The U.S. government evacuated hundreds of Americans on Sunday night from the Diamond Princess cruise liner, docked in Tokyo and quarantined since Feb. 5, and flew them out of Japan on two chartered planes bound for U.S. military bases – a carefully monitored process that will include another quarantine once they land.

Another 44 Americans aboard the Diamond Princess tested positive for coronavirus and will stay at hospitals in Japan as they recover, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told The Washington Post on Sunday.

At the same time, public health officials scrambled to determine whether passengers onboard a different cruise ship, the Westerdam, were exposed to the virus after an 83-year-old woman tested positive days after disembarking in Cambodia. The unexpected finding upended a basic assumption by several governments, including the United States, that the ship was virus-free, which motivated local and U.S. officials to allow passengers to disembark and depart for other cities and countries around the world.

As these cruise passengers and other travelers fan out across the globe, infectious-disease experts say the dynamic illustrates how the virus could be introduced into new communities in quiet ways. Until now, officials have been aggressively monitoring those who traveled to China and those who have had close contact with an infected person. But the Westerdam oversight demonstrates how travelers without obvious symptoms could slip through screening processes.

“This illustrates there is transmission occurring in unexpected places that we’re not aware of,” said Jeff Duchin, health officer and chief of communicable disease epidemiology section at Seattle and King County health department. “The virus is moving very quickly and silently and presents a real challenge to containment.”

Duchin noted, however, that the reported cases occurring in places outside China are not large-scale yet. Health officials still need to focus on where they can have the greatest impact on controlling the outbreak, he said, which is in China.

“But increasingly, we are seeing it pop up in other parts of the world and in other settings, and that makes it difficult for us as a country to know when someone who may have been exposed outside of China enters the United States,” Duchin said.

Health experts have warned that the coronavirus is difficult to contain precisely because symptoms are often mild and the coronavirus could replicate inside the human body and infect others for up to 14 days before showing symptoms at all.

As of Sunday, the World Health Organization has reported cases in 26 countries, the majority of which remain in mainland China. Chinese officials have tallied about 70,500 cases of the illness and 1,770 deaths. Outside of China, the WHO reports about 680 confirmed cases and three deaths.

Chinese officials said Sunday that they believed measures taken across the country to control the epidemic were paying off. Several cities in the central region have declared strict “wartime measures” that allow residents to leave their homes only several times a week and upon approval from neighborhood authorities.

Guards in Hubei are required to check identification 24 hours a day at the entrance to residential compounds, and driving is banned for all nonessential purposes under new regulations released Sunday.

The number of new cases across China, including in Hubei, has been falling, said Chinese National Health Commission spokesman Mi Feng, who noted that doctors in the hardest-hit province had broadened their diagnosis criteria for patients suspected of suffering from the disease and were able to treat them more quickly.

“The effects of our counter-coronavirus measures in every part of the country are already becoming apparent,” Mi said.

In Taiwan, authorities reported the first death Sunday, a man in his 60s with diabetes and hepatitis but no recent history of overseas travel, according to the state-run Central News Agency. Officials said they were still investigating how the man contracted the virus while living in the central part of Taiwan, which has so far recorded 20 confirmed cases across the island.

On Saturday, Cambodia’s health minister issued a statement urging the public to “not be overly afraid” but to take protective measures. That night, charter flights that were originally scheduled to take Westerdam passengers to Kuala Lumpur were canceled by Malaysian authorities.

The Westerdam was believed to have no infections onboard among the 2,200 crew and passengers who were stranded at sea for weeks as countries rejected their entry after a stop in Hong Kong, where they took on hundreds of new passengers.

The 83-year-old American woman, whose identity has not been disclosed, was among the relieved passengers who were let off the Westerdam on Friday and welcomed and embraced by Cambodian Prime Minister Hun Sen, who has downplayed the epidemic’s threat and described the decision to bring them onshore as an act of humanitarian goodwill. The ship had been stranded at sea for nearly two weeks and was running low on provisions after it was denied entry to Taiwan, Japan, the Philippines, Thailand and the U.S. territory of Guam.

U.S. Ambassador to Cambodia Patrick Murphy brought his family onto the cruise ship and posed for pictures on Saturday with American passengers. Murphy and other passengers did not appear to be wearing masks in photos shared on the embassy’s Twitter account.

Holland America, the cruise operator, said in a statement Sunday that no other passengers or crew who were on the ship have reported any symptoms of the coronavirus. About 1,000 people remain on the ship, with the rest on their way home.

Grant Tarling, Holland America’s chief medical officer, said in the statement that the company was working with health experts to contact national health authorities around the world to investigate and follow up with individuals who may have come into contact with the American woman found to carry the virus.

In Japan, U.S. passengers were faced with a difficult decision. They could stay on the Diamond Princess until Feb. 19, when the original quarantine is scheduled to lift, but risk being stuck in Cambodia and bound by commercial flight restrictions, or leave on the chartered flights to military bases in Texas and California – only to face another 14-day quarantine.

About 400 Americans were on the cruise ship when it docked in Japan, and the Japanese Defense Ministry said 300 of them disembarked Sunday night, The Associated Press reported.

The number of coronavirus diagnoses has continued to rise sharply among the 3,700 passengers and crew members originally on board. Japanese Health Minister Katsunobu Kato said early Sunday that the quarantined ship floating near Tokyo has 355 confirmed cases, or about 30% of the 1,219 people who have been tested. That represents one of the highest infection rates in the world.

“The degree of transmissibility on that cruise ship is essentially akin to being in a hot spot,” Fauci, who is also a member of the White House task force for the coronavirus, told CBS.

Canada, South Korea, Italy and Hong Kong announced Sunday that they would also arrange charter flights.

“He had not come to our house to live,” Daniel Wallace, his son-in-law, told me. “He had come to our house to die. The last thing he wanted to do was die at a hospital.”

Kellison was part of a striking trend: For the first time since the early part of the 20th century, more Americans are dying at home than in the hospital or a nursing home. This finding, included in a recent study by me and co-author Sarah Cross, is encouraging because the vast majority of Americans say they prefer to die at home. So this reflects that many more people are being able to achieve that goal.

But as more people die at home, it also means that much more responsibility falls on the shoulders of patients and their caregivers. Caregiver burden is a growing problem in America. As a doctor tending patients with heart failure, I am keenly aware of how hard managing care can be for both patients and family members.

Taking care of an ailing loved one can be exhausting physically and emotionally, and frequently caregivers lose sight of themselves. My study co-author used to work as a social worker and has seen many families struggle with managing a loved one at home. “Caregivers need to prioritize their own care,” she told me. “It isn’t selfish to take breaks, make time with friends, ask for help, look into respite options.”

After Kellison moved in with his daughter, he stayed mostly in the upstairs guest room, and for the last five months rarely, if ever, came downstairs. That physical separation was important for everyone.

“It was helpful that we delineated the house and our lives. We still went out and we still had people over,” Daniel Wallace said. “Sometimes he was part of that and sometimes he wasn’t.”

Making shared living space work is just one issue. If dying at home is important to someone, that person and their caregivers should think about – and prepare for in advance, if possible – other factors:

Perhaps most importantly, the person nearing the end needs to make clear that they want to die at home. Family, friends and medical teams need to know that. Physicians and nurses will frequently ask patients how they would like their end to be, particularly what types of intensive treatments they might or might not want. They rarely ask people where they would like to die, however.

Once at home, there are certain physical considerations worth noting: Many people have strong feelings about where in the house they would like to spend their last days – in a dark, quiet room, or looking out a window, or away from too much hubbub. Nearness to a bathroom is key. Sometimes, light remodeling, such as installing handrails in bathrooms or ramps, is helpful.

A person at the end of life will probably have feelings about who they want to spend time with – or who they don’t want – so it is important to discuss in advance who will provide caregiving, along with who might provide occasional backup for regular caregivers.

There are often community resources available as well, such as end-of-life doulas trained to care for the physical, emotional and spiritual needs of a dying person. Adaire Petrichor is one such doula. She said she “helps with rituals, ceremonies, legacy work and advice on nonmedical comfort care.”

Online resources are available through such organizations as Compassion & Choices. The Conversation Project can provide guidance for patients and their loved ones about what to expect in the final days.

Perhaps the most critical resource available for those wanting to die at home is hospice care. Hospice is covered by Medicare (and most other insurance) for patients with an expected life expectancy of less than six months. It is designed to help caregivers take care of a dying loved one at home with 24-hour call-in numbers to answer urgent questions, visits from hospice nurses, social workers and other staff. But home hospice does not provide full hands-on service, and caregivers still carry the bulk of the responsibility. While in many cases the care of the patient can be tougher than loved ones expect, most people find hospice guidance and support invaluable.

Wallace said hospice was key for taking care of his wife’s father after he moved in with them to die.

“Hospice was a way to bring a quality of life that he didn’t have before, because he couldn’t take care of himself and we couldn’t take care of him without hospice,” Wallace said. “If you need a wheelchair, they have that. If you need Haldol (an antipsychotic drug to treat end-stage delirium and agitation), morphine, they have it, and you can have it the next day.”

While the vast majority of hospice services are delivered at home, hospice care can also be provided in nursing facilities for dying patients who require more intensive medical care or don’t have other social supports.

Hospice is the primary reason more Americans are able to die at home today. Yet, only half of Americans who die receive hospice help. One reason may be that some people don’t ask for it because they think it is sending a depressing message to their ailing loved one or admitting what they may not want to acknowledge – that the person is in their last days.

“The obvious misconception is that it’s a death sentence,” Wallace said. But “it really is a quality-of-life sentence.”

Outside remote regions, most areas have multiple hospice agencies from which to choose.

Agencies can differ in how often nurses visit, what they might offer in crises and what equipment they provide, including hospital bed, oxygen tanks, wheelchairs. It is worth having a discussion about the support they’ll provide and other options before committing to a particular hospice provider.

With advances in public health, medicine and longevity, people now live longer with disabilities. Death is not just the terminal event in our mortal lives, but the final word of a story that can often take years to unfold.

Intermixed with periods of relative stability can be moments of terror as someone hits their final days. Physicians and other health-care providers need to prepare patients and families for these health shocks, such as worsening breathing for a patient with heart or lung disease or a pain crisis for someone with cancer.

Calling 911 when an end-of-life crisis hits initiates a cascade that can often lead to the hospital. This might be necessary if a patient has symptoms that caregivers at home feel unable to manage. For that reason, Cross said, “I recommend not making promises to a loved one such as ‘I promise I’ll always take care of you at home.’ When it becomes too much to manage at home, I’ve seen many caregivers racked with guilt for having ‘broken a promise.’ ”

Some endings can take a much more erratic course, common for those with heart or lung disease. This might be one reason our study showed that patients with cancer are more likely to be able to die at home than those with heart or lung disease.

One morning, a year after his father-in-law had moved in, Wallace went upstairs to check on him and unexpectedly found he had died.

“He did not present himself as dying when it happened,” he said. “We weren’t on death watch or anything like that.”

Some caregivers I have talked to feel uncomfortable with the idea of their loved one dying at home. Even though death has occurred at home for eons, the 20th century interrupted that historical legacy, and for many, it is a novel concept.

But for many, fulfilling a loved one’s wish to die at home provides a fitting and natural end to the story of that person’s life.

When I asked Wallace whether he viewed his house differently after his father-in-law died in it, he said: “It deepens my experience of being alive, to be in a house where someone has died. It’s a remarkable thing.”

– – –

Warraich is associate director of the Heart Failure Program at VA Boston Healthcare System and a cardiologist at Harvard’s Brigham and Women’s Hospital.

Malaysian Deputy Prime Minister Wan Azizah Wan Ismail told reporters Sunday that an 83-year old American passenger on the cruise liner tested positive for the coronavirus twice – once on Friday and once on Saturday – after she landed in Kuala Lumpur despite being screened earlier by Cambodian health officials.

https://www.washingtonpost.com/video/c/embed/7c89362b-5db8-400a-854e-e37aeb7dcdb0

“The results were the same. That is positive for the wife and negative for her husband,” Wan Azizah told reporters at a news conference, adding that Malaysia would now bar entry for all passengers from the cruise ship, according to Reuters.

The unexpected finding upends a basic assumption by several governments, including the United States, that the ship was virus-free and that passengers could be greeted at proximity without protective gear and allowed to travel.

The American woman, whose identity has not been disclosed, was among hundreds of relieved passengers who were let off the Westerdam on Friday and welcomed and embraced by Cambodian Prime Minister Hun Sen, who has downplayed the epidemic’s threat and described the decision to bring them onshore as an act of humanitarian goodwill.

The U.S. ambassador, W. Patrick Murphy, also brought his family onboard the cruise ship and posed for pictures on Saturday with American passengers. Murphy and other passengers did not appear to be wearing a mask in photos shared on the embassy’s Twitter account.

Disembarkation, which was set to continue over the weekend, was halted Sunday, according to Cambodian journalists at the scene.

On Saturday, Cambodia’s health minister issued a public statement urging the public to “not be overly afraid” but to take protective measures. On Saturday night, charter flights that were originally scheduled to take Westerdam passengers to Kuala Lumpur were canceled by Malaysian authorities.

As of Sunday, authorities worldwide have tallied roughly 69,000 cases of covid-19 and 1,669 deaths. The overwhelming majority of infections remain in mainland China, which reported 2,009 new cases on Saturday.

In Taiwan, authorities reported the first death on Sunday, a man in his 60s with diabetes and hepatitis but no recent history of overseas travel, according to the state-run Central News Agency. Officials said they were still investigating how the man contracted the virus while living in the central part of Taiwan, which has so far recorded 20 confirmed cases across the island.

Chinese officials said Sunday they believed that measures taken across the country to control the epidemic were paying off. Several cities in the central region have declared strict “wartime measures” that allow residents to leave their homes only several times a week and upon approval from neighborhood authorities.

Guards in Hubei are now required to check identification 24-hours a day at the entrance to residential compounds and driving is also banned for all nonessential purposes under new regulations released Sunday.

The number of new cases across China, including in Hubei, were falling, said Chinese National Health Commission spokesman Mi Feng, who noted that doctors in the worst-hit province had broadened their diagnosis criteria for patients suspected of suffering from the disease and were able to treat them more quickly.

“The effects of our counter-coronavirus measures in every part of the country are already becoming apparent,” Mi said.

The Westerdam was believed to have no infections onboard among the 2,200 crew and passengers who were stranded at sea for weeks as countries rejected their entry following a stop in Hong Kong where they took on hundreds of new passengers.

https://www.washingtonpost.com/video/c/embed/8c69ef04-cbfd-4251-9323-a12e167ad082

Health experts have warned that the coronavirus is difficult to contain precisely because symptoms are often mild and the coronavirus could replicate inside the human body and infect others for more than two weeks before showing symptoms at all.

The U.S. Embassy in Phnom Penh said Cambodian officials individually screened all disembarking passengers for fever with the help of embassy staff this week, and any passenger who reported feeling ill had received lab tests, all of which returned negative. The tests were processed by a lab trusted by the U.S. Centers for Disease Control, the U.S. Embassy said.

The Westerdam and another cruise ship, the Diamond Princess in Japan, are posing logistical and public health challenges for governments as they try to contain the spread of the disease known as covid-19 and repatriate citizens.

The United States prepared to evacuate American citizens from the Diamond Princess on Sunday as the number of coronavirus diagnoses continued to rise sharply among the 3,700 passengers and crew originally onboard.

Japanese Health Minister Katsunobu Kato said early Sunday that the quarantined ship floating near Tokyo now has 355 confirmed cases, or about 30 percent of the 1,219 people who have been tested so far. That represents one of the highest infection rates in the world.

Three Israelis on board have been found positive for the virus, according to the Israeli Health Ministry, but their condition is mild and they are now in a hospital in Japan. The ministry added that an expert physician has been sent to liaise with Japanese health officials.

The U.S. government-chartered flights comes days after public health experts warned that time spent on the Diamond Princess, which has been quarantined since Feb. 5, increases the risk of coronavirus exposure and Japanese authorities began letting some passengers disembark to complete their quarantine on land.

Two charter flights are scheduled to depart from Japan Sunday evening and bring roughly 380 evacuated Americans from the Diamond Princess to military bases in Texas and California, where they will be quarantined and monitored for an additional 14 days.

Canada, South Korea, Italy and Hong Kong announced Sunday they would also arrange charter flights.

Amid widespread shortages of protective equipment for health care workers in China’s Hubei province, Friday’s announcement highlighted the challenges Beijing faces as its overwhelmed heath care system tries to contain the epidemic.

At the same time, officials noted the infection rate among health care workers is in line with that of previous respiratory viruses, including the 2003 SARS outbreak. The total appeared to be a count of infections that have occurred over many weeks, rather than a sudden escalation of the crisis.

“This isn’t surprising, if I’m being honest,” said Saskia Popescu, senior infection prevention epidemiologist for Honor Health, a hospital system in Phoenix. “It is very, very easy to have failures in infection control.”

Michael Ryan, executive director of the World Health Organization’s Health Emergencies Program, said he believes the cases peaked in the third and fourth week of January and have declined since because of improved training and awareness.

“It’s a lower percentage than has occurred in other coronavirus outbreaks,” Ryan said. “Now that’s not a guarantee that it won’t change.”

A total of 1,716 Chinese medical providers were infected as of Feb. 11, 3.8 percent of the confirmed cases, Chinese health authorities said. Six have died. One health care worker in Singapore also was infected.

The Feb. 7 death of Li Wenliang, an ophthalmologist at Wuhan Central Hospital who had warned fellow medical school graduates in a private chat of an outbreak of the virus, prompted a national outpouring of grief and rage toward authorities. He died after being detained and released by police for speaking out.

By acknowledging the toll on health professionals, Beijing is trying to signal some transparency on a flash point issue, and letting ordinary people know officials share their sense of alarm.

“It might raise a red flag about how serious the situation is,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “And hopefully that leads to a more effective government response.”

But Huang cautioned against seeing the figure as the final word on medical workers. “If it is coming from an official source, we have to take it always with a grain of salt,” he said.

Concerns about how medical personnel are faring in this crisis have been front and center from the start. Photos and video from Wuhan have shown exhausted doctors and nurses working in overflowing hospitals.

At Zhongnan Hospital in Wuhan, 40 health care workers were infected with the virus in January, according to a JAMA study. The majority worked in the general wards, but seven were assigned to the emergency room and two worked in the intensive care unit. In one case, a single patient infected more than 10 health care workers.

Still the toll on front line workers appears to be smaller than it was in other lethal coronavirus outbreaks. When SARS emerged in 2002, health care workers accounted for a fifth of the cases. A study of MERS infections from 2012 to 2018 found that health care workers made up a similar share – 415 of the 2,223 confirmed cases.

“Patients need to be wearing a mask. Physicians taking care of them need to be protected themselves – not only medical doctors or nurses, but people who work in the hospitals: the transporters, the person who is at the front desk. All these individuals are at risk,” said Charles Dela Cruz, a pulmonary and critical care physician at Yale University School of Medicine.

To date, covid-19, the disease caused by the new coronavirus, has caused more than 1,500 deaths, all but two in China, and 66,000 illnesses, with only 600 of those outside China. The United States has seen 15 cases and no fatalities.

Egypt’s Ministry of Health confirmed Friday that it had detected a case of coronavirus, the first known example of the outbreak in Africa. Health officials have worried about the virus reaching the continent because of its weak health care systems.

A spokesperson for the ministry, Khaled Megahed, said in a statement that a foreign national had tested positive for the coronavirus and the WHO had been notified.

Although the person had not shown symptoms, they were tested because of their travel history. The person was subsequently transported to a hospital and they are in stable condition under quarantine.

A number of people who came into contact with the patient have been tested for the virus, Megahad said. All tested negative, but they will be placed under 14-day quarantine as a precaution.

In Japan, meanwhile, the Health Ministry said Friday that 10 people evacuated from the quarantined Diamond Princess cruise ship in the port of Yokohama are in serious condition, with eight confirmed to have the new coronavirus. One of the other two is still awaiting test results.

Amid persistent criticism of its approach, the government said it would begin allowing some people who have tested negative for the virus to leave the ship and finish their quarantines on shore. Priority will be given to passengers over the age of 80 and those with existing medical problems, as well as people in windowless cabins, Health Minister Katsunobu Kato said.

So far, 218 people aboard the ship have tested positive for the virus out of 713 who were assessed. The government says it plans to step up testing in a bid to examine everyone on board before the quarantine ends Feb. 19.

A quarantine officer involved in screening passengers also fell sick. The health ministry said he did not follow proper procedures, wiping away sweat with his gloves and reusing a mask he had worn earlier, Japan’s national television network, NHK, reported.

The U. S. Centers for Disease Control and Prevention, moving forward with its plan to boost disease surveillance, named the five cities where labs will begin testing flu specimens for the coronavirus. They are Chicago, Los Angeles, New York, San Francisco and Seattle.

The public health labs are part of CDC’s existing flu surveillance network, which monitors seasonal influenza and hospitalizations. Specimens that are negative for flu will be tested for coronavirus, the CDC’s Nancy Messonnier said. Testing will be expanded to additional labs in coming weeks.

Lab tests that confirm additional coronavirus cases could allow public health authorities to take actions to forestall outbreaks, such as canceling large gatherings or calling for telemedicine and telework.

At the same time, flu illnesses have risen sharply in recent weeks, Messonnier said, complicating efforts to determine whether an illness is caused by the new coronavirus or the flu virus. So far this season, at least 26 million people in the U.S. have contracted the flu, including 14,000 who died and 250,000 who were hospitalized.

Despite ongoing violence that has hampered the response from its outset, and that has spiked again recently, new cases have dwindled. At its height last May, hundreds were contracting the disease every week.

The waning of the Ebola outbreak comes as a new one captures global attention – and potentially funding, too. Global health officials have warned that while the novel coronavirus, now known as covid-19, racks up thousands of new cases a day, the hard work of ending the Ebola outbreak and preventing another is far from over.

“Funding needs [for the Ebola response] have not as yet been fully met, and currently there is a risk there will not be funding for WHO activities beyond February,” said Margaret Harris, a World Health Organization spokeswoman.

On Wednesday, an independent committee that advises the WHO unanimously agreed that the Ebola outbreak “still constitutes a public health emergency of international concern” – a designation that was recently extended to the covid-19 outbreak.

Ebola and covid-19 are vastly different viruses; Ebola can be transmitted only through exchange of bodily fluids, but it killed nearly 70 percent of those who contracted it in eastern Congo.

The WHO’s director general, Tedros Adhanom Ghebreyesus, said Thursday that covid-19 “might have adverse consequences for the [Ebola] response efforts through diminishing focus” on it.

While the WHO, the U.S. Centers for Disease Control and Prevention, a constellation of nonprofits and the Congolese Health Ministry have mounted a relentless campaign to contain Ebola, little has been done to shore up the region’s health system, which is sorely lacking in even the most basic infrastructure. Ebola is endemic to Congo’s rainforest, and the likelihood of future outbreaks is high.

“Only half of health facilities have access to water,” said Tedros. “Strengthening a health system may not be as sexy as responding to an outbreak, but it is equally important.”

Almost all of this month’s cases have been reported in the restive city of Beni, which has also been besieged by an Islamist militia that calls itself the Allied Democratic Forces, or ADF.

In late October, the Congolese military launched an offensive against the ADF, complicating the Ebola response and sparking a wave of retaliatory attacks that have killed hundreds of civilians. The offensive has been lauded by Congo’s president, Félix Tshisekedi, as nearly flushing the group out of Beni and the surrounding region, but a resurgence of ADF attacks in February has cast doubt on those claims.

Harris, the WHO spokeswoman, said that while officials were confident in asserting that only one chain of Ebola transmission remains, ongoing violence has made it impossible to reach some areas that have had cases over the past few months.

“Given the lack of access in some areas like Lwemba, it’s possible that there are other areas where there could be cases that we are not aware of, but it’s unlikely,” she said.

With the end of the outbreak in sight, some of the response’s protocols have shifted as resources have been freed up from emergency activities. Now, patients can be afforded a greater degree of comfort, instead of being confined to Ebola treatment centers where the dead and dying were present.

“Everyone who has been in contact with someone confirmed to have Ebola is now offered the option of voluntary isolation – meaning that if they would like, they can be accommodated in a guesthouse where they are provided with food and health support – so that they can be monitored as closely as possible, and if they develop symptoms they can be brought to care as quickly as possible,” Harris said. “Most people are taking up this offer.”

In addition to a shortfall of investments in eastern Congo’s health infrastructure, a large funding gap exists for an ongoing measles outbreak in the same region that has killed 6,300 people in far less time than Ebola.

Peace is also unlikely to return soon to the region, known as the Great Lakes for its defining geographical feature, as competition over minerals heats up between the Congolese, Ugandan, Rwandan and Burundian governments and local militias aligned with them.

“The Great Lakes region is increasingly on edge. Distrust is rife among Burundi, Rwanda and Uganda, all of which have connections to insurgents in eastern Congo,” said a recent report by the International Crisis Group. Plans by Congo’s Tshisekedi to invite armies from those countries to help defeat the ADF and other groups heightens the chances for an intensification of conflict.

“Were Burundian, Rwandan and Ugandan forces given a green light” to operate in Congo, the report said, “the danger would be all the graver, raising the specter of an interlocking proxy war wherein each Great Lakes country is backing its rivals’ enemies.”

Young people are the most affected by this isolation, struggling due to a lack of networks and safe spaces where they might share their experiences. One million young Thais deal with clinical depression every day and 3.5 per cent of the youth population struggles with anxiety disorders, unable to reach out for help.

Social-change creative agency Love Frankie, in partnership with Acorn & Associates and TQPR, have introduced the Nook, a free-to-visit pop-up space that hosts workshops, sharing circles and coaching in wellness practices.

“Our own independent research looking into key barriers young people face about mental health in Thailand found out that many young Thais long for safe spaces to share and receive guidance, but there are very few such places,” said Love Frankie co-founder Rebecca Frankie.

Initially at Yelo House, the Bangkok warehouse-turned-creative space, from February 29 to March 3, daily from 9am to 8pm, the Nook will host more than 30 activities.

These will include art therapy workshops by Persona Studio and Labaai, group discussions facilitated by Aristotle’s Café, talks with experts like Amornthep Sachamuneewongse, founder of Sati App, and wellness activities led by Cat Lau, Karma Break and Mindful Sparks.

Mind Medicine Inc., which is undertaking clinical trials of psychedelic-based drugs, intends to list on Toronto’s NEO Exchange by the first week of March, said JR Rahn, the company’s co-founder and director. A NEO spokesman confirmed the listing, which is pending final approvals.

The company plans to list via a reverse takeover under the ticker MMED. It’s not yet generating revenue and is targeting a valuation of approximately $50 million, Rahn said. Mind Medicine counts former Canopy Growth Corp. co-chief executive officer Bruce Linton as a director and Shark Tank star Kevin O’Leary as an investor.

“Our ambition is to be one of the first publicly listed neuro-pharmaceutical companies developing psychedelic medicines,” Rahn said in a phone interview.

For those who are still getting used to legal marijuana, the idea of publicly traded companies working with psychedelic drugs like MDMA and psilocybin, which is derived from magic mushrooms, may sound a bit out there.

Yet a growing number of companies are conducting clinical trials of psychedelic treatments for everything from depression to post-traumatic stress disorder, and some have recently received the blessing of the U.S. Food and Drug Administration. This has created a legal way for these companies to conduct research on otherwise illegal drugs, opening the door to public listings.

In late 2018, the FDA gave “breakthrough therapy” status to a psilocybin treatment developed by London-based Compass Pathways Ltd. for clinical depression, expediting the development process.

Meanwhile, Toronto-based Mind Medicine is preparing a Phase 2 clinical trial into the use of a psychedelic called ibogaine to treat opioid addiction, which will be conducted in New York and governed by the FDA.

Compass Pathways declined to comment on whether it’s planning a public listing, but the company is “always looking at options to ensure continued growth and funding,” chief communications officer Tracy Cheung said in an email.

The Canadian Securities Exchange, which has become the go-to bourse for U.S. cannabis companies that can’t list in their home country, is also expecting listings from psychedelic drug companies in 2020.

The FDA has “given clearance for a variety of trials at this point and it looks like they are going to be expanding that framework,” said Richard Carleton, CEO of the Canadian Securities Exchange. “If that is the case then I’m certain we’ll see our first issuers probably before the middle of the year.”

There’s growing investor interest in psychedelics, said Ronan Levy, executive chairman of Field Trip Psychedelics Inc. Field Trip is building a network of clinics focused on ketamine-enhanced psychotherapy, with the first one opening in Toronto next month and others planned for New York City and Los Angeles. It’s also conducting research into psilocybin at the University of the West Indies in Jamaica.

Last week, Field Trip closed a Series A financing round that raised $8.5 million from a variety of investors including cannabis-focused asset manager Silver Spike Capital and Harris Fricker, the former CEO of GMP Capital Inc., which helped a number of marijuana companies go public.

The funding round attracted interest from all over the world, including “some very large Silicon Valley tech investors and entrepreneurs,” Levy said.

Field Trip is considering a public listing, although Levy also sees further opportunities to raise private funding, he said. Unlike cannabis, which remains federally illegal in the U.S., the work psychedelic companies are doing is legal. This creates “greater opportunity to access growth capital from private investors in the U.S. who may not touch cannabis,” he said.

It also sets the industry apart from cannabis, which has seen stock prices collapse amid slower-than-expected sales in Canada and ongoing federal illegality in the U.S.

“I think that the psychedelics industry could be much bigger than the cannabis industry because it’s going to attract institutional capital and already is starting to,” Rahn said. “It’s also going to be a more concentrated space because the barriers to entry are much higher.”

.
https://www.washingtonpost.com/video/politics/trump-chinas-president-says-heat-generally-kills-viruses-like-the-coronavirus/2020/02/10/f24867f2-b361-4e08-8a01-abffebc4725f_video.html

https://www.washingtonpost.com/video/c/embed/f24867f2-b361-4e08-8a01-abffebc4725f
.

Chinese health officials announced Monday that 103 more people died from coronavirus, bringing the total global death toll to 1,013. The health ministry in Hubei province also confirmed 2,097 new cases of the disease, which has now sickened more than 42,000 people around the world, the majority in mainland China. More than 6,000 remained in critical condition in the hospital, officials said.

The outbreak has claimed 974 lives in Hubei province, the epicenter of the public health crisis. A Japanese citizen and an American citizen were recorded dead in Wuhan over the weekend.

More than 25,000 people remained hospitalized in mainland China, and roughly 76,000 were under medical observation, according to Chinese officials.

In Japan, an additional 65 people on board a quarantined cruise ship have tested positive for the virus, according to Japan’s Health Ministry. Pressure is mounting to test everyone on the ship now docked in Yokohama, where 135 people are known to have been infected. Eleven Americans are among the additional people, the cruise ship operator said Monday.

Earlier, U.S. officials confirmed that physicians in Wuhan, China, began testing an experimental drug called remdesivir last week.

The drug, made by Gilead Sciences, was successfully used on the first U.S. patient, a 35-year-old man in Snohomish County, Washington. He recovered, but a single case can’t determine the extent to which the drug may have contributed.

Although remdesivir failed an ebola clinical trial, it has shown promise in laboratory tests against other coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Timothy Sheahan, an assistant professor of epidemiology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said that instead of developing a new drug for each emerging virus, the hope is that remdesivir could be broadly useful and work against multiple coronaviruses.

“I think starting a clinical trial is essential for determining if this drug will work” against the coronavirus, Sheahan said.

One of the clinical studies will test remdesivir on infected patients who are in the hospital but do not have severe symptoms. The other will test it on people with severe infections, who are on supplemental oxygen or have other complications.

Gilead is providing the drug to Chinese researchers at no charge, according to spokeswoman Sonia Choi.

An advance team of World Health Organization experts has arrived in China to help lay the groundwork for a larger team, officials from the organization said Monday.

The team is led by Bruce Aylward, a Canadian physician and epidemiologist, who previously worked on the WHO’s response to the 2014 ebola outbreak in West Africa.

“Bruce and his colleagues will be working with their Chinese counterparts to make sure we have the right expertise on the team to answer the right questions,” Tedros Adhanom Ghebreyesus, the WHO director general, told reporters at a daily news conference.

Officials from the WHO declined to be drawn into specifics about what Aylward’s team would be doing in China, describing the members as medical professionals who would be given a large degree of autonomy to coordinate with local counterparts.

“The team is there first and foremost to learn,” said Michael Ryan, executive director of the WHO health emergencies program.

Tedros had made a trip to Beijing for preliminary talks with President Xi Jinping and Chinese officials in late January, during which it was agreed that an international mission would be sent, but subsequent deliberations over its format lasted weeks.

Some public health experts have criticized the Chinese government for initially misleading the world about the threat posed by the outbreak.

“We were deceived,” Lawrence Gostin, a professor of global health law at Georgetown University who also provides technical assistance to the WHO, told The Washington Post.

A new disease-transmission model created by University of Toronto researchers suggests that the coronavirus epidemic started in November, one month earlier than commonly believed.

The model uses open-access data to replicate epidemiological scenarios, allowing the researchers to test some narratives about the outbreak.

Although it is only a model, it may provide a plausible explanation for how the virus was able to spread so quickly – useful in the absence of hard evidence.

“You can’t get up to that level of cases if the epidemic started in December even if you pushed the reproduction really high,” David Fisman, a professor in the Dalla Lana School of Public Health and one of the model’s creators, said in a statement.

In China on Monday, emergency service workers were soaking cars, buildings and airplanes with disinfecting spray in an attempt to eliminate the virus from the city of Wuhan, where the epidemic began.

It’s unclear how effective the method is, especially considering that the entire region is under a travel lockdown and many people are not venturing outside.

Thus far, experts think the coronavirus is largely transmitted by close person-to-person contact and respiratory droplets. “Some coronaviruses can persist on surfaces, but I usually don’t think of a street as a surface I worry about,” Rivers said.

Hong Kong’s Center for Health Protection announced early Tuesday that it would be evacuating some residents of an apartment building after two people were diagnosed with coronavirus, despite living in apartments 10 stories apart.

Officials said engineers from Hong Kong’s housing department would investigate the sewage system in the building to see whether it could have been the source of the virus’s spread.

During the 2003 SARS outbreak, more than 300 people were infected in the Amoy Gardens apartment complex in Kowloon, Hong Kong, eventually leading to a quarantine of the apartment complex. Officials later said that the outbreak had spread through bathroom drainpipes.

Some 3,600 passengers and crew were allowed to disembark from a ferry quarantined in Hong Kong on Sunday after all 1,800 crew members tested negative for the virus. It was feared the crew members might have come into contact with infected passengers on a previous trip.

In Washington, President Donald Trump said Monday that Xi reassured him that the cases of coronavirus are likely to dwindle during warmer months.

“He feels very confident, he feels very confident,” Trump said. “And he feels that, again as I mentioned, by April, or during the month of April, the heat generally speaking kills this kind of virus. So that would be a good thing.”

Trump made the remarks during a meeting with governors at the White House. He had spoken with China’s leader on the phone Friday.

In Canada, the coronavirus will “undoubtedly” have a “real” impact on the economy, the country’s finance minister said Monday.

Delivering a keynote address at a meeting of the Economic Club of Canada in Alberta, Bill Morneau said the virus is likely to disrupt supply chains and hit Canada’s tourism sector. He also noted that oil prices have fallen 15% since the outbreak began because of a decrease in demand and fewer flights traveling to and from China.

There have been seven confirmed cases of the coronavirus in Canada.

Russian health authorities are monitoring more than 20,000 people in their country for signs of the virus, including 6,000 Chinese citizens. Two cases of the virus have been found so far.

Russia’s Federal Anti-Monopoly Service warned Monday of “economic looting” by retailers seeking to take advantage of the crisis, with a sharp increase in the cost of medical masks across Russia.

“The vast increase in retail prices for medical masks in 68 regions of the Russian Federation has all the indications of ‘economic looting’ during a period of increased demand,” the FAS said in a statement.

Russian President Vladimir Putin said last week that pharmacies that price-gouged on medicines and medical masks should have their licenses canceled.

A top Chinese diplomat has been quarantined by Russian authorities as a safety precaution, Interfax news agency reported Monday.

The diplomat, Consul General Cui Shaochun, had arrived in Yekaterinburg on Thursday to take up his new post but had not yet met with any Russian diplomats, according to Interfax.

Li Ka-Shing, the richest person in Hong Kong with , has pledged a donation of $12.9 million to help Wuhan, the city at the center of the coronavirus outbreak.

The donation was made through the Li Ka Shing Foundation, which announced the news Monday that it would be making the donation “in support of the frontline healthcare professionals battling the Novel Coronavirus outbreak in Wuhan.”

Li, who has an estimated net worth of $29.4 billion, is one of Asia’s best-known philanthropists. His charitable organization is the second largest private and individual-led foundation in the world, after the Bill & Melinda Gates Foundation.

On Thursday, the Gates Foundation announced that it would commit $100 million toward the global response to the coronavirus epidemic. A number of other wealthy figures have pledged money to help in the fight against the outbreak.

The Jack Ma Foundation, established by and named after the Chinese billionaire and co-founder of Alibaba Group, pledged $14.4 million toward fighting the outbreak in late January. The funding will primarily go toward vaccine research underway at Chinese institutions. Other big names donating millions in funds include the online food delivery company Meituan Dianping, logistics subsidiary Cainiao Global and Tencent Charity Foundation. Alibaba’s payment and health subsidiaries are also offering loans and free services to affected people.

Gabrielle Autry, a 26-year-old American from Georgia living with her Chinese boyfriend in Hangzhou, China, suddenly experienced this firsthand. Hangzhou is the capital of Zhejiang province, one of the worst-hit by the coronavirus outbreak that has killed at least 720 people and infected more than 34,000 in China since December. The world around her is on lockdown.

But although Autry had the choice to leave because of her U.S. citizenship, she stayed. Her boyfriend, now effectively trapped along with many other Chinese nationals by travel restrictions, would otherwise have had to stay alone in their shared apartment.

“I’m not leaving, even though I can,” she told The Washington Post. “It wouldn’t be the right thing to do for our relationship, just to leave him.”

Their bond has weathered the first storm. But their reality is far from romantic.

As China and governments around the world impose hastily concocted quarantines, travel bans and evacuations, mixed-nationality couples and families looking to leave China have found themselves divided by citizenship status. Frustration and anxiety is running high as people struggle to navigate emergency measures meant to contain the virus, but which critics say have stoked xenophobia and public panic.

Monte Gisborne, a Canadian citizen whose wife and stepchild are visiting relatives in the Chinese city of Wuhan, the epicenter of the epidemic, had hoped that they would get seats on a plane evacuating Canadians. He said Canada excluded his wife and child because they are Canadian permanent residents, not citizens. “Aren’t we a Canadian family?” he asked.

Getting out of China, no matter one’s nationality, is getting harder and harder. Airlines around the world are canceling flights. Countries are imposing bans on people traveling from China. Within the country, movement between and within cities is highly restricted. Chinese regulations and diplomatic relations have further complicated some efforts by governments to evacuate their citizens.

On Jan. 31, the Trump administration issued stringent new travel restrictions, effectively barring entry to any non-U.S. citizens who recently traveled in China and imposing a 14-day quarantine on returning U.S. citizens. Chinese nationals who are spouses or immediate family members of a U.S. citizen are exempt from the ban.

Autry and her boyfriend, Li, who spoke on the condition that only his last name be used to protect his privacy given sensitivities around the virus, had been set to travel to Hong Kong to get engaged. The couple met while she was studying in China. Two years later, “he’s part of my family,” she said.

Then the virus hit. Autry first heard about it from the U.S. media and Reddit, she said, while news from China was censored. The two decided to proactively self-quarantine and began limiting trips outside their apartment. After a few weeks, officials formally banned any unnecessary travel.

These days, the guards at Autry’s apartment complex take her temperature before and after she steps out for a moment to pick up delivered groceries, she said. Inside, life is fairly boring: Li works remotely, she studies Chinese and they play video games. But at least they’re together.

“I can’t imagine being alone in this kind of situation,” she said. “(Leaving), it’s not something I would even consider.”

Others have been separated, though not by choice.

Gisborne’s wife, Daniela Luo, and their daughter, 9-year-old Dominica, were visiting Luo’s family in Wuhan when the quarantine took effect. Gisborne had not joined the trip.

As permanent residents of Canada, Luo and her daughter have nearly all the rights of Canadian citizens; however, Canada only allows permanent residents seats on flights out if they are accompanying a minor who is a Canadian citizen – so Luo and her daughter suddenly don’t count. They have no option but to remain in Wuhan.

“If there is a reason for the criteria, it has not been made clear to us,” Gisborne said. “I really need clear information from my government.”

Gisborne is gripped by fear and anxiety about what his daughter and wife have to endure. “Who would not be afraid for their family and try and do whatever they can?” he said.

Countless families have faced a maddening array of international barriers.

Kai Huang, a Canadian citizen, had to decide whether to leave Wuhan or stay with his 78-year-old mother, a permanent Canadian resident not allowed on the Canadian flight, he told the Canadian Broadcasting Corp. Two weeks ago, British authorities first told Natalie Francis, a British citizen working in Wuhan, that her 3-year-old son, Jamie, who is a dual British-Chinese citizen, would not be allowed to leave on the flight with her because of his Chinese citizenship.

“It really wasn’t up until the very last minute that she got some assurance there was a strong possibility her and Jamie would be allowed on the flight,” Francis’s aunt, Michele Carlisle, told the BBC.

Back in China, Autry said her boyfriend’s family doesn’t trust reports from the Chinese government. They are also extremely distrustful of the United States, which Chinese media and officials have accused of using the outbreak to weaken China. It’s uncomfortable, she said, but it hasn’t had an effect on their relationship.

“They said no, their issues are with the American government and not with me,” she said.

Not surprisingly, the story went viral as people embraced the images of the elderly Murphy flexing her muscles for the cameras.

While older men and women needn’t become powerlifters, athletes like Murphy who lift massive weights, experts say strength training – using weights heavier than you might expect – can be an important component of a healthy future.

Beginning about age 30, men and women lose muscle mass at about the rate of 10 percent per decade until about 50, when that loss accelerates to 15 percent per decade, according to research.

By the eighth decade, the loss of muscle mass – known as sarcopenia – and strength can be severe, greatly affecting quality of life by increasing the odds of falls and bone breaks that can cascade into other medical problems.

“When we talk about bone health and falls, we talk about three factors: fall, fragility and force,” says Matt Sedgley, sports medicine physician with the MedStar Orthopaedic Institute. “Participating in weight-bearing and resistance-training exercises helps develop muscle mass. This may help treat fragility conditions like osteoporosis. So if you fall you have stronger bone density. It may also lead to more cushioning when you do fall.”

Building strength can also help with the ability to stay independent as someone ages. “Strength declines rapidly if it’s not maintained,” says Seth Larsen, a Fort Worth-based primary care physician and certified strength and conditioning coach. “Without it, daily activities like picking up a bag of groceries, opening a kitchen cabinet or getting in and out of a chair can become difficult.”

Resistance training can be part of the antidote, but picking up five-pound dumbbells and doing a few biceps curls won’t get you where you need to be, Larsen says.

“In daily life, you’re going to need to lift things bigger than five pounds all the time, You might also need to catch yourself from falling, or get yourself off the floor. Both require far more strength,” he says.

For the best results, experts say a varied, heavier workload is needed.

“In most cases, what people think of as strength training really isn’t,” says Chris Nentarz, a Buffalo-based physical therapist. “If you want to offset age-related muscle loss, you need to be working at an intensity of 60 percent to 80 percent of your maximum load (meaning the highest amount you can lift). You can’t recruit your muscles if you aren’t working hard enough.”

Larsen agrees. “If you don’t overload your tissues, they won’t respond,” he says. “If you continue using the same weights and rep scheme, you’ll actually go backwards. The body wants and needs to be challenged.”

Before embarking on a program of heavier weight training, however, it’s important to get a medical checkup, particularly if the person is middle aged or older, with a focus on heart health to ensure it can handle the demands, Larsen says. And it’s important to assess whether there are any muscular problems or bone issues that need to be worked with before starting a new regimen. “The approach should be very individualized,” he says. “If vascular health is good, there’s not much off limits, but you need to start simple and progress.”

After that, finding a qualified trainer, gym or coach is the best place to learn how to lift weights without injury and also obtain guidance for progression to heavier loads.

Many gyms offer basic weightlifting classes using everything from barbells, dumbbells and kettlebells, or, in larger gyms, even a TRX system, a suspension system of straps that taxes you with body weight.

At the heart of a good strength routine, says Larsen, are several moves. “You need to be able to push, pull, hinge at the hips, carry and squat,” he says. “And as you age, you must be able to get up off the floor in case you fall. This is what saves lives.”

Developing good balance is also important, and something you can work on with your strength routine. Mortality rates within a year of a hip fracture in populations over 60 range between 14 percent and 58 percent.

“The most common algorithms to assess fall risk recommend strength and balance exercises whether you are found to have low, moderate or high risk for falls,” Sedgley says. If it is not challenged, balance disappears with age. Strength moves that meet this need include those like a split squat – where one leg is in front in a lunge position – with a barbell you are able to handle comfortably on your back/shoulders.

The good news is that to make the strength and balance gains you need, you won’t have to invest a massive amount of time.

“Three to four sessions a week that include 20 to 30 minutes of intense training does it,” Nentarz says. “Use some of that time to practice your moves with good form.” Especially for beginners, a trainer can help discern the right starting weight as well as watch your form to help you make adjustments and ensure you are executing the moves properly.

Larsen adds that good form is key and should serve as a guiding principle. “Your workload should be determined by your ability to complete it with the proper form,” he says.

Another guiding principle is progressing in small increments. “We know that spikes in volume or intensity increases the risk of injury,” Nentarz says. “In general, this means increasing either at a rate of about 10 percent week to week.”

If you begin chest pressing using an empty barbell pole – weighing 35 pounds for women/45 for men – then you’d go up 3.5 pounds/4.5 pounds the next week, assuming you have proper form at the lower weight and have performed the exercise several times the previous week so your muscles are prepared.

Michele Greenfield, 58, has been active all her life – including as a collegiate swimmer.

Since college, she has been a runner and has weight trained. But two years ago, she felt like her strength-training routine had stagnated, so she began taking group fitness classes that included a large element of strength training at a nearby gym.

Today, she says her legs have more muscle tone, her back is stronger and her overall body composition has changed.

And progressing to lifting much heavier weights has made a difference. “I don’t need to return to the strength level of my college days, but I want to take advantage of the things I can control as I age,” she says.

“I see some of the older people in my life and how they have to work to do simple things, like getting out of the car,” she says. “I feel confident in my strength and movement and I want to stave off losses as long as possible.”

As for Willie Murphy, the 5-foot powerlifter who bested the intruder, she told NBC’s “Today” show that she began powerlifting in her mid-70s to stay healthy, fit and independent.

“When it snows in Rochester, guess who’s doing the snow? Me,” she said in the interview.