“I’m now a dermatologist and a patient at the same time,” he says.

While he isn’t seeing many patients in person – only urgent cases – he’s still around his co-workers all day, so the mask must stay on. “These masks are super uncomfortable,” he says.

Skin irritation from wearing personal protective equipment is a hazard already familiar to health-care providers working in settings where infection control is critical. Now it has also become familiar to many people wearing masks in public, and frequently washing their hands. (Even bandannas and cloth masks, different from medical masks, can cause reactions, depending on the cloth, dyes and the detergent used to clean them, experts say.)

Friedman applies moisturizer to his face several times a day to decrease friction between his skin and the mask, useful advice for everyone, he says.

“It’s all about the barrier,” he says. “We need to protect our biological armor. This means not overwashing, especially with soap, and applying a moisturizer, preferably a thicker lotion or cream, to damp skin to lock moisture in where it’s needed, and to add an extra layer of protection from all the nasty things out there.”

The Centers for Disease Control and Prevention recommends that everyone wear face masks or cloth coverings over the mouth and nose when in public, especially where social distancing may be difficult, so it’s probably wise to take steps to protect the skin to prevent or alleviate problems.

“I think we will be wearing masks for months to come, given the smoldering nature of this viral pandemic,” Friedman says. “These skin issues, without good preventive and treatment strategies – which we have – will likely persist and become more prevalent.”

Dawn Davis, a dermatologist with the Mayo Clinic, says the skin, which is the body’s largest organ, protects us from the environment but can become damaged when it cannot respond fast enough to stresses.

“The skin is a very active organ of the body, just like any other organ,” she says. “In contrast to many other organs, it continually regenerates and produces its own moisturization. Our skin is very busy on a day-to-day basis on a level we don’t think about. It’s a full-time job.”

She compares skin to beleaguered feet that end up in ill-fitting or too tight shoes.

“The skin compensates by creating calluses,” she says. “The difference between the foot and the hands and face is that the bottom surface of the foot is much thicker than the skin on the backs of hands and on the face, so it doesn’t have the natural mechanism to form a callus. Instead, you get irritation, dryness, friction and dermatitis.”

She suggests using hypoallergenic soaps and washing hands and face in warm – not scalding – water. Pat dry, using linen or cotton, less abrasive than a paper towel. For hands, if moisturizing with cream or lotion alone doesn’t work, she recommends covering the lotion layer with an ointment, like petroleum jelly, then putting cotton socks over the hands overnight.

And if that’s not enough, try what she calls the “skin burrito,” a technique that adds additional moisture. Wash your hands, pat them dry and apply two layers of hypoallergenic lotion or cream. Put a teaspoon of white vinegar into a glass or small bowl of warm water and soak two clean washcloths in the solution. Wring them out, wrap them around your hands and cover them with socks.

The advice is similar for the face. Wash, pat dry and apply hypoallergenic moisturizer – lotion or cream – twice, leaving a thick layer. The vinegar soak works here, too. Lay the wet cloths across the irritated parts of the face for about 15 minutes, three or four times a day.

Davis also likes zinc oxide – which fights inflammation – the same stuff lifeguards put on their noses to prevent sunburn, and parents put on babies’ bottoms to treat diaper rash. Put a thin layer in facial areas where the mask rubs.

It’s also important to remember that broken skin is a portal for infection, and that ignoring skin problems can cause long-lasting, although treatable, skin discoloration, or require prescription medications. Moreover, mask wearing can worsen existing primary skin diseases, such as seborrheic dermatitis, or red scaly skin, rosacea, or red patches and visible blood vessels, eczema, an itchy inflammation, and perioral dermatitis, an acnelike redness around the mouth.

“Many of the masks that people – and myself – have at home are these fairly hard cone masks that can be very irritating from the pressure,” says Brian Kim, a dermatologist and co-director of Center for the Study of Itch and Sensory Disorders at Washington University School of Medicine. “Usually these masks are used very transiently while people are doing housework that creates dust.

“However, during covid-19, people are wearing them all day,” Kim says. “My face had long pressure lines, with redness, soreness, and my face was also very flushed underneath. I also have some mild rosacea, which was getting exacerbated by the heat and humidity and causing my face to get unusually red.”

Karen Ousey, director of the Institute of Skin Integrity and Infection Prevention at the University of Huddersfield in England and the author of a recent paper describing the skin issues among health-care workers, urges them to ensure masks are fitted correctly and aren’t too tight.

Apply moisturizer at least 30 minutes before putting on the mask, to avoid an improper fit, she says. She also warns that paraffin products are flammable, so anyone using them should not smoke. Finally, “if possible and safe to do so,” she says, remove masks every two hours to relieve pressure.

Most of these problems are preventable and easily treated, Friedman says.

“In this unprecedented time, we all need to do our part to protect ourselves and those around us,” he said. “Face masks save lives. Moisturizers save skin. Apply both to your daily routine.”

But scientists believe that another factor in the observed heightened risk is probably the general decline in the immune system that happens with age. In medicine, it has long been known that older immune systems struggle to fight off infections.

The ebbing of resistance to infectious disease with age is particularly clear when looking at studies of vaccines. During 2018-2019, for example, the seasonal flu vaccine was effective for roughly 3 of 5 children 17 and younger, according to the Centers for Disease Control and Prevention. The same vaccine was effective for only about 1 of 4 adults 50 and older.

Scientists have rushed to start trials for a vaccine against coronavirus. But even when they succeed in developing an effective one, University of Pennsylvania immunologist Michael Cancro worries that any coronavirus vaccine may be less effective for older adults – just as current vaccines are for other diseases.

“I doubt it’ll be worse, I don’t think it will be any better,” says Cancro, who wrote about age-associated changes in the immune system in the most recent Annual Review of Immunology.

Scientists are working hard to understand how age changes the immune system so that they can better protect seniors against current and future infectious diseases. It’s a timely goal. By 2030, there will be more adults over 60 than children under 10, according to the United Nations. In addition to the current threat of covid-19, influenza poses a serious risk to this age group: Nearly 3 of 4 people who died of flu during the 2018-2019 season were 65 or older, according to the CDC.

Here’s some information about what researchers know so far.

– How do vaccines work?

Vaccines stimulate the immune system in much the same way as an actual infection – minus the risk of major, deadly symptoms – because they contain fragments of disease-causing microbes, or pathogens, for the immune system to recognize. A prime example is the seasonal flu shot, made of pieces of the influenza virus. Other vaccines, such as polio, use inactivated or weakened versions of the whole virus or bacterium.

“It’s more or less been: You slice and dice the pathogen, you see what works,” Cancro says.

A successful vaccine will activate two classes of immune cells: B cells and T cells. B cells inactivate pathogens or mark them for killing by coating them with Y-shaped molecules called antibodies. T cells kill infected cells and direct the activity of the rest of the immune system, including B cells.

Those T cells are alerted to potential threats by another immune player called the antigen-presenting cell. It engulfs chunks of the pathogens, chomps them into bits and displays those bits on its surface. Nearby T cells respond to this by dividing rapidly to increase about a thousand-fold; your doctor can feel this by checking for swollen lymph nodes in your neck.

Most of the activated B and T cells will die soon after encountering a microbe or vaccine. But some become memory cells, which can last years or even decades and protect against future infections of the same kind. Memory responses are the hallmark of a successful vaccine, and are especially valuable for those with the least prior exposure to pathogens: children.

– How do immune responses change with age?

Older adults struggle to respond to pathogens they haven’t already been exposed to. One example is yellow fever, a virus endemic to sub-Saharan Africa and Latin America. Studies show that older people from other regions, most of whom have never been exposed to the virus before, take longer to produce antibodies in response to yellow fever vaccine, and those antibodies tend to be less effective at stopping the virus.

Something similar may happen with a vaccine for coronavirus, Stanford immunologist Jörg Goronzy says. “It will be one of those events where we vaccinate older people for something they’ve never seen before.”

There are likely multiple reasons for a waning immune response with age. One is that B cells in older adults produce antibodies that are less fine-tuned. When a B cell activates and starts to divide, with each division it slightly tweaks – mutates – its antibody-producing genes. This creates a population of cells with slightly differing versions of the same antibody, a bit like musical variations on a theme.

Some antibody versions will latch onto a pathogen better than others. B cells producing the most efficient forms get signals from neighboring T cells to continue dividing, while the remaining cells die off. But the genes regulating mutations in antibody-producing genes become less active with age, maybe helping to explain the sometimes-lackluster antibody responses in older adults.

And while older adults do retain immune cell memory, they can also struggle to respond to new versions of a pathogen that have shifted a bit since the person’s last encounter with it.

Scientists have long known that, when confronted with a new strain of a pathogen, the immune system will respond less strongly to it than to the first strain. That happens because memory cells from the first exposure gear into action and drown out a more tailored response to the newer strain.

“We still don’t exactly understand why the heck that is, but it’s a fact,” Cancro says.

Immunologists call this phenomenon original antigenic sin. Original antigenic sin makes it harder to mount effective antibody responses to rapidly mutating pathogens, such as influenza. The H1N1 flu strain, for example, has been with us ever since its emergence in the 1918 flu pandemic and during that time has acquired about 14 new mutations a year.

Older adults also have fewer T cells that can respond to new infections or vaccinations. After around age 20, we mostly stop making new T cells and rely on keeping existing cells alive, says Goronzy, who studies aging’s effects on T cells. He likens this change to a city losing skilled laborers.

T cells that do survive behave differently from those in youth. Work from Goronzy’s team and colleagues has shown that T cells in older adults are less likely to assist B cells or become long-lived memory cells. Instead, older adults tend to produce T cells that die after short bursts of activity – a necessary part of any immune response, but not one that leads to lasting protection.

– How are researchers improving vaccines for older adults?

One success story that researchers hope to learn from is Shingrix, a vaccine for the varicella zoster virus, which causes chickenpox and shingles. Shingrix was approved by the Food and Drug Administration in 2017 and is recommended by the CDC for adults 50 and over.

Studies show that the vaccine is about 90 percent effective in preventing shingles among adults 70 to 79, and equally effective for those over 80. One strength of the vaccine is its ability to boost immune memory; older adults vaccinated with Shingrix had stronger memory T cell responses than adults vaccinated with Zostavax, an older shingles vaccine that is only about 50 percent effective. Unlike Zostavax, Shingrix was designed to include molecules that stimulate antigen-presenting cells through the same pathways that activate these cells when they encounter bacteria.

“We’re seeing more imagination in the way we formulate vaccines,” Cancro says, “either in terms of mimicking what a pathogen looks like or providing molecules that drive immune cells.”

Researchers are also looking to identify immune pathways affected by age and trying to reverse some of these changes. In a 2018 study, 264 adults ages 65 and older were treated with experimental drugs that inhibit a biochemical pathway that becomes more active with age. Those pretreated with the drugs had stronger flu vaccine antibody responses than those given the flu shot alone – suggesting that older adults may benefit from vaccines tailored to their biology.

– How can older people best protect themselves against infectious diseases such as the flu?

One option is to take a flu vaccine designed specifically for older adults. The CDC doesn’t specifically recommend any one version of the flu vaccine for them, but two in the United States are offered only to people 65 and older.

One of these, Fluzone High-Dose, contains four times the dose of a standard flu shot. A 2014 study reported that while 1.9 percent of older adults who received the typical vaccine got the flu, only 1.4 percent of those administered Fluzone became infected. The other choice, FLUAD, is a standard-dose vaccine that includes an additional ingredient to boost antibody and T-cell responses – a similar strategy to the Shingrix vaccine, although the specific ingredient is different.

Even a vaccine that isn’t 100 percent effective can reduce recovery time and symptom severity.

A CDC study reported that adults 50 and older who got the flu vaccine during 2010-2011 cut their risk of ending up in the hospital due to flu by more than half. Plus, getting vaccinated makes you less likely to infect family, friends and co-workers – some of whom might be immunosuppressed or unable to get certain vaccines.

“I get my flu vaccine every year,” Cancro says. “And I’m 70.”

– – –

This report was produced by Knowable Magazine and can be read in full at knowablemagazine.org.

State officials said the company, Blue Flame Medical, failed to deliver masks and ventilators as promised and that the matter has been referred to Maryland Attorney General Brian Frosh, a Democrat, for review.

Blue Flame received a nearly $6.3 million down payment from Maryland in early April – after promising to provide within weeks desperately needed personal protective equipment for front-line medical personnel dealing with the novel coronavirus.

Ethan Bearman, the Los Angeles attorney for Blue Flame Medical, said Saturday he was unaware the state was unhappy with the firm.

“This comes as a surprise,” Bearman said when told that the attorney general had confirmed receiving a referral about the company from the state General Services Department. “This does not comport with what I know of Blue Flame Medical.”

However, a letter sent to the firm Thursday by Danny Mays, Maryland’s director of procurement, revealed deep frustration.

“Despite numerous requests for information and order status, Blue Flame Medical has yet to deliver any items under this order, or provide any pertinent data as to a pending shipment,” Mays wrote. “As Blue Flame Medical LLC has failed to honor its delivery commitment under the terms and conditions, [the Department of General Services] is now formally requiring Blue Flame Medical to cure this deficiency.”

Bearman acknowledged that delays had occurred in filling the order but said such problems have become commonplace this spring during the chaotic rush to locate masks and other protective equipment.

The Wall Street Journal first reported the contract’s cancellation Saturday.

Blue Flame was started in late March by Michael Gula, a Republican fundraising and lobbying consultant in Washington, and John Thomas, a California political consultant.

Before moving in to the medical supply business, Gula was known in GOP circles for his political fundraising prowess. His firm has raised campaign funds for Sens. Patrick Toomey of Pennsylvania, Steve Daines of Montana, Ron Johnson of Wisconsin and dozens of other influential Republicans. He startled some longtime clients in March when he announced he was quitting the fundraising world during an election year to start the medical supply business with Thomas.

Thomas recently worked as a strategist and fundraiser for Republican Don Sedgwick, who sought to run against Rep. Katie Porter, D-Calif., but lost in the March primary.

The two Republican consultants incorporated their firm in Delaware on March 23 and a week later received the contract from Maryland.

Gula used a connection to a staffer in the administration of Gov. Larry Hogan, a Republican, to initially make a pitch for the sale, according to a Maryland official who spoke on the condition of anonymity to discuss a sensitive legal matter. After Gula started using that staffer’s name on a reference sheet to seek contracts with other states, the official said, the staffer referred the matter to the chief legal counsel for Hogan, Mike Pedone.

Pedone then referred the matter on April 9 to Frosh’s office, the official said.

Gula and Thomas did not respond to requests for comment.

The April 1 purchase order, which was obtained by The Washington Post, identifies June 30 as the delivery deadline. But the Maryland official said that is only because June 30 is the end of the current fiscal year. The agreed upon shipping date for the masks and ventilators was April 14, this person said. Bearman did not respond to a request for comment on this complaint.

The order shows that Blue Flame agreed to provide 1.5 million N95 masks and 110 ventilators, and that the state wired the company nearly $6.3 million as a deposit.

Michael Ricci, a spokesman for Hogan, said in an interview Friday that none of the masks and ventilators had arrived.

“We placed this order on April 1, and we haven’t gotten anything,” Ricci said. “We received no shipping confirmation. Obviously, that’s a concern. That’s not been the case with any of our other vendors.”

The price Blue Flame was charging at the time for N95 masks – $4.52 each – was much higher than the list price provided by manufacturers.

Frosh confirmed Saturday the matter had been referred to his office.

Frosh would not comment on the contract, the investigation or what precipitated the referral.

Asked about the delays in fulfilling the contract, Bearman said: “I know Blue Flame Medical wanted to deliver the shipment [masks and ventilators] in April. I know, too, of actions by the Chinese government. Their supplier in China wrote a letter to Blue Flame Medical informing them that the Chinese government interfered with the supplier’s ability to ship.”

Bearman said his client “has done everything in its power to fulfill, and has alternate suppliers to fulfill the order as written. And they so informed the state of Maryland.”

The Hogan administration has been aggressively working to shore up the state’s supplies of equipment needed to fight the pandemic, including the purchase of 500,000 coronavirus tests from South Korea last month.

Local officials in Maryland were frustrated that those tests were not made available for their use, in part because of a lack of swabs, reagents and other testing supplies.

The last time the government tried that, it was a total fiasco.

Gerald Ford was president. It was 1976. Early that year, a mysterious new strain of swine flu turned up at Fort Dix, New Jersey. One Army private died. Many others became severely ill. The nation’s top infectious disease doctors were shaken.

“They were well aware of the ravages of the 1918 flu, and this virus appeared to be closely related,” political scientist Max Skidmore wrote in his book, “Presidents, Pandemics, and Politics.” “The officials were concerned about a repetition of the tragedy, or the threat of perhaps an even more virulent pandemic.”

Ford raced to come up with a response, consulting with Jonas Salk and Alfred Sabin, the scientists behind the polio vaccine, and in late March he announced an audacious plan for the federal government to both produce the vaccine and organize its distribution.

“No one knows exactly how serious this threat could be,” Ford said, with Salk and Sabin by his side, a shocking sight given the two scientists had become enemies over who should get credit for the polio vaccine. “Nevertheless we cannot afford to take a chance with the health of our nation.”

Every American, Ford said, would be vaccinated.

The government had never attempted such an endeavor – both in its breadth and speed.

Almost immediately, there was chaos.

According to Skidmore, a professor at the University of Missouri-Kansas City, insurers were concerned about liability and balked at covering the costs. Manufacturers the government wanted to partner with had similar concerns, prompting Congress to pass a law waiving liability.

One manufacturer produced two million doses with the wrong strain. As tests progressed, more scientific problems emerged – even as there were few, if any, signs that a pandemic was materializing. In June, tests showed the vaccine was not effective in children, prompting a public squabble between Salk and Sabin over who should be vaccinated.

But Ford was undeterred. He directed the vaccination program to proceed, announcing plans to inoculate one million people per day by the fall – an unprecedented timeline the government struggled to meet.

By mid-October, vaccinations were underway. Ford was injected by the White House doctor.

And then more problems emerged. There were reports of sporadic deaths possibly connected to the vaccine. Cases of Guillain-Barre syndrome also emerged, and are still cited today by the anti-vaccine movement. Panic emerged, with dozens of states pausing vaccinations.

By December, following 94 reports of paralysis, the entire program was shut down.

Almost immediately, in grand Washington fashion, fingers were pointed. Scientists and government officials turned on each other, with allegations that Ford acted recklessly for political gain without knowing for sure whether a pandemic would emerge – an impossible predictive game, his defenders argued.

The recriminations were fueled by the fact that the swine flu pandemic hadn’t materialized.

“Had it done so,” Skidmore wrote, “the swine flu vaccination program would immediately have been reinstituted.” The risk-benefit analysis – a relatively small number of cases of Guillain-Barre syndrome vs. widespread death from the flu – would have appeared differently.

Despite the problems, Skidmore and other historians have given the program credit for its swiftness in the face of typical government red tape. The infrastructure Ford’s team set up was able to quickly identify the side effects. And in the end, Ford had the backing of the world’s foremost vaccine experts — Salk and Sabin.

The program “appears clearly to have been based on concern for the public good,” Skidmore wrote, “not to achieve political advantage.”

Lorna Breen, chair of the emergency-medicine department at NewYork-Presbyterian Allen Hospital, died of self-inflicted injuries after being transported to UVA Hospital in Charlottesville, Virginia, police said.

Breen’s father, Philip Breen, told the New York Times that she had described coronavirus patients flooding her hospital and sometimes dying before they could be removed from the ambulances. She had no history of mental illness but seemed detached before she died, the Times reported.

“She tried to do her job, and it killed her,” the elder Breen told the newspaper.

He later added: “Make sure she’s praised as a hero, because she was. She’s a casualty just as much as anyone else who has died.”

After she contracted the coronavirus, Lorna Breen, 49, recovered for about a week and a half and then tried to return to work, Philip Breen told the Times. The hospital directed her to go back home, and her family brought her to stay with them in Charlottesville.

The Washington Post could not immediately reach Breen’s family on Tuesday.

Lucky Tran, a spokesperson for Columbia University Irving Medical Center and NewYork-Presbyterian, echoed Philip Breen’s praise of Lorna as a hero.

“Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department,” Tran said in a statement.

The Allen campus of NewYork-Presbyterian, located on the north side of Manhattan, serves the region of the United States that has been most devastated by the pandemic. New York state had reported 295,106 cases of the coronavirus and 22,866 deaths as of Tuesday.

Breen’s suicide comes during a global pandemic that increasingly directs health care workers’ attention toward the mental-health risks faced by physicians, who die by suicide at twice the rate of the general population. Among doctors, women are the most vulnerable.

Early research out of Wuhan, China, where the coronavirus outbreak is believed to have originated, indicated that female front-line workers experienced higher rates or more severe symptoms of depression, anxiety, insomnia and distress than health care workers overall.

Suicides are an occupational risk for emergency physicians, and the brutality of a pandemic can make them more common, said Loice Swisher, an emergency-room physician in Philadelphia and member of the American Association of Suicidology.

“I’m afraid we’re going to see more of this. And not just physicians,” Swisher said. “People who are losing their jobs, who think all is lost and just don’t see an end to this.”

While suicide and many of the feelings that precede can be difficult to talk about, Swisher said doctors in particular can struggle within a larger culture that views doctors as steady, competent and driven. Doctors who struggle may be especially reluctant to ask for help from the people best positioned to intervene – their own colleagues.

“We don’t want to be seen as a weak link. We don’t want to be seen as incompetent, or place an extra burden on our colleagues,” Swisher said. “It’s almost like you’re being kicked off the island – you don’t belong anymore – if you admit to [needing help].”

There are also professional consequences that can deter doctors from seeking support, said William Jaquis, president of the American College of Emergency Physicians. State medical boards and hospitals often ask doctors seeking hospital credentials whether they have ever been treated for depression.

Those credentialing and licensing boards do not distinguish between whether a depressive episode was 20 years ago or last month, Jaquis said. The risk is the same.

“We need to be able to get treatment for depression without the stigma behind it,” he said, adding that a history of depression or mental illness does not necessarily indicate a risk of suicidal thoughts. “There are ‘happy’ doctors who kill themselves.”

Charlottesville Police Chief RaShall Brackney said Breen’s suicide serves as a reminder that health care workers on the front lines of the pandemic are not immune to its mental or physical effects.

“Personal protective equipment (PPE) can reduce the likelihood of being infected,” she said in a statement. “But what they cannot protect heroes like Dr. Lorna Breen, or our first responders against is the emotional and mental devastation caused by this disease.”

Before working at NewYork-Presbyterian, Breen attended the Medical College of Virginia at Virginia Commonwealth University and completed her residency at Long Island Jewish Medical Center in Queens, New York. She also taught emergency medicine at Columbia University Medical Center, according to her bio on the hospital’s website.

As a longtime member of the American College of Emergency Physicians, Breen spearheaded a point-of-care tool – a research resource that doctors can use while with a patient – for people with autism spectrum disorder, the organization said in a statement.

JoAnne Tarantelli, executive director of the ACEP’s New York chapter, said in the statement that she and Breen often discussed Breen’s travels and snowboarding vacations.

“She was a gentle soul with a kind heart and engaging personality,” Tarantelli said. “Lorna will be remembered for her dedication, devotion and contributions to emergency medicine.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.

The Swiss drugmaker has paused new enrollment in a large U.K. clinical trial called Orion-4 that’s evaluating the experimental heart drug inclisiran, Chief Executive Officer Vas Narasimhan said in a Bloomberg Television interview. The medicine, a potential blockbuster, was central to Novartis’s $9.7 billion takeover of Medicines Co. last year.

Novartis is far from alone as regulators around the world ask researchers to avoid in-person interactions and try to use telephone or video visits instead, and medical centers focus on tackling the coronavirus. Sanofi said it’s seen some slowdowns, without giving examples, while Wolfe Research analysts said the outbreak is probably affecting enrollment for a study of Biogen Inc.’s experimental Alzheimer’s drug aducanumab.

“The real issue for us, and across the sector, has been new clinical trial starts, as well as continuing enrollment of studies that are ongoing,” Novartis’s Narasimhan said in an interview with Anna Edwards. “We’re doing our best to mitigate that.”

Most studies are still on track at Novartis, the CEO said. The company has been able to shift tests to China and other Asian countries. The Orion-4 study, expected to finish in 2024, aims to recruit 15,000 participants from sites in the U.S. and U.K., Novartis said last month. The delay shouldn’t have a long-term impact on the trial if enrollment can resume in coming months.

“There are a few digital technologies we have deployed over the years that are helping us manage this situation,” Narasimhan said on an earlier call with reporters, pointing to the company’s global surveillance hub that monitors its network of hundreds of drug studies and aims to predict potential problems on a minute-by-minute basis.

Covid-19 is having an impact on clinical trials in areas such as respiratory diseases that could divert hospital resources from tackling the crisis, Sanofi said by email. The drugmaker said it’s maintaining progress on key projects.

The U.K. regulator last month cited reports of deviations from clinical-test procedures related to the coronavirus. Patients with health problems may be advised to stay away from hospitals or they may be reluctant to visit them, it said.

Another large pharmaceutical company, Eli Lilly and Co., delayed most new study starts and paused enrollment in most ongoing trials, but will continue tests for patients who are already enrolled. And, Erytech Pharma SA, a small drugmaker, said last week that the pace of recruitment for a pancreatic cancer trial has slowed.

The pandemic so far hasn’t hurt demand for existing Novartis medicines — quite the contrary as patients rushed to buy essential drugs before lockdowns. The company maintained its sales and profit forecast for the year as it reported first-quarter earnings.

The philanthropist and founder of Microsoft said that the Bill & Melinda Gates Foundation, with an endowment exceeding $40 billion, will give “total attention” to the pandemic that has killed more than 200,000 and is roiling economies around the world, he said in an interview with the newspaper.

“You’re going to have economies with greatly reduced activity levels for years,” Gates said. The pandemic could cost the global economy “tens of trillions of dollars,” he said in the interview.

The foundation has contributed $250 million to help counter the coronavirus and is re-purposing units dedicated to fighting other diseases to join in the battle against the pandemic.

“We’ve taken an organization that was focused on HIV and malaria and polio eradication, and almost entirely shifted it to work on this,” he told the FT.

Gates also defended the World Health Organization against accusations from U.S. President Donald Trump that the body had mishandled the virus response.

“WHO is clearly very, very important and should actually get extra support to perform their role during this epidemic,” Gates said. He said he doesn’t believe Trump will follow through on his threat to withdraw funding for the WHO.

The symptoms, which the CDC reports could appear two to 14 days after exposure to the virus, are:

– Chills

– Repeated shaking with chills

– Muscle pain

– Headache

– Sore throat

– New loss of taste or smell

Previously, the CDC listed just three known symptoms: shortness of breath, cough and fever.

Mario Ramirez, the former acting director of the Office of Pandemic and Emerging Threats under President Barack Obama, told The Washington Post that the frequency of symptoms in new diseases changes with time, even with recurring illnesses like season influenza. The recent additions, he said, reflect the CDC’s confidence in stating: “we can say reliably that these six symptoms go with covid-19.”

Ramirez, who is also an emergency room physician, said that confidence stems in part from the growing number of patients being treated for covid-19 in the United States. Local trends in symptoms, in conjunction with data from other countries, allow the CDC to present information that captures the right segment of the population for testing, he added.

“You don’t want to list twenty-something symptoms, especially if half the population has those symptoms,” Ramirez said. “You’re trying to balance targeting the right people to come in for testing, so it must be specific.”

The additions confirm what patients and doctors have been reporting anecdotally for weeks. In particular, the loss of taste or smell has been known to appear in patients since at least mid-March when a British group of ear, nose and throat doctors published a statement amid growing concern that it could be an early sign someone is infected but otherwise asymptomatic.

A study of European covid-19 patients found between 85.6% and 88% of patients “reported olfactory and gustatory dysfunctions, respectively.” In an Iranian study, 76% of covid-19 patients who reported a loss of smell said it had a sudden onset. In many of the cases, anosmia, as it’s called, appeared before other symptoms.

“It scared the hell out of me,” said Vallery Lomas, a 34-year-old champion baker, who feared she would never get her senses of smell and taste back. “I could smell nothing for probably five days.”

Lomas was presumed positive for covid-19 in the midst of writing a cookbook. Smell and taste are intertwined, so some people who think they have lost both senses may have lost only their sense of smell.

“What happens with loss of the sense of smell is you lose flavor,” but not taste, said Jo Shapiro, a professor of otolaryngology at Harvard Medical School.

Though not listed on the CDC website, fatigue also has been reported in people who have either tested positive or told to assume they have covid-19 when testing was not available.

Hedy Bauman told NBC News the fatigue hit her like a truck. Even reading was exhausting, she said.

“My bathroom is maybe 15 steps from my bed,” Bauman told NBC News. “I wasn’t sure I could get from the bathroom to my bed.”

Bauman told NBC she had chills but no fever.

Early reports of the virus suggested it caused standard respiratory symptoms, though it is extremely contagious and deadly. During the past few weeks, health experts have noted how covid-19 attacks many organs in the body.

In some patients, physicians are reporting a blood-clotting complication that does not respond to anticoagulants. Some patients’ lungs fill with hundreds of microclots, autopsies have shown, and larger clots can break off and travel to the brain or heart, causing a stroke or heart attack.

Evidence from the more than 80,000 coronavirus cases reported in China indicates symptoms in about 80% of patients are mild. The additional symptoms will make it easier for people to know when to ask for a test, Ramirez said, and it could help physicians determine when patients need to be tested or at least be told to assume they have it and self-isolate.

“Anecdotally, we’ve heard about the symptoms – and most physicians were already including it in their decision-making process,” Ramirez said. “But to the extent the U.S. population reads CDC guidelines, this is a much more public-facing document.”

The CDC continues to recommend managing symptoms at home unless they include trouble breathing, persistent pain or pressure on the chest, new confusion or inability to arouse, or bluish lips or face.

https://www.washingtonpost.com/video/c/embed/d12c3fe0-b5a9-4759-9b91-fc3db96af25e

It’s a virus that has the world on its knees, so when Maccabi Healthcare Services recently unveiled what it billed as a simple one-stop testing booth, I was curious.

Could this be the solution to freeing millions of Israelis from a months-long lockdown? If anyone could go to a health clinic for a fast and fairly painless test, confirm whether they have the virus, seek treatment and isolate themselves, then maybe our lives could get back on track.

I decided I had to go see this “roadside” testing booth for myself.

In Israel, which has managed to keep the number of covid-19 cases and related deaths relatively low – as of Friday, there were roughly 14,800 confirmed infections and fewer than 200 deaths – there is still quite strict criteria on who can take a coronavirus test.

Showing no symptoms of the virus, not having traveled overseas lately and not living in a high-risk area, I did not qualify for a test, but when I asked Maccabi if I could try out the new testing booth, it readily agreed – though my results would not be fully processed.

Part of me was relieved. I had already thought about what a positive result might mean for me, my husband and our two teenage daughters, who have all been stuck at home with me since early March. Even if I tested negative, I wasn’t sure I really wanted to appear in Israel’s digitalized medical system as being a suspected carrier.

The concept of the testing booth is simple. It is basically a booth that allows the examiner to stand safely inside, eliminating the need for protective personal equipment as they interact with patients from behind a fiberglass screen. They administer the test through oversized rubber gloves that poke out of the booth. Immediately after each test, the examiner presses down on a foot pump that sprays disinfecting soap over the outside of the booth, including on the gloves.

As nervous as I felt, I was so excited to get out of the house after six weeks of lockdown.

I approached the booth awkwardly, hampered by a face mask and a funky GoPro on my head (to film the process). I strained to hear the tester’s instructions, wondering if a face mask hampered one’s hearing too.

“Come closer but don’t touch anything,” he said, directing me to swipe my health insurance card and then, after a quick scan of my details on his computer, ordered me to hold up my ID card.

Israeli law requires citizens to join one of four public health funds, services heavily subsidized by the government to ensure that everyone has access to health care. I am a member of the Maccabi health organization.

I watched as a pair of giant rubber gloves clipped open a test tube and withdrew an extra-long Q-tip-type stick. The tester instructed me to open my mouth wide and poked around inside, reaching the back of my throat, scraping for a few seconds on the top of my tongue. It was very similar to the DNA test I did myself a few years ago, but obviously I was much more gentle. Then came the kicker: He told me to tilt my head back before pushing the same swab up my left nostril.

But it was over in seconds and I felt no lingering pain.

I watched as the tester placed the resealed test tube with my sample inside into a cooler box attached to the booth. Then began the process of sterilizing the outside of the stand.

According to Ran Sa’ar, Maccabi’s chief executive, the development and building of the testing booth took less than a week. The health fund is working to improve and modify the idea.

“The great thing about this testing booth is that it’s not only simple and easy to assemble, it is also very cheap to manufacture,” Sa’ar said in an interview with The Washington Post.

Maccabi has some 2.4 million members and, in regular times, carries out about 25,000 different kinds of medical tests per day. Sa’ar said the plan is to place these booths at each of his organization’s clinics.

There are still some barriers though. At the start of Israel’s outbreak, Magen David Adom, Israeli’s first-aid agency, hurried to take up the challenge of testing for the virus, and the government is still reluctant to open up the process. But Sa’ar, along with the heads of the other public health funds, is pushing to have the testing process transferred to them. This would not only increase the number of tests being carried out – this week Israel reached more than 10,000 tests per day – but it would also enable the virus to be tracked more effectively, Sa’ar said.

As I drove home from Jaffa, I wondered to myself if what I had just experienced could soon become the new norm shaped by the coronavirus crisis. Will we all need to stand in front of a booth like that every time we get a sore throat, or have been near someone who has covid-19, or when we want to travel?

The anonymous tester, the giant gloves, even the cotton swab deep up my nostrils – if that’s what we have to do to reclaim our pre-coronavirus lives, at least until a cure or a vaccine, then I can live with that.

Confirmed cases have surpassed 25,000 among Africa’s 1.3 billion people, and the death toll has exceeded 1,200.

Dozens of nations have “very, very limited” capacity for testing, said John Nkengasong, director of the Africa Centers for Disease Control and Prevention, at a Thursday briefing. The lack of tests could be obscuring a larger danger.

The virus threatens to kill more than 300,000 people in Africa, according to a United Nations estimate, and plunge tens of millions more into poverty.

Leaders can still dodge worst-case scenarios, officials said, with wider testing nets and aggressive contact tracing. Most African countries have sealed or tightened their borders, banned public gatherings and closed schools, among other preventive measures.

“Are you finding the cases?” Nkengasong asked. “Are you isolating and tracking the contacts?”

But doctors, aid workers and residents say the lockdowns are blocking people from food, water and health care. For many, money comes from human interactions: cleaning houses, doing odd jobs, hawking fruit.

“It’s as if we are in a grave,” said Moussa Diallo, 22, who sells milk, sugar and other basics on a street corner in the Senegalese capital, Dakar.

Customers are disappearing, he said. His perishable goods expire in May, and he doesn’t have the cash to restock if they go bad.

“I have nothing to eat – just this milk,” said Diallo, who said social distancing has disastrously slashed incomes. “It’s unthinkable.”

About 135 million people worldwide, mostly in Africa and the Middle East, are already “marching toward the brink of starvation,” David Beasley, executive director of the World Food Program, told reporters this week.

Pandemic-sparked food insecurity could nearly double that total by the end of the year.

Fallout from food scarcity is expected to be most extreme in Yemen, Syria, Congo, South Sudan and Nigeria, the organization said.

“More people will die of hunger than the coronavirus,” said Isa Sanusi, spokesman for Amnesty International in the Nigerian capital, Abuja.

Nigeria’s lockdowns have put an untold number of workers out of jobs, he said. Most people in Africa’s most populous nation can’t afford to eat if they miss a day of paid labor.

The government is passing out bags of rice and other necessities, but people tell him they haven’t received anything.

“They say, ‘We don’t see these things. Where is the food? We only read about it in the news,’ ” he said.

The struggle to find clean water also hinders the fight against covid-19, said Canisius Kanangire, executive secretary of the African Ministers’ Council on Water in Abuja.

In densely packed urban neighborhoods, where police and soldiers enforce stay-at-home orders, poorer residents routinely lack running water at home.

“The lockdown cannot work because people have to go out for water,” Kanangire said. “They have little to drink or for hand-washing.”

Another effect of travel restrictions: Medical deliveries are stalled, health-care workers say, and people battling illnesses other than the coronavirus face longer waits.

A shift in efforts away from malaria control could fuel another fatal outbreak, a new WHO report cautioned Thursday.

Sub-Saharan Africa accounts for 94% of all malaria deaths, and the victims are usually younger than 5. If prevention services, such as the distribution of mosquito nets, decline during the pandemic, the number of casualties this year could double.

“Even in times of lockdown, these essential services must be continued,” Matshidiso Moeti, WHO’s Africa director, said Thursday.

Breakdowns in some services are already happening, said Nicolas Mouly, program manager for emergency response at the Alliance for International Medical Action, an aid group that ships health-care supplies across West Africa.

Roughly two-thirds of the continent’s airports are closed, and lifesaving drugs are sitting in storage. Finding flights for them is an increasingly strenuous task.

“It’s a daily fight,” he said.