned why the Coast Guard would not pursue criminal penalties against the boat's owners. "Six people lost their lives. This is just not right," said Gayle Andrew, mother of Destination crewman Darrik Seibold.

Hannah Cassara, daughter of the captain, said the families "didn't hold back on their questions, and I think this is probably as close to closure as we will ever get."

The Destination sank at the start of a winter snow-crab harvest as weather forecasts called for heavy freezing spray that would form ice on boats.

Search efforts recovered a life ring, debris and an EPIRB -- emergency position indicating radio beacon -- that gave off a distress signal when the boat went down. But there were no signs of the crew or the Destination's life raft that was supposed to break free of the boat in event of a disaster and give the crew a chance of survival. The marine-board team said there was not enough evidence to determine if the raft launched properly.

Later, in the summer of 2017, a sonar image taken by the crew of a federal research vessel located the Destination, lying on its side more than 250 feet down on the ocean floor.

Hathaway was a veteran captain who had served on the Destination for 23 years, and he had an experienced crew who -- after a long season catching cod -- were getting a late start on the crab season. His boat was scheduled to deliver crab to a processing plant on the Pribilof Island of St. Paul. And, in radio communications with another skipper, Hathaway was concerned it would be hard to catch the boat's quota by a Feb. 25 plant shutdown.

The National Transportation Safety Board also investigated the accident, releasing a report in July that found the accident was caused by Hathaway's decision to head out in hazardous conditions, and then -- once at sea -- failing to have the crew combat the ice buildup that helped make the boat disastrously top heavy.

Some family members bridled at the NTSB singling out Hathaway.

"If anyone wants to criticize my husband, they can soak on this," said Sue Pierce Hathaway, the captain's widow, in an email to The Seattle Times that provided a memorial tribute, calling her husband "The best Sea Captain/Crab Fisherman -ever who respected and loved his crew."

A Coast Guard stability analysis found that the Destination's margin of safety had been eroded by changes made over the years to the gear and the vessel, such as adding a bulbous bow in 2012.

The Destination marine board is the latest in a long line of Coast Guard investigations into the fishing industry, where crew jobs rank as one of the most hazardous occupations in the nation. One of the most wide-ranging reports -- triggered by 11 deaths in the East Coast clam and conch fleet -- was released in 1999.

That report stated: "The history of fishing vessel safety has been an ongoing struggle between the rights of fiercely independent individuals willing or resigned to accept the hazards of the profession, and of those from within and outside of the industry who attempt to mitigate the extreme dangers of retrieving the ocean bounty. "

Dylan Hatfield, a former Destination crewman who lost his brother, Darrik Seribold, and close friend, Kai Hamik, in the sinking, still has questions about what happened that early February morning.

"There is still no accountability," Hatfield said.

He doubts crew members were so fatigued that they failed to remove ice. That's a job, he said, that typically got done no matter how tired anyone was.

Staff reporter Evan Bush contributed to this report.

Overloading, heavy ice and an open hatch: Coast Guard details what sank the Seattle-based Destination
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:13

The Destination.  (Jack Molan Photography)
The Destination. (Jack Molan Photography) (Jack Molan Photography/)

Researchers now are uncertain when and to what extent the ice may return, and have scrambled to better understand the consequences of back-to-back years of its loss.

"There are very few places on the planet where environmental change is more apparent than Alaska," said Robert Foy, director of the National Oceanic and Atmospheric Administration's Alaska Fisheries Science Center. "When we talk about ... sea ice, the changes we are seeing, they are on a massive scale."

This summer, the pace of change also quickened on shore as a record-shattering heat wave contributed to the deaths of salmon before they could spawn, to wildfires that shrouded the city of Anchorage in smoke, and to the further melting of permafrost, which causes ground to shift and can create problems for buildings and roads.

Offshore, temperatures in some spots at the bottom of the northern Bering Sea this summer measured more than 12 degrees Fahrenheit higher than nine years earlier.

The warming supports the spread of toxic algae blooms, which have been found not only in the northern Bering Sea but in Arctic waters. Scientists aboard the U.S. Coast Guard Cutter Healy in August detected the cells of these algae at surprisingly high levels in two spots in the Beaufort and Chukchi seas, raising concerns about the impacts on marine life.

The Bering Sea changes brought about by the lack of winter ice represent "the ecosystem of the future," said Phyllis Stabeno, a Seattle-based oceanographer with the Pacific Marine Environmental Laboratory who has studied this body of water for 30 years. "As a scientist, I'm fascinated by it. But as a human being, I'm depressed."

The northern Bering Sea now abounds with cod as well as pollock, two big-volume commercial species once largely found hundreds of miles to the south.

Meanwhile, halibut in these waters have declined, and smelts -- an important food for seabirds -- have crashed.

Delbert Pungowiyi walks back from the cliffs near Savoonga where the seabirds are missing from their normal cliff habitat.  He's walking past the skeleton of a minke whale on a beach that used to be sand before the sea ice receded and erosion from the Bering Sea occured.   (Steve Ringman / The Seattle Times)

Some of the birds also appear to be struggling.

Emaciated murres and other seagoing species have washed onto the beach that fronts Savoonga and other western coastal villages. In Savoonga, residents also see fewer birds in a rocky island rookery near the village.

Savoonga's location on St. Lawrence Island, midway between Russia and mainland Alaska, gives its population a ringside seat to the sweeping changes in the Bering Sea.

"Our cliffs are sick," said Delbert Pungowiyi, president of the Native Village of Savoonga, a tribal organization.

A break in the food chain

In harsh winters -- full of winds from the north -- the ice used to extend south from the Bering Strait almost to the Alaska Peninsula. Even in milder years, it typically stretched for hundreds of miles.

The ice froze through the fall and winter, shedding very cold, very briny seawater that -- due to its density -- would sink and eventually form a frigid layer down deep. Pollock, cod and many other species avoided the cold pool, and it often kept them from swimming north.

As the ice melted in the spring, it gave marine life a big boost.

Blooms of the ice algae -- known as phytoplankton -- spread through a less-salty band of water close to the surface, which also was rich in other forms of algae. All of this was a buffet for zooplankton, tiny creatures such as copepods and krill that are rich in fats and are key food sources for young fish, birds and some marine mammals.

When there's no ice, there are still later blooms of phytoplankton. But they support less-fatty zooplankton.

"They're ... much smaller, not nearly as much bang for the buck, so the fish and seabirds are feeding on less-nutritious prey," said Janet Duffy-Anderson, a federal research biologist at the Alaska Fisheries Science Center in Seattle.

The consequences for fish appear serious.

Duffy-Anderson was a part of a team that looked at pollock after a five-year stretch of ice-free winters in the southeast Bering Sea, ending in 2005. Young pollock had lower survival rates, and the adult pollock population later dropped by more than 40%.

The study, Duffy-Anderson said, raises the possibility that the entire Bering Sea -- once it permanently loses winter ice -- will sustain far fewer fish.

This ice core, removed from arctic sea ice, reveals the host of algae and small plant life that forms the backbone of the sea ice food chain. Scientists say melting summer sea ice already is changing life in the ocean, as Arctic cod and other fish move farther offshore to find the food that lives beneath the ice.  (Steve Ringman / The Seattle Times)

As the winter ice thinned and retreated, the cold pool shrank. The past two summers, it almost disappeared. Without that barrier, some fish are now migrating north and scattering across broader areas as they search for food.

Federal trawl surveys show huge shifts.

Since 2010, summer cod have increased more than 20-fold and pollock more than 50-fold in the shallow northern Bering Sea, which narrows where Asia and North America reach out toward one another.

Scientists are uncertain whether this area can support all these fish -- over the long term -- especially if the winter ice, and the algae that grows on it, fail to return.

But these fish seem to be on a long-term northern migration.

Overall, the center of the pollock population since 2012 has moved north an average of more than 18 miles a year.

"It is certainly one of the fastest (northward movements) I have heard of worldwide," said Jim Thorson, an ecologist studying the loss of sea ice with NOAA Fisheries.

Skippers on the front lines

The owners of the Bering Sea fleets have billions of dollars invested. So far, though some are fishing farther north, overall harvests of nearly 4.4 billion pounds a year have remained relatively stable, producing fillets, fish burgers, surimi and other products for U.S. and global markets.

The Beauty Bay, a Seattle-based vessel that sets miles of hooks along sea-bottom lines, this summer sometimes caught more than 40,000 pounds of a cod a day -- headed, gutted and frozen on board.

"The fish we are catching now are just beautiful. They are big and healthy," said Scott Hanson, the boat's co-owner and captain, during summer fishing that at one point took him into northern Bering Sea within 10 miles of St. Lawrence Island. The cod appeared to be finding plenty of food, including adult king crab, prickly shells and all.

“I’ve found their stomachs stuffed with hard-shelled crab legs,� said Hanson.

Still, industry officials are closely monitoring the science and some are wary as fishermen notice disconcerting changes.

"Climate change is really in your face," said Kevin Ganley, a Washington skipper with nearly 40 years' experience fishing for pollock.

The ice melt in years past would help create big undersea bands -- stretching for miles -- of zooplankton, bait fish and other food that pollock like to eat. Ganley said he used to find these areas and drop his nets close by.

But these bands are "disappearing more and more," Ganley said. "That's a real concern."

While some skippers this year report good pollock fishing, Ganley says it is often much harder to find them in big schools. So his boat, the 123-foot American Beauty, must sift through what he calls "micro-patches" of fish. And it may take 36 hours to fill the vessel's enormous trawl net -- six times longer than in decades past when Ganley found the pollock more bunched together.

This summer, much of the pollock catcher-processor fleet has been fishing farther to the northwest. They have congregated in an area near the international date line that divides the U.S. portion of the Bering Sea from that of Russia.

Some U.S. fishermen are afraid that if pollock continue to move in this direction, more will wind up on the other side of the maritime boundary. This will leave less for them to catch and more for the Russians, who have their own fleets of factory trawlers.

"There is certainly that potential," said Alex De Robertis, a biologist with NOAA Fisheries in Seattle who this year set down four acoustic devices along the international date line to monitor the pollock's cross-boundary movements.

Cod where there were crab

For crab fishermen who live by the northern Bering Sea, the loss of ice appears to be upending their livelihoods. Most are based in Nome, which sprouted on the shore of the Bering Sea's Norton Sound in the early 1900s, as news of gold found on the beach drew thousands of miners.

Small suction dredges continue to operate just offshore. Crabbers have made a living venturing onto the winter ice, where they cut holes to the water to catch king crab. In the open water of summer, they drop pots from more than 35 boats in harvests that in 2017 generated more than $2.5 million.

But this year has been disastrous.

Without the traditional covering of ice, winter was a bust.

During the summer, despite long offshore forays, crews failed to find much crab and fell far short of harvest limits.

"I typically have caught 23,000 pounds by now -- but this summer, I have less than 5,000 pounds," said Don Stiles, who fishes out of Nome on the 37-foot boat Golovin Bay.

Researchers say this scarcity could be because the crab -- due to warming or other factors -- moved out of their traditional harvest grounds, out of reach of the Nome fleet.

Some crab may have been eaten by cod that have moved in.

As Stiles and other skippers searched for king crab this summer, they pulled up pots that were sometimes filled with a dozen or more cod.

"That's a lot of cod," Stiles said. "You see it coming, and you think, 'Oh, no.'"

In the middle of July, after pulling up several pots containing only cod and a few starfish, he got so discouraged that he opted not to retrieve more than three dozen other pots. In late August, he returned to check them.

Many pots held cod. And there wasn't much adult crab.

A tradition on the ice

In Savoonga, the ice often held fast to the island shore deep into May, and the Yu'pik hunters used it to good advantage.

A pressure ridge of folded ice created a "perfect little hiding spot," when hunting seals, wrote Denny Akeya, Derek's father, in his book, "God Created Heaven and Earth, Including Me," that documents the traditions of his people, Siberian Yu'pik, who share their culture and language with a Native people on the Russian side of the Bering Strait.

Though the ice could be an ally, it could also quickly turn deadly, if a hunter stepped in the wrong place, or got caught on a piece of ice drifting out to sea.

Denny Akeya, 68, taught his son Derek how to hunt on the ice during the later years of the last century, when winters packed enough of a punch to pile up ice around the village. Derek would help push boats across the ice as his father searched for patches of open water to hunt walrus and bearded seal.

Ice also made possible one of Derek's cherished after-school pastimes. He would chop a hole, drop a line and catch fish to give to village elders.

Derek, now 31, once had doubts about staying in Savoonga.

The Yupik village, Savoonga on St. Lawrence Island in Alaska.   (Steve Ringman / The Seattle Times)

After graduating from high school, Derek met Melanie Gustafson, a young woman from Minnesota who worked in Savoonga as part of Youth With a Mission, a Christian service group. They were married in 2010, and Derek moved for a few months to his wife's small town of Alexandria, where the corn grew sweet and there were plenty of ripe summer tomatoes.

He missed Savoonga and the much more difficult food-gathering tasks that bound his people to the land and the sea.

"I just couldn't do it -- everything was just too easy," Akeya said.

So the couple returned to start their family that now includes two young boys and a girl.

But with warmer winters, the shore-fast ice has been on a yearslong decline, and villagers have had a harder time hunting. Villagers hope each spring to land a bowhead whale, which are typically drawn to the island waters by the food they find at the edge of ice as it retreats. This year, Savoonga crews failed to land one.

In the summer, catching halibut offers a way to earn cash with fish that are cleaned and air-freighted to market.

But the halibut often are smaller than when the village's commercial harvests began back in the 1990s.

On a good day, fishermen may still fill up their boats with more than 20 halibut, tossing over many of the cod to make room for the more valuable fish.

As Derek Akeya and two other villagers return from their late-summer fishing trip, they have just two halibut in their skiff as it pounds through the waves.

There is a slight chill to the air, a reminder that a change of season is not far away.

With the warm water temperatures of this summer, it will be harder for ice to form.

Still, climate change does not move in lock step from year to year, and scientists are unsure, in a time of such extreme changes, what happens next.

Akeya is not giving up hope that the coming winter will bring thick sea ice for his children to experience.

But he is not expecting a big turnaround.

Hal Bernton is a former reporter for the Anchorage Daily News who now reports for the Seattle Times.


As Bering Sea ice melts, Alaskans, scientists and Seattle’s fishing fleet witness changes ‘on a massive scale’
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:13

The story, from The Seattle Times, is part of the Pulitzer Center’s Connected Coastlines reporting initiative. For more information, go to pulitzercenter.org/connected-coastlines

SAVOONGA — Derek Akeya hopes for calm waters and a lucrative catch when fishing from a skiff in the Bering Sea that surrounds his island village.

But on this windy late summer day, waves toss about the boat as Akeya stands in the bow, straining to pull up a line of herring-baited hooks from the rocky bottom.

Instead of bringing aboard halibut -- worth more than $5 a pound back on shore -- this string of gear yields four large but far less valuable Pacific cod, voracious bottom feeders whose numbers in recent years have exploded in these northern reaches.

"There's a lot more of them now, and it's more than a little bit irritating," Akeya says.

The cod have surged here from the south amid climatic changes unfolding with stunning speed.

For two years, the Bering Sea has been largely without winter ice, a development scientists modeling the warming impacts of greenhouse-gas pollution from fossil fuels once forecast would not occur until 2050.

This ice provided a giant platform for growing algae at the base of the food chain, and has been a significant contributor to the remarkable productivity of a body of water, stretching from Alaska to northeast Russia, that sustains some of the biggest fisheries on the planet.

Much of U.S. seafood -- ranging from fish sticks to king crab legs -- comes from the Bering Sea, which generates income for an arc of communities that reaches from Savoonga to Seattle, where many of the boats that catch and process this bounty are home-ported.

For Native people such as Akeya, who is Yup'ik, the ice also has shaped their culture, helping them to hunt the walruses, whales, seals and other marine life that have long formed a crucial part of their diet.

Denny Akeya holds a Pacific Cod, one of many caught on longlines off of Savoonga while out fishing for halibut.   (Steve Ringman / Seattle Times)
Denny Akeya holds a Pacific Cod, one of many caught on longlines off of Savoonga while out fishing for halibut. (Steve Ringman / Seattle Times) (Steve Ringman/)Delbert Pungowiyi walks back from the cliffs near Savoonga where the seabirds are missing from their normal cliff habitat. He's walking past the skeleton of a minke whale on a beach that used to be sand before the sea ice receded and erosion from the Bering Sea occured. (Steve Ringman / The Seattle Times) (Steve Ringman/)This ice core, removed from arctic sea ice, reveals the host of algae and small plant life that forms the backbone of the sea ice food chain. Scientists say melting summer sea ice already is changing life in the ocean, as Arctic cod and other fish move farther offshore to find the food that lives beneath the ice. (Steve Ringman / The Seattle Times) (Steve Ringman/)The Yupik village, Savoonga on St. Lawrence Island in Alaska. (Steve Ringman / The Seattle Times) (Steve Ringman/)

NOME — The shipment arrived airfreight: 47 seabird carcasses collected by the Bering Strait villagers of Shishmaref.

Marine biologist Gay Sheffield drove to the airport on an August day to pick up the grisly cargo and bring it back to a laboratory just off the main street of this northwest Alaska town.

Inside a cardboard box, Sheffield found mostly shearwaters, slender birds with narrow wings -- also kittiwakes, crested auklets, thick-billed murres, a cormorant and a horned puffin. Most were painfully skinny, bones protruding like knife-edged ridges.

"They starved to death," Sheffield said. "Why?"

The birds should have been able to fatten on small fish, krill and other food that typically abound in the northern Bering Sea, a body of water so rich in marine life that gray whales, after they winter off Mexico, swim more than 5,000 miles north to feed here each summer.

But as climate change warms the die-offs of seabirds and marine mammals have been on the rise. The grim tally includes a nearly fivefold increase in ice-seal carcasses spotted on shore, strandings of emaciated gray whales, and near the St. Lawrence Island village of Savoonga, a discouraging spectacle: auklets abandoning seaside nests as their chicks succumb to hunger.

"I came upon a baby auklet on the beach. It was getting weak, dying slowly and suffering," said David Akeya, a Savoonga resident. "I had to end its life."

The animal die-offs offer the world a stark example of the perils of rising ocean temperatures, which already are upending parts of the Bering Sea ecosystem as climate change -- driven by greenhouse-gas pollution from fossil fuels -- unfolds in Alaska at a breakneck pace. For the past two years, the winter ice has largely disappeared, and this fall, ice formation in some of the northern waters has been at historic lows.

These are startling developments for those who live along the shores and for the Seattle-based fishermen whose fortunes are tied to the Bering Sea harvests that are some of the biggest on the planet.

Federal and university scientists are trying to better understand why some birds and marine mammals have been unable to find enough food, and whether toxic algae blooms -- increasing as the water warms -- could have contributed or caused some of the die-offs.

The pace of the research frustrates Sheffield, an Alaska Sea Grant biologist who has worked in the northern part of the state for more than a quarter century. As the warming takes hold -- raising some summer sea-bottom temperatures by more than 12 degrees in less than a decade -- Sheffield has emerged as a front-line scientist traveling around the region to document death tolls and gather specimens for analysis. Along the way, she's heard from Yup'ik and Iñupiat villagers who eat the seabirds and marine mammals, and -- disturbed by what they were finding -- began to gather samples from dead animals and airfreight them to Sheffield in Nome.

"It's not an academic issue out here," Sheffield said. "If you live here, it's a real-world problem. It's an immediate, stop, get an answer problem. It's a food security and health problem ... and people are very brave in taking action."

Alaska Sea Grant biologist Gay Sheffield prepares to bag a dead seabird, one of 47 picked up off a beach near the village of Shishmaref and airfreighted to her University of Alaska Fairbanks Northwest Campus office in Nome. She is assisted by intern Ethan Ahkvaluk. (Hal Bernton / The Seattle Times)

“Things are out of whack�

The struggles of Alaska’s seabirds grabbed scientists’ attention in 2015, when hundreds of thousands of dead and dying common murres washed ashore along state’s Southcentral coast during a period of unusually warm water temperatures.

That Alaska seabird die-off was thought to be the biggest on record and could be devastating if repeated, according to a National Park Service publication. It was followed by a series of other die-offs.

Scientists have sent more than 220 seabird carcasses found along different parts of Alaska's shoreline to a U.S. Geological Survey (USGS) laboratory in Madison, Wisconsin, for necropsies.

More than 80% of the birds were found to have died from a lack of food, according to Robert Dusek, a government biologist in Madison.

Why can't the seabirds find a meal?

In some areas, the answer may be simple: a food shortage.

Many of these seabirds eat tiny shrimplike creatures such as krill and copepods, whose numbers -- according to federal marine surveys -- have declined as the water off Alaska has warmed.

Others, such as the murres, dine on small fish such as smelt, which in the northern Bering Sea have suffered a 98% population drop in eight years, according to federal surveys. And as seabirds search for these fish, they may face increased competition for their prime food sources from Pacific cod and pollock that -- as the winter ice has faded -- migrated here from waters farther south.

In surveys this year, northern Bering Sea pollock populations surged more than 50-fold compared to 2010, and the Pacific cod increased more than 14-fold.

"Things are out of whack. When you throw in multiple species of these predatory fish, it's no surprise that we are going to have problems," Sheffield said.

The seabird's difficulties finding food were on painful display this summer near Savoonga, a St. Lawrence Island village in the northern Bering Sea, where a poster on the wall in the local tribal building urges people to not eat birds found dead along the beaches, to handle them with gloves and to report those locations to scientists in Nome or Anchorage.

During a monthlong visit last summer, biologist Alexis Will observed auklets diving into the water in search of copepods. She examined their vomit for signs of this key food but found they did not have much success in their foraging.

Exhausted birds washed up on the beach and died. Meanwhile, in the more than 30 nests Will surveyed, none of the baby chicks survived past two weeks, prompting the adults -- first the least auklets and later the crested -- to abandon the colony.

"Usually, there are 'cheeps' (from chicks) coming out of every single crevice," Will recalled. "But it was just silent. It was kind of like you show up at a dance party and no one is there."

The plight of seals

As the winter ice has faded -- and waters have warmed -- seal deaths also have been on the rise.

During the past two years, 282 seal carcasses have been spotted on the northern Alaska's shoreline, and a lack of food appeared to play a role in one major die-off Sheffield investigated.

In June 2018, she tallied 45 carcasses of bearded, ringed and spotted seals on a half-mile stretch near the village of Wales, north of Nome on the Seward Peninsula.

These were all ice seals, which during the winter and spring months depend on the frozen sea to help them find food, bear their young and escape predators. They were mostly pups and young adults, and during this summer season they should have been foraging for small fish and other marine life in coastal waters.

But many of those found in Wales had only thin layers of blubber over their ribs. Checking their stomachs, Sheffield wrote in a report that she found "no recognizable prey items," only "sand, plastic debris, a pebble and a wood fragment."

"I had never seen such a die-off," Sheffield said.

Threat of toxic algae

Toxic algae produced by the warming Bering Sea poses another risk for mammals and birds.

The cysts of these algae have been found in surprising amounts on the ocean bottom in northern Alaska waters, according to Don Anderson, a researcher at the Woods Hole Oceanographic Institution, whose team mapped the cysts during a trip on the Coast Guard cutter Healy.

As ice recedes and water temperatures climb, the cysts unleash blooms, which in the years ahead are expected to become more intense and more widespread.

"You could see die-offs of whole groups of animals. This is the unknown," said Kathi Lefebvre, a Seattle-based federal biologist who studies the effects of toxic algae on animals and humans.

The two most common strains -- saxitoxin and domoic acid -- attack the nervous system. In low amounts, they appear to cause no harm but at higher levels can cause illness or death.

Lefebvre was the lead scientist of a 2016 study that detected one or both of these harmful algae in 13 species of marine mammals. Walruses were found to have the highest concentrations -- roughly the same levels of domoic acid that had triggered seizures in California sea lions in Pacific waters much farther south.

Two years later, in the summer of 2017, saxitoxin emerged as a suspect in the strange behavior of a walrus that pulled out on the northern Bering Sea island of Little Diomede. The great, tusked creature was fatigued and hung its head. Surprisingly, it was not spooked by the presence of villagers nearby.

The hunters who killed the walrus after observing it for 45 minutes were wary that something was wrong. They opted not to eat it, and -- after a phone call to Sheffield -- opened the intestines, scooped out a fecal sample and shipped it to her, and she forwarded it to a federal lab in Seattle.

The analysis showed saxitoxin concentrations more than four times higher than federal standards allow in seafood eaten by humans. Toxin levels likely would have been much lower in the muscle and blubber -- but that assumption still requires further investigation, according to Lefebvre.

This was disturbing news back in Little Diomede. There, walrus is a staple food, and people may eat all parts, including organs, though hunters have long keenly observed the body conditions of marine mammals and don't eat those that are sick. But the potential for a toxic algae had not been a consideration.

"We were astounded, said Francis Ozenna, tribal coordinator for the village of Little Diomede.

Toxic algae may have played a role in the deaths of 39 walruses that in the summer of 2017 washed up on the shores of Northwest Alaska. Analysis found moderate levels of saxitoxin in samples taken from some decaying bodies.

"There is no doubt that the toxins are a suspect," Lefebvre said.

Algae toxins may be involved in some of the bird die-offs.

During the August cruise of the Coast cutter Guard Healy, scientists spotted dead birds, including in an area where the Woods Hole team detected high levels of an algae that can produce saxitoxin.

They collected more than 100 deep-water samples of clams, worms and krill, all of which are food for marine life. Tests by Lefebvre in Seattle showed two of the clams had levels of saxitoxin above the federal seafood safety limit. The rest had moderate levels of saxitoxin, according to Lefebvre.

Scientists also retrieved a very skinny short-tailed shearwater for analysis at the U.S. Geological Survey laboratory in Wisconsin. So far, the USGS scientists have looked for traces of saxitoxin in more than 100 dead Alaska seabirds. More than 30% tested positive, including many that were determined to have died from starvation.

This finding raises the possibility that some birds are disoriented and weakened by ingesting the toxins to the point where they can't forage for food.

"That's certainly a hypothesis we are considering," said Dusek, the USGS biologist who conducted the testing.

Spreading the word

With so many unanswered questions, Sheffield has wrestled with how to assess -- and communicate -- the risks posed by the die-offs.

She helped put together an Alaska Sea Grant publication that summarized the findings of saxitoxin in walruses, and urged villagers to be vigilant for odd walrus behavior. She presented timelines, maps and test results at community meetings in Little Diomede and other villages. And this summer in Nome, she organized a workshop on algae toxins that helped alert local health officials to the potential for human illness.

So far, there have been no confirmed cases of algae toxin illness among the native people of Northwest, Alaska, according to a state epidemiology official. But Sheffield is concerned about a lack of monitoring, so it's hard to know just what is happening.

This summer, Sheffield spent a lot of time documenting the die-offs. She spent a long afternoon, her hands clad in blue plastic gloves, examining birds that came out of the box from Shishmaref. Each was put in a plastic bag, then put in a freezer so they could be shipped south for further analysis.

“We have a crisis. We’ve got to get answers.�

Why are birds and seals starving in a Bering Sea full of fish?
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:12

The series is part of the Pulitzer Center’s Connected Coastlines reporting initiative.

Delbert Pungowiyi holds a seagull carcass found on the beach that runs along the village of Savoonga, on the Bering Sea island of St. Lawrence, where there have been a series of seabird die-offs. (Steve Ringman / Seattle Times)
Delbert Pungowiyi holds a seagull carcass found on the beach that runs along the village of Savoonga, on the Bering Sea island of St. Lawrence, where there have been a series of seabird die-offs. (Steve Ringman / Seattle Times) (Steve Ringman/)Alaska Sea Grant biologist Gay Sheffield prepares to bag a dead seabird, one of 47 picked up off a beach near the village of Shishmaref and airfreighted to her University of Alaska Fairbanks Northwest Campus office in Nome. She is assisted by intern Ethan Ahkvaluk. (Hal Bernton / The Seattle Times) (Hal Bernton/)

In December, Christine Rayburn detected a painful lump in her right breast that biopsies would later show included two different types of cancer. One had invaded her lymph nodes.

Rayburn and her doctors settled on a plan. First, surgery to remove the tumor was scheduled for March 20 at Providence St. Peter Hospital in Olympia. Then, chemotherapy.

Two days before the operation, Rayburn got disturbing news from her surgeon. The procedure had been postponed due to the spread of the coronavirus.

"I actually burst into tears and started crying," Rayburn said. "I really wanted that cancer out ... I felt like I was being sacrificed ... for the good of the people."

Rayburn is one of many Americans whose surgical procedures, tests and examinations have been canceled as part of the broader response to the rapidly unfolding crisis. These disruptions represent a huge but largely hidden toll of the pandemic, which has slashed services available to patients and inflicted a major economic blow on hospitals and health care workers, one intended to be softened with $100 billion from the stimulus package approved by Congress last week.

These actions have been impelled by the need to conserve scarce protective gear for health care workers. They also represent an effort to reduce the risk of sickening patients and those who treat them, and to dedicate more space, staff and ventilators for the expected increase in hospitalizations of people with COVID-19, the disease caused by the virus.

The measures were initially called for by national recommendations from the Centers for Disease Control and Prevention. Then, in Washington state, a March 19 emergency proclamation by Gov. Jay Inslee banned medical procedures that would not be anticipated to cause harm to the patient if delayed for three months.

Inslee, in his order, noted that some scheduled surgeries, such as removal of serious cancerous tumors, could proceed. And after inquiries from a state legislator about her case and an appeal from her surgeon, Rayburn learned Thursday that Providence St. Peter had rescheduled her operation for Monday.

But there is no easy formula for this rationing of health care, and The Seattle Times has found a wide range of care pushed into an uncertain future, with some of these delays having potentially serious consequences for patients. They include an operation to remove a throat lesion in an 11-year-old girl, a stent repair of a swollen artery (a condition known as an aneurysm) at the base of man's brain, and a procedure to remove an intrauterine birth-control device causing a woman intense pain during menstrual cycles.

Other conditions deferred involved surgery on a herniated disc that made it difficult for a man to walk and cutting away a portion of a prostate to allow removal of a catheter that poses a serious infection risk due to the weakened condition of an elderly patient.

There also have been large-scale cancellations of routine appointments that include measles vaccinations and screenings, such as colonoscopies and mammograms, that can detect possible cancers.

Dr. Peter Benda, a Kirkland-based pathologist who interprets biopsies from such tests, said that the volume of his work has dropped dramatically. "The untold story is that we put the rest of the health care system on the back burner ... If we are not making diagnoses, patients don't know if they have cancer."

Revenue slashed

As the flow of patients implodes, so does the revenue that sustains clinics and hospitals.

Dr. Sara K. Benda, a pediatrician married to Dr. Peter Benda, said she works in a physician-owned private practice on the east side of Lake Washington that has had to lay off 30% of its staff and cancel all face-to-face checkups with the exceptions of babies 15 months and younger.

Hospitals large and small are struggling.

A Providence network of 11 hospitals in Washington and Montana has suffered a 50% decline in revenue due to the reduced services, according to Melissa Tizon, a Providence spokeswoman.

And the 25-bed Three Rivers Hospital in Brewster, one of three in Okanogan County, will run out of money within a month without an infusion of federal or state money due to the lack of general surgeries, according to its CEO. It is one of five smaller hospitals facing "imminent closure" cited in a March 20 letter to Gov. Jay Inslee from the Washington State Hospital Association.

"We have always kind of struggled in an underserved community, just doing enough business to cover our costs," said J. Scott Graham, chief executive of Three Rivers and North Valley Hospitals. "There is a lot of sleepless nights and anxiety about whether we are going to make it through."

Who gets a procedure, who doesn’t

For doctors paring down caseloads, the coronavirus outbreak represents a difficult foray into triage, a term often used in wartime to decide difficult decisions on treating battlefield wounds. The American College of Surgeons has embraced the technique in developing guidelines for what operations to postpone. The guidelines are keyed to how many coronavirus patients are in a hospital, and call for tightening restrictions on surgeries as these numbers climb.

At UW Medical Center's Montlake campus in recent weeks, surgeries have dropped by about half. A lot more could be postponed if more coronavirus patients are hospitalized there. That scenario -- if it does happen -- would likely unfold in April.

"We're still at a phase where we feel we can do cancer operations. But we might get to a phase two or three weeks from now where ... we can only do true emergencies -- someone who might die right now," said Dr. Douglas Wood, who chairs UW Medicine's surgery department and helped develop the guidelines for the American College of Surgeons.

Wood is increasingly hopeful that a big surge will not happen, as the numbers of coronavirus patients last week were less than anticipated, but he says the UW must stockpile personal protective gear in case it does.

Wood says UW Medicine has left it up to individual surgeons to decide which cases to keep on the schedule and which to postpone. He has not heard of patients who contested these decisions. If there are complaints, cases could come under broader scrutiny from UW faculty and hospital leadership.

Within the Providence hospital network, Christine Rayburn, the cancer patient, and her husband, David Forsberg, did push hard for reconsideration.

They emailed three Olympia-area legislators for help. They also talked repeatedly with a Providence St. Peter administration official who said there was a hospital decision to suspend elective surgeries, which then would be taken under review by doctors, according to Forsberg.

"It's OK to be a squeaky wheel to ensure that you get the care and attention that you need," Forsberg said.

Elaine Couture, chief executive of Providence, Washington & Montana Region, said a few weeks ago as serious COVID-19 cases rapidly escalated in the Puget Sound area that hospitals had to quickly make tough decisions to scale back.

The scarcity of personal protective equipment quickly emerged as a major constraint. Providence Everett went through the same amount of gear in three months as the entire Providence network of western hospitals typically consumed in the same time period.

Couture told The Seattle Times that surgeons -- not hospital administrators -- were making the key decisions about which procedures could continue at the Providence hospital network. Once a patient's surgery is put on hold, Coutere said, doctors review cases several times a week, and approve them if they need to be done.

"The process is working. We're not putting people on a list and their names go away," Couture said.

Wide range of operations on hold

For patients whose appointments are canceled, the stalled medical care can add to the anxieties in an already anxious time.

Glen Godwin, of Leavenworth, is cooped up indoors with a herniated disc that was scheduled to be operated on at Wenatchee Valley Medical Center. Godwin, 60, said he injured his back last month trying to lift a snowmobile. One of his legs is so numb he can barely walk, and he has a mix of light- and heavy-duty pain pills prescribed to help him through his days.

"The last I heard it would probably be June before they could do the surgery," Godwin said.

Corey Miller is a Seattle oncology researcher whose husband, Timothy, had surgery for colon cancer last year, and was due for a colonoscopy this month. Instead, the appointment was canceled for at least six weeks.

"I was surprised when we got the word. The protocol is for a one-year check up to ensure that there is no return," Miller said.

Patra West is unsettled by a lesion in the throat of her 11-year-old daughter that was removed last summer and has since grown back. An initial ultrasound indicated it is likely benign. But Patra didn't want to take any chances and opted to have it removed in an operation this month that has yet to be rescheduled at Seattle Children's hospital.

"Obviously, there is a growth where there shouldn't be," West said.

For the patients who are able to access hospitals for scheduled appointments, there can be a kind of eerie calm on some floors.

Rayburn, in recent days, has been able to resume some cancer care at Providence St. Peter. Last week, she got an echocardiogram of her heart, a prerequisite for the chemotherapy that will follow Monday's surgery.

As she waited for the examination to begin, Rayburn watched a hospital staffer make call after call canceling the appointments of other patients who needed echocardiograms.

“I was the only one there. I felt incredibly lucky,� Rayburn said.

With surgeries delayed, patients wait with anxiety — some in pain — as hospitals make way for coronavirus cases
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:11

iStock / Getty Images
iStock / Getty Images (sudok1/)

CARTERSVILLE, Ga. — For three days, he was hooked up to an oxygen tube. For six days after that, he was cooped up in a 26-foot RV in a special quarantine camp run by the state of Georgia.

So when Joey Camp, a 30-year-old Waffle House line cook, learned he no longer had COVID-19 and could go home, he figured things were getting back to normal. Immediately, the former National Guardsman started making lunch and dinner plans: all-you-can-eat wings at Hooters? A super burrito from Los Arcos Mexican restaurant?

Soon, heavier concerns loomed. The divorced father of two made $10.65 an hour at Waffle House and has lived with friends since being evicted last year from his apartment. After leaving quarantine, he worked just one shift before his boss cut his hours because so few customers were coming in. His other part-time gig, as a party bus driver, went away.

"I'm making zero dollars for the foreseeable future," Camp said. "A person who makes $50,000 or $60,000 a year just isn't understanding what this means."

Almost every day since he got out of quarantine, Camp has squeezed into his dusty black '98 Chevy Camaro with its cracked windshield and driven, seat belt unbuckled, to a string of restaurants: Hooters and Applebee's, Waffle House and Buffalo's, Los Arcos and Huddle House.

Inside, he has sought to resume small acts: greeting a server, sitting in a booth, perusing a menu.

Until now, COVID-19 has mostly been experienced through the lens of metropolitan areas: Seattle, San Francisco, Los Angeles, New York. But as the virus spreads into rural and small-town America, significant numbers of Americans continue to dismiss calls for more aggressive social distancing and shutdowns.

Media sensationalism and liberal fearmongering, they say, will destroy the economy.

"With all the craziness going on in the world, America should show people that this is not something that should shut down countries," Camp said after wiping his hands at a sanitizing station posted at the entrance of 7 Tequilas restaurant. "We need to be the adults in the room."

Public health officials say that such doubters pose a major obstacle to efforts to reduce the spread of the virus and prevent mass casualties.

The coronavirus is at least 10 times deadlier than the flu and can be transmitted by people who are infected but asymptomatic. Even though many cases are mild, especially in the young, widespread infection could lead to hundreds of thousands or even millions of deaths.

A libertarian who voted for President Donald Trump in 2016 and plans to vote for him again, Camp compares COVID-19 to the flu.

"It's not going to kill the vast majority of the population," he said. "People are hearing 3.4% mortality. They're not hearing the 96.6% survival rate."

Polls show that Democrats and those living in large cities and suburbs have significantly more anxiety about COVID-19 than Republicans and residents of small towns and rural areas.

While Democratic strongholds like California and New York have banned public gatherings and closed restaurants, reaction to the pandemic has been slower and more uneven in Republican states, like Texas and Florida, where distrust of big-government regulations coincides with suspicion that the media is overplaying worst-case scenarios.

A good chunk of conservatives have also taken their cue from Fox News, whose pundits were late to take the virus seriously and are now backing Trump's call to reopen the economy. (Camp doesn't have cable, but he uses his smartphone to follow commentary on Daily Wire, Fox News and CNN.)

Cartersville is a fast-growing farming and manufacturing hub of about 20,000 people northwest of Atlanta. Here, pastures with horse fences increasingly give way to subdivisions and strip malls.

It also is one of the epicenters of the coronavirus in Georgia. More than 80 people in Bartow County have tested positive and a 69-year-old man has died. The local medical center has erected outdoor triage tents and a large sign saying, "We are all in this together."

In Georgia, where more than 1,200 residents have tested positive, with 394 hospitalized and 40 dead, Republican Gov. Brian Kemp has been reluctant to institute widespread business closures. On Monday he ordered bars to close and banned public gatherings of more than 10 people, but he has yet to shutter restaurants.

Bartow County officials have taken matters into their own hands, closing all bars, dine-in restaurants and theaters.

While Camp distinguishes himself from his father, a conventional Southern conservative who he said would march with Trump to the gates of hell, he insists there are still too few coronavirus victims to warrant extreme government intervention.

"We have probably more owners of chickens in this county than we have coronavirus victims and there aren't that many farms around here," Camp said as he stood outside his friends' home on a rolling green pasture dotted with ducks, Canada geese, turkeys and chickens.

As if on cue, a rooster crowed in the background.

———

When Camp came down in late February with a cough, he figured he had the flu or pneumonia and could tough it out. After growing up in poverty in a trailer park — the son of a construction worker father and drug dealer mother — Big Bad Joey could take care of himself.

So he carried on with his commitments, officiating at the wedding of one of his best friends and frying bacon over a hot grill at Waffle House, until eventually the chills and body aches became so severe he had to hole up at home.

Finally, when curling under the covers wouldn't stop his chills and chattering teeth, he went to an emergency room.

A diabetic, he was diagnosed with pneumonia. After a few days, he tested positive for the virus.

Camp had no clue how he contracted the virus and assumes it came from someone who was asymptomatic. He hadn't been overseas. He hadn't taken a cruise or ventured to the West Coast.

After four days in the hospital, his symptoms abated. He decided not to self-quarantine at home — he was living with a family with an infant son — and became the first Georgian to live in a special quarantine site at Hard Labor Creek State Park, about 50 miles east of Atlanta.

As he recuperated in his trailer, watching Star Wars movies and "Ferris Bueller's Day Off," Camp was aghast as officials closed schools, urged people to work from home, and shut down major sporting events.

Camp made light of the situation on Facebook, sharing a stream of memes ("I want to get quarantined with you — flirting in 2020") and a TikTok video of a pole dancer dressed up in a white hazmat suit, black platform stilettos and orange rubber gloves spraying anti-anti-disinfectant on a pole ("When there's a coronavirus outbreak but you have bills to pay").

Leaving quarantine, he was shocked by what seemed like extreme behavior.

At a Circle K gas station, he watched a man put on surgical gloves to go to the restroom, take off the gloves when he came out, wipe his hands down with baby wipes, pump gas and then wipe his hands with baby wipes again.

"It's like 'Mad Max,'" he said as he drove down a four-lane highway, passing very few cars. "It's kind of weird. It's like everybody's holding their breath, waiting for either society to collapse or society to get back to normal."

When Camp returned to the Waffle House, which had temporarily closed after his diagnosis, for his first shift after the quarantine, Camp urged folks on social media to drop in and meet "King Coronavirus."

Walking back into the diner, Camp felt like Michael Jordan returning to the Chicago Bulls in '95 after his foray into baseball.

Andrea, a server, wrapped her arms around him.

Two other servers gave him elbow bumps.

It was like he never left.

But only a smattering of customers sat in the restaurant. As business slowed, his next shifts were canceled.

With minus $3.33 in his checking account and no savings, it wasn't like he wasn't any better off than his co-workers.

"If I have to, I'll make a bow and arrow and go hunting in the woods," he said after driving past the nearly deserted Waffle House.

If things got really desperate and society collapsed, at least his roommate, Trey, has a couple of pistols, an AR-15 and a 12-gauge shotgun.

A few hours later, he was on the porch with Trey when his boss called: the diner would close, at least for now.

"It doesn't make any sense," he said. "When Waffle House shuts down, that's crisis mode."

He paused, shaking his head.

It didn't feel like crisis mode. All around him, everything was calm: wind chimes tinkled softly in the spring breeze; birds chirped as they flitted around a pair of blooming Bradford pear trees.

"I don't know how to deal with it," he said. "It does not compute at all."

But when he picked up his cellphone to check the number of new coronavirus cases, doubt crept in. Was he wrong? Could he get reinfected?

"Worldwide, it's starting to kill more people," he said. "Maybe this thing is mutating and becoming more deadly. And that worries the hell out of me, because that puts me back in the pool."

By Wednesday, he had found a temporary job — making hand sanitizer.

He survived COVID-19. He’s broke. But he thinks America is overreacting.
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 19:00

Joey Camp was the first person in Georgia to be quarantined at a special site after being diagnosed with COVID-19. (Jenny Jarvie/Los Angeles Times/TNS)
Joey Camp was the first person in Georgia to be quarantined at a special site after being diagnosed with COVID-19. (Jenny Jarvie/Los Angeles Times/TNS) (Jenny Jarvie/)

WASHINGTON— Wary of President Trump’s criticism that they were ungrateful for his management of the coronavirus crisis, governors of several of the hardest-hit states sought gingerly Sunday to avoid provoking him anew and risk losing desperately needed federal aid.

Despite the drastic shutdown of much of the country, Dr. Anthony Fauci, the government's top infectious-disease specialist, warned Sunday that 100,000 to 200,000 Americans might die before the pandemic eases. More than 2,400 had died as of Sunday.

Several governors made clear they fear inadvertently harming their own citizens if they are too strident in demands for desperately needed medical supplies, or if they clash too publicly with Trump over pandemic policy as the contagion spreads.

So they took a new tack, articulating their states' needs while ignoring Trump's insults and demands.

Michigan Gov. Gretchen Whitmer— who Trump has derided on Twitter as "half-Whit"— touted her cooperative relationship with Vice President Mike Pence, who heads the White House coronavirus task force, and with the Federal Emergency Management Agency.

"It's gotta be all hands on deck— we shouldn't be fighting one another; we need to be fighting COVID-19 together," Whitmer said on CNN's "State of the Union," referring to the disease caused by the coronavirus.

"I don't have the energy to respond to every slight," she added.

Washington Gov. Jay Inslee, also the object of Trump's withering remarks, sought to turn the other cheek and focus on his state's needs and his "good partnership" with federal authorities.

"We're not distracted by some of the noise out of the White House," he said on CNN.

With cities and states pleading for federal help to obtain critically needed medical supplies and complaining that Trump has moved too slowly, tensions have grown between the White House and the governors.

On Friday, Trump openly criticized governors who were reluctant to praise his leadership and suggested their states could suffer as a result.

"When they're not appreciative to me, they're not appreciative to the Army Corps, they're not appreciative to FEMA, it's not right," Trump told a White House briefing on Friday. He said he had advised Pence not to call the governors of Washington, which saw the first major outbreak of COVID-19, and Michigan.

"I say, 'Mike, don't call the governor of Washington. You're wasting your time with him,'" Trump said, referring to Inslee.

"'Don't call the woman in Michigan,'" the president added, referring to Whitmer.

The White House nonetheless on Saturday approved Michigan's request for an emergency declaration, freeing up federal aid.

Another case study in Trump's tense dealings with governors emerged Saturday, when the president said he was considering putting parts of New York, New Jersey and Connecticut under enforced quarantine. New York City is the nation's infection epicenter, at least for now.

None of the three Democratic governors involved was consulted beforehand; not even New York Gov. Andrew Cuomo, who had spoken with Trump earlier in the day.

After hearing of the proposed tri-state quarantine, Cuomo warned it would amount to a federal "declaration of war" on the states and would paralyze the region's already battered economy. Trump then dropped the idea, and a travel advisory was issued instead, telling people in the area to stay home.

Fauci, who directs the National Institute of Allergy and Infectious Diseases and is a member of the White House coronavirus task force, made plain Sunday that Trump—who frequently cites his hunches over scientific advice— had to be talked out of the proposed quarantine.

"We made it clear, and he agreed, it would be much better to do what's called a 'strong advisory,'" Fauci said on CNN. Trump's enforced quarantine would have created "a bigger difficulty," he said.

New Jersey Gov. Phil Murphy, interviewed on ABC's "This Week," did not mention being blindsided by Trump's proposal, merely observing that the travel advisory that was ultimately announced would serve the same purpose.

Then he pivoted to his state's top priority: obtaining ventilators and respirators to help overwhelmed hospitals deal with critically ill patients.

Among the governors, not all praise or criticism of Trump breaks down along party lines. Many governors from both parties have urged him to use the Defense Production Act to order private companies to turn their manufacturing ability to making medical supplies.

There have also been bipartisan calls for Trump to order federal authorities to find and distribute existing medical supplies for states. Earlier this month, the president batted aside such calls, saying the federal government is "not a shipping clerk."

Another confrontation between governors and the White House is likely looming over how quickly to ease isolation measures in order to get the economy up and running again by Easter, as Trump has said he wants. GOP governors are unlikely to act as a bloc in supporting an accelerated timetable.

Maryland Gov. Larry Hogan, a Republican, said Sunday he didn't "see any way that we're going to be opening back up in a couple weeks." Hogan said the outbreak was likely to get much worse in his state before it gets better.

"I think in two weeks, around Easter, we're going to be looking a lot more like New York," he said on "Fox News Sunday."

To the president's defenders, highly personal attacks on governors amount to little more than Trump's customary pugilistic style, however jarring it may be in the midst of illness and death.

Others around the president suggest that states' interests are not at serious risk, even when the president angrily vents at governors he dislikes.

Fauci, asked about Trump's implied threats against governors who are not "appreciative" enough, said it was important to distinguish between inflammatory language and actions.

"There's the reality, and the rhetoric," he said. "I think the reality is that the people who need things will get what they need."

For his part, Trump appeared focused on other concerns Sunday, at least on Twitter.

In tweets, he praised his televised coronavirus briefings as a "ratings hit" and said the United States would not pay for security for the Duke and Duchess of Sussex, Harry and Meghan, who have reportedly moved from Canada to Southern California.

Later Sunday, the couple issued a statement saying they had “no plans� to ask the U.S. for pay for their security detail and that “privately funded arrangements� had already been made.

Governors shrug off Trump’s insults as they plead for federal aid
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 18:53

In a pool photo provided by the Michigan Office of the Governor, Gov. Gretchen Whitmer tells Michigan residents to stay at home, in her most sweeping order of the coronavirus crisis, Monday, March 23, 2020 in Lansing, Mich. (Julia Pickett/Michigan Office of the Governor via AP, Pool)
In a pool photo provided by the Michigan Office of the Governor, Gov. Gretchen Whitmer tells Michigan residents to stay at home, in her most sweeping order of the coronavirus crisis, Monday, March 23, 2020 in Lansing, Mich. (Julia Pickett/Michigan Office of the Governor via AP, Pool) (Julia Pickett/)

FLAGSTAFF — The sweeping bill that President Donald Trump signed will help better equip health care systems that serve Native Americans, improve the emergency response time on tribal lands, provide economic relief for tribal members, and help with food deliveries to low-income families and the elderly.

Tribes have been lobbying Congress to help address shortfalls in an already underfunded health care system and to ensure the federal government fulfills its obligation to them under treaties and other acts. While the $10 billion for tribes in the $2.2 trillion package is less than they requested, tribes say it represents progress.

"The silver lining is perhaps in the future we will have resources and the ability to really change those chronic disease trends in a meaningful way so our communities aren't impacted in such a devastating way in the future should something like this happen again," said Jerilyn Church, chief executive of the Great Plains Tribal Chairmen's Health Board.

More than $1 billion will go to the Indian Health Service, a federal agency that provides primary medical care for more than two million Native Americans. About half of that amount will go to tribes and tribal organizations that have contracts with the federal government to run their own health care facilities.

The Indian Health Service didn't immediately respond to a request for comment Friday.

As of Thursday, the agency reported 110 cases of COVID-19 within the facilities it operates. The number doesn't represent all cases in Indian Country because reporting by tribes and tribal organizations that receive IHS funding is voluntary.

The Navajo Nation has by far the most cases in Indian Country on its vast, 27,000-square-mile (70,000-square-kilometer) reservation in the Southwest with 115 confirmed cases and two deaths. Tribal officials have been delivering wood and coal to tribal members while encouraging them to stay home, a difficult task considering many drive long distances for basic necessities or live without them.

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.

Some health care clinics have closed and hospitals that serve Native Americans have scaled back services to focus on the coronavirus. Like the rest of the country, they're facing severe shortages in supplies, like masks, gowns and nasal swabs. Tribes and tribal organizations had asked Congress to fund more equipment, more medical providers and temporary housing.

"As we are seeing in other state such as New York and California, the Navajo Nation will have to identify alternative facilities to house patients and, perhaps, health care workers, and provide the equipment and safeguards for protection and to prevent the further spread of COVID-19," Navajo Vice President Myron Lizer said in a statement.

The Seattle Indian Health Board, which operates a clinic serving 5,000 people in Seattle, shuffled services and the way people enter the clinic to reduce the risk of exposure to the new coronavirus. It shut the clinic on Saturdays indefinitely because of staffing constraints but hopes to reopen it soon to serve children and pregnant women.

Many appointments have transitioned to being done remotely through phone or video conferencing — a cost that likely will be covered under the federal bill, said board spokesman Aren Sparck.

"It's peace of mind for our administration that all the changes we've had to make in our care that previously were unbillable might have a billing avenue," said Sparck, from the Qissanamiut Tribe of the Native Village of Chevak in Alaska.

Tribes also will be eligible for federal loans to help pay tribal employees. Many have shut down casinos and tourism operations that serve as major sources of revenue.

The Cherokee Nation in Oklahoma has been paying 4,000 entertainment and hospitality workers despite the businesses being closed, putting a "real strain on our budget," said Principal Chief Chuck Hoskin Jr.

The Senate bill didn't initially have much for tribes, but negotiations between Democrats and Republicans led to the $10 billion — $8 billion of which will help reimburse tribes for coronavirus-related expenses they've already incurred. It was designed to avoid what tribes consider cumbersome requirements of a funding package approved by Congress earlier this month.

"If there's anything positive to say out of this, it's people will learn a lot," said Robert Anderson, a visiting law professor at Harvard University and a member of the Bois Forte Band of the Minnesota Chippewa Tribe. "When an emergency comes up, what do we do to make sure Congress thinks about Indian Country, and there's equity in these bailouts."

The $8 billion in the latest relief fund will be distributed by the Treasury Department, working with Native American tribes and the Interior Department based on need, according to New Mexico U.S. Sen. Tom Udall's office. The $40 million earmarked for tribes in the earlier package is being distributed through a grant program under the Centers for Disease Control and Prevention, and tribes can start applying Monday.

More than a dozen of the country's 574 federally recognized tribes that don't have contracts to run federal programs on their reservations, for example, and more that don't have the staffing or expertise to apply for grants potentially will be left on the sidelines.

Other provisions of the bill signed Friday allow tribes to be reimbursed for some unemployment benefits, and to access more funding for housing. The U.S. Bureau of Indian Affairs will receive more than $450 million to support teleworking and overtime costs, welfare assistance and social service programs, and to expand public safety and emergency response.

Money also is going to help child care providers, and to pay for staffing, transportation and cleaning at Bureau of Indian Education schools and tribal colleges.

___

Associated Press writer Sean Murphy in Oklahoma City contributed to this story.


Tribes say persistent efforts pay off in massive stimulus
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 18:50

HOLD FOR USE WITH STORY MOVING THURSDAY, MARCH 19,2020-FILE - This Sept. 9, 2012 file photo shows the entrance to the Pine Ridge Indian Reservation in South Dakota, home to the Oglala Sioux tribe. Native American tribes across the U.S. for weeks have been shutting down casinos, hotels and tourist destinations, and shoring up services amid worries that the spread of the coronavirus quickly could overwhelm a chronically underfunded health care system and affect a population that suffers disproportionately from cancer, diabetes and some respiratory diseases. (AP Photo/Kristi Eaton, File)
HOLD FOR USE WITH STORY MOVING THURSDAY, MARCH 19,2020-FILE - This Sept. 9, 2012 file photo shows the entrance to the Pine Ridge Indian Reservation in South Dakota, home to the Oglala Sioux tribe. Native American tribes across the U.S. for weeks have been shutting down casinos, hotels and tourist destinations, and shoring up services amid worries that the spread of the coronavirus quickly could overwhelm a chronically underfunded health care system and affect a population that suffers disproportionately from cancer, diabetes and some respiratory diseases. (AP Photo/Kristi Eaton, File) (Kristi Eaton/)

Five of the new cases are adults older than 60, two of the cases are adults between ages 30-59, four of the cases are adults age 19-29 and one person under 18 contracted the virus, according to the health department.

The state saw its first confirmed COVID-19 case on March 12 and the number of cases surpassed 100 over the weekend.

The 73-year-old woman died Saturday evening after she was admitted to an Anchorage hospital and tested for COVID-19 on Monday, DHSS said.

Two other deaths included a 76-year-old Petersburg man who died in Washington state and a 63-year-old woman died from the virus Friday at Alaska Native Medical Center in Anchorage.

[First known patient to die in Alaska of COVID-19 had not traveled, was social distancing, family says]

By exposure type

[Family of Southeast Alaska man who died from COVID-19 in Washington state warns: ‘Just stay home’]

There are currently 59 confirmed cases in the Anchorage area, seven in the Gulf Coast region, 28 cases in the Interior, two in Mat-Su and 18 in Southeast Alaska. A resident at a Fairbanks care facility tested positive for the virus Saturday, prompting all employees and residents there to be tested.

The state has tested 3,654 people as of Sunday, according to data from DHSS.

Third Alaskan dies of COVID-19; state confirms 12 more cases Sunday
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 18:42

We're making coronavirus coverage available without a subscription as a public service. But we depend on reader support to do this work. Please consider joining others in supporting local journalism in Alaska for just $3.23 a week.

A 73-year-old woman died in an Anchorage hospital Saturday after testing positive for COVID-19, marking the state’s third death from the virus, state health officials said.

There were 12 new confirmed COVID-19 cases in Alaska on Sunday, bringing the total number of cases to 114.

Seven people have been hospitalized across the state, according to the Alaska Department of Health and Social Services.

Among the new cases were four in Anchorage, four in Fairbanks and one each in Juneau, Eagle River, Ketchikan and North Pole.

Six of the people contracted the virus through close contact with a previously diagnosed case, the department said in an online statement. One of the new cases is travel-related and five are under investigation.

By location
By location (Kevin Powell/)By exposure type (Kevin Powell/)

Miller is a primary care physician and science writer who is part of the COVID-19 response at her hospital in San Francisco.

Three days after my first shift in my hospital’s new coronavirus screening clinic, I woke up to the news that two American emergency doctors were in critical condition.

My first reaction, oddly, was disbelief. Of course this makes no sense. For weeks, I had been tracking stories about medical colleagues in China and Italy and understood that many were getting infected with COVID-19 and some had died.

But even as the first people tested positive in the San Francisco Bay area where I practice family medicine, I was so focused on the well-being of patients, friends and family that I had not contemplated my own risk.

I was telling myself that it would be different in the United States, that we had better protective wear and protocols, that we've learned from other countries. And if I were to contract the virus, I would be fine. After all, I'm only 54, I exercise regularly, eat vegetables and don't smoke.

But no, two American doctors were in the intensive care unit in mid-March, and one of them was at least 14 years my junior and the other was in charge of the infection protocols in his hospital. I stared at my phone, hearing sirens in the distance, and suddenly felt woozy with dread.

Stay calm, I whispered.

But instantly I noticed my scratchy throat and a mysterious constriction deep in my chest. I began to replay scenes from that shift three days earlier. My job was to sort patients into three categories, keeping in mind that testing capacity was limited: 1) test and send home to isolate, 2) no test and send home, 3) test and send to the Emergency Department across the street.

That was the screening clinic's second day of operation but already the doctor who signed out to me had the ragged look of a war-weary soldier.

"Protocols are changing by the minute," he said as he oriented me to the workings of the place. We were almost out of yellow gowns and N95 masks and the stash of viral swabs was dwindling. "Make do," I thought as I hustled from room to room, deciding who should get these precious tests or a higher level of care. The simple act of swabbing tonsils and nostrils was risky because of the sharp cough and spray it provoked.

Reading about the critically ill emergency medicine doctors, I suddenly understood my own vulnerability. After all, 54 was not exactly low risk, I was somewhere in the gray zone. Also, whom might I infect? Should I send my family away? My partner is almost 60; he seems to get every respiratory infection that comes his way. My daughter is part of a skeleton crew working in a dementia unit in a nursing home. My sore throat and the tightness in my chest were making it hard to think straight.

Then I remembered a therapy I’ve been prescribing for years, one that should remain plentiful, even as other resources dwindle. A therapy which, ironically, deploys the same organ that COVID-19 attacks: our lungs.

The technical term for this therapy is "regulated breathing" but it is a practice borrowed from ancient Eastern traditions - including yoga and Zen meditation - and has been recognized for centuries as a way to fight stress and quiet a racing mind. Experiments show that regulated breathing can slow heart rate, improve digestion, lower blood pressure and ease anxiety. Other research shows that conscious breathing patterns can lower cortisol levels and can even downregulate the amygdala, the anxiety center in the brain.

One such pattern, popularized by integrative medicine doctor Andrew Weil, is called 4-7-8. (Breathe in for 4 counts, hold for 7 and breath out for 8.) "Takes no time, needs no equipment. Very cost effective," he says in his instructional video.

James Gordon, a psychiatrist and mindfulness practitioner, uses "soft belly" breathing to help communities cope with trauma. In the past 45 years, he's brought this technique to the war-torn Balkans, Haiti after the earthquake, schools after mass shootings, and other disaster zones worldwide.

"Often, [soft belly breathing] is the first step toward healing a variety of different kinds of trauma, dealing with chronic stress, and getting on the road to much greater resiliency," he said in a recent interview with a wellness writer. "It's an antidote to fight or flight - but it's also an antidote to those feelings of helplessness and hopelessness."

In 2016, presidential candidate Hillary Clinton used another form of focused breath, alternate nostril breathing, to get through her post-election despair.

In these examples, breathing patterns varied but had three things in common: slowed respiratory rate, an exhale that is longer than the inhale and a breath that starts deep in the belly rather than high in the throat. The theory is that these activities turn on the vagus nerve, which sends calming messages to our brain and other organs.

For years, I'd encouraged patients to mindfully breathe their way through stress and pain. Now, standing in the predawn darkness of my bedroom, thoughts racing, I realized that I needed to get a taste of my own medicine: I touched my tongue to the roof of my mouth and practiced three cycles of 4-7-8.

The band around my lungs released and my throat felt better. I kept on doing this simple breathing cycle throughout the day, whenever I felt overwhelmed, and it reliably gave me some quick relief.

Two days later, I had my first shift in our respiratory video clinic, another service that has been hastily created to deal with the pandemic. Once again, this was a sorting exercise: Who could stay at home, who needed to come to the hospital for testing, and who should be routed straight to the Emergency Department?

I worked from the safety of my kitchen counter but this experience was almost as stressful as the screening clinic, because of what was at stake. I did not want to overwhelm the packed hospital clinics but at the same time I didn't want to miss anyone who was sick and doing poorly, or anyone who needed testing because they were likely to infect many others even as they sheltered in place.

"Can you please lean in closer to the screen and breathe as naturally as you can?" I asked a young woman with a cough. I was trying to count her respirations and she seemed to be breathing quite fast.

"I'm really scared," she said, fogging up her camera. I looked at the clock. I had 10 minutes until my next patient was expected in my virtual waiting room.

"Let's practice 4-7-8," I suggested.

It turns out that video visits are a great way to teach breathing techniques. Her respirations slowed down, and so did mine.

"Wow, works like Valium," she said.

There is some evidence that chloroquine, a plant-derived drug used as medicine by indigenous peoples for centuries, might help prevent the severe pneumonias associated with COVID-19. This has been observed only in a test tube and it’s still unclear whether this will prove to be an effective treatment. But as we deploy a raft of modern technologies - from AI to Zoom - to fight this disease and cope with our fear, our stress and our isolation, let’s not forget another ancient treatment that has been on hand all along: our breath.

Inhale, Exhaaaaale and repeat.

Originally published by The Washington Post

Coronavirus anxiety overwhelmed this doctor. Deep breathing helped.
Source:  AlaskaDispatch - News and voices from the Last Frontier
Sunday, 29 March 2020 18:33

iStock / Getty Images
iStock / Getty Images (Sergey Tinyakov/)

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