Q: Do you really need to wear a face mask in the present situation?

The Public Health Ministry: Patients or sickly persons should wear a mask all the time. Those who are healthy don’t need to wear one except when among a community or crowed area.

Medical Services Department director-general Somsak Akkslip: Healthy people who visit crowded areas or use public transportation or go to a hospital or visit high-risk areas should wear face masks. If you stay in your house or in an open space you do not need one.

Thiravat Hemachudha, head of King Chulalongkorn Memorial Hospital’s Centre for Emerging Diseases: Doctors and nurses are normally required to wear face masks under sanitation standards. But people carry the risk of contracting body fluid droplets from others in a 1-2-metre radius via the mouth or nasal mucosa.

WHO Thailand: Wearing medical masks is one of the preventive measures to limit the spread of respiratory diseases, which includes the new type of coronavirus. The use of masks alone is not enough to protect one fully. Therefore, it’s also necessary to wash one’s hands.

The World Health Organisation does not recommend the use of masks for healthy people unless such a person has to take care of another with respiratory symptoms.

Q: Which type of face mask can prevent contracting the virus?

Public Health Ministry: Fabric masks, surgical face masks, or N95 masks.

Communicable Diseases Institute director Dr Sopon Iamsirithawon: For a healthy person, a fabric mask is enough. When the swine flu (H1N1) pandemic occurred in 2009, we also suggested using fabric masks.

For those with pneumonia, use a surgical mask which has blue or green on one side. When wearing a face mask, the patient should flip the coloured side to face out as the white side can absorb water, nasal fluids and saliva. Adjust the mask to fit your face – do not forget to pinch the wire to fit your nose securely and pull the mask down to cover your chin. N95 masks are more suited for medical teams who have to take care of patients and need maximum protection.

WHO Thailand: For suitable protection, wear a surgical mask.

Q: Can I re-use the mask?

Public Health Ministry: Fabric masks can be washed and re-used. A surgical mask is made for single use only.

Department of Health director-general Panpimol Wipulakorn: Physically fit people and those not in crowded areas or not taking public transportation don’t need to wear a mask. A healthy person can also protect himself/herself by wearing a clean cloth mask. The advantages of the cloth mask is to help prevent ingestion of large dust particles. It can also be washed and re-used and even sewn by yourself if need be.

WHO Thailand: Medical masks should not be used again and again. These masks must be discarded after they are used once.

Q: Can you make your own mask?

Public Health Ministry: Yes.

WHO Thailand: Not specified. But it is not recommended to use a cloth mask (such as one from cotton or mesh cloth) instead of a surgical mask.

Q: Which side of the mask should face outside?

Public Health Ministry: Flip the coloured side to face out and use the side with the wire edge up. Secure the mask in place.

WHO Thailand: Health management suggests masks should be worn carefully, covering your mouth and nose. Tighten the mask strap and attach the mask to your face as tight as possible to reduce the gap between the face and the mask.

The justices will review a federal appeals court decision that found part of the law unconstitutional and raised questions about whether the law in its entirety must fall. The Trump administration agreed with the lower court’s decision but said it was premature for the court to join the legal fight now.

Democrats seemed delighted that the court had decided to ignore that advice. They said the focus on health care will help their candidates, as polls show it did in 2018 when Democrats won back the House majority, and increase the importance of the Supreme Court with their voters.

“Today’s Supreme Court announcement ensures health care will remain front and center throughout 2020 and that House Republicans won’t be able to hide from their long history of attacking Americans with preexisting conditions,” said Robyn Patterson of the Democratic Congressional Campaign Committee.

Democratic presidential candidate Joe Biden, the vice president when President Barack Obama secured his most important domestic achievement, issued a statement: “This fall, Donald Trump will be trying to get the Supreme Court to strike down Obamacare — ripping health insurance away from 30 million Americans, ending protections for 100 million more with preexisting conditions, destroying families, and costing a million jobs. I’ll be fighting to end Donald Trump’s administration.”

Republican reaction was almost nonexistent, even though President Donald Trump has made abolishing the law a priority. While he has said he will preserve some of the program’s most popular provisions — such as guaranteed coverage for preexisting conditions — he has not put forward a plan.

The court’s review will come in the term that begins in the fall. It is one of the first cases accepted for that docket, and if the court follows its usual pattern, oral arguments would be in October. But the timing is up to the justices.

A decision would not be likely until the spring or summer of 2021. The law remains in effect during the legal challenges.

It will be the Supreme Court’s third consideration of the legal merits of the Affordable Care Act. And while the court has become more conservative with the addition of Trump’s two nominees, the majority of five justices who have sided with the ACA in the past remains intact.

In both cases, Chief Justice John Roberts has joined with the court’s liberals — Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan — in voting against the challenges. Some Democrats were open in their hopes that the court take up the next challenge before there were any changes to that group.

The court had earlier turned down a request from Democratic-led states and the House of Representatives to hear the case this spring.

The latest ACA suit was organized by Republican attorneys general in Texas and other red states. When the Trump administration declined to defend the law, a coalition of Democratic-led blue states entered.

“As Texas and the Trump Administration fight to disrupt our health care system and the coverage that millions of people rely upon, we look forward to making our case in defense of the ACA,” California Attorney General Xavier Becerra, whose office had led the Democratic effort, said in a statement after the court’s announcement. “American lives depend upon it.”

Texas Attorney General Ken Paxton was one of the few Republicans commenting Monday on the court’s decision to take the case, and said he looks forward to defending the decision of the U.S. Court of Appeals for the 5th Circuit.

“Without the individual mandate, the entire law becomes unsupportable,” Paxton said in a statement. “The federal government cannot order private citizens to purchase subpar insurance that they don’t want, and I look forward to finally settling the matter before the U.S. Supreme Court.”

Paxton’s case began after the Republican-led Congress in 2017, unable to secure the votes to abolish Obamacare, reduced the penalty for a person not buying health insurance to zero. Paxton argued that in doing that, Congress had removed the essential tax element that the Supreme Court had found made the program constitutional.

A district judge in Texas agreed and said the entire law must fall.

The Trump administration eventually agreed with that assessment

On Monday, House Speaker Nancy Pelosi, D-Calif., chastised the administration for targeting the law while health officials throughout the United States race to contain the spread of a highly infectious respiratory disease that has caused more than 3,000 deaths globally.

“Even in the middle of the coronavirus crisis, the Trump Administration continues to ask the court to destroy protections for people with preexisting conditions and tear away health coverage from tens of millions of Americans,” she said in a statement, calling the law “even more critical during a dangerous epidemic.”

When the 5th Circuit considered the district judge’s decision, the panel split 2 to 1.

The two Republican-appointed judges on the panel — Kurt Engelhard and Jennifer Walker Elrod — said that because Americans are free to ignore the insurance requirement with no risk of penalty, the “attributes that saved the statute because it could be read as a tax no longer exist.”

They voted to send the case back to the district judge for a closer look at whether parts of the law could survive.

In her dissent, Judge Carolyn Dineen King, nominated by President Jimmy Carter, wrote that “questions about the legality of the individual ‘mandate’ are purely academic, and people can purchase insurance — or not — as they please.”

As for sending back to the lower court the question of whether the rest of the law remains intact, King wrote: “Answering that question should be easy, since Congress removed the coverage requirement’s only enforcement mechanism but left the rest of the Affordable Care Act in place.”

The Supreme Court’s decision essentially short-circuits the decision about the need for further lower court review, and the justices will make such decisions on their own.

In 2012, the court upheld the mandate that most Americans obtain insurance or pay a penalty, saying it fell under Congress’ taxing power. Roberts drew the lasting enmity of some conservatives when he said the court’s job was to save the work of Congress if there was a way to square it with the Constitution.

In 2015, Roberts and the court’s liberals were joined by Justice Anthony Kennedy, who is now retired, in upholding the law against another challenge. It involved tax subsidies.

Simon was a rower who worked out daily. His initial stay for treatment at Children’s Hospital was three weeks long, and the sedentary routine of chemotherapy was tough. “I got stir crazy,” Simon said. “Patients in a pediatric oncology unit are immunocompromised, so we couldn’t leave the floor. There’s not much to do but walk around.”

He walked laps around the unit when his strength permitted. But walking isn’t rowing, so the staff found an Expresso Go virtual reality bike and moved it into his room, where he rode it daily. After this initial round of treatment, Simon moved to Johns Hopkins, where he sometimes spent several days at a time as an inpatient. There was an exercise bike there too, which he rode often. It helped ward off some of the fatigue from the grueling chemotherapy and even elevated his mood. It was as if he were contributing to his own treatment plan.

“I felt like I was helping myself stay healthy,” he said.

Simon, now in his second year at the University of Virginia, discovered something seemingly counterintuitive: exercising during chemotherapy made him feel less fatigued. Yet as little as 20 years ago, medical experts prescribed bed rest to conserve energy for treatment. It wasn’t until 2010 that the American College of Sports Medicine established exercise guidelines for cancer survivors and patients. Its directive, updated in 2018, is simple: “avoid inactivity.” Exercise training, it said, “is generally safe for cancer survivors.”

Chemotherapy wreaks havoc on the body. It causes fatigue, muscle loss, nausea, pain and disrupted sleep. Patients can become depressed. But regular exercise can help minimize these side effects in cancer patients. Evidence has shown that a consistent exercise routine can reduce cancer-related anxiety and fatigue, and it can reduce depressive symptoms both during and after treatment. Doctors are spreading the word that exercise improves quality of life and that patients need to stay moving after their treatment concludes.

But getting kids to exercise isn’t always easy, which is why Simon two years ago started an organization, Bike to Fight, to raise money to place Expresso Go bikes on adolescent and young adult oncology floors in hospitals nationwide. The bikes are not cheap, retailing for about $7,000, although Interactive Fitness, the company that makes the Go, gives Simon’s group a discount. So far, the bikes are being used in five hospitals, including Johns Hopkins and Children’s Hospital. They feature 26-inch screens with interactive courses and games that riders play.

The bikes have been a huge hit, both with patients and their doctors.

The easy availability of exercise “is a way to normalize [young patients’] lives and a huge psychological benefit. It’s also a way to improve stamina,” says Pat Brown, director of the Pediatric Leukemia Program and associate professor of oncology at Johns Hopkins. The bike helps patients whose sleep cycle is disrupted by treatment.

“Sleep/wake cycles can be unpredictable in hospitals, and it’s discouraging to be awake at 3 a.m. in a hospital bed with nothing to do. The bike is always there for them,” Brown says.

On the virtual reality courses, patients compete against other patients and even against other Expresso Go users anywhere.

Bridget Diveley, 12, rode the bike while undergoing treatment at Hopkins.

“It’s much better than walking laps around the unit,” she says. Like many of the patients, Diveley’s favorite were the virtual reality courses where she raced other people. And while the bike did make her tired, “it also made me feel motivated.”

Another one of the bikes is at Massachusetts General Hospital, where psychologist Giselle Perez-Lougee, chair of the Adolescent and Young Adult (AYA) Oncology Task Force, says the exercise the bike provides is particularly important to this cancer patient population, which has “an elevated risk for adverse physical and emotional health outcomes. There are many health benefits of exercise during and after cancer treatment, but research suggests that AYAs are not meeting exercise guidelines.” (The National Cancer Institute defines the AYA population as ages 15 to 39.)

Besides potentially improving overall health, exercise can improve self-esteem and confidence and decrease fatigue, Perez-Lougee says.

At Comer Children’s Hospital in Chicago, where Simon placed a bike in the pediatric oncology unit, physical therapist Catherine Kennedy tells her young patients that opting out of exercise is not an option. “It’s a way to fight the tired feeling they can get from chemo,” she says. For those who need to be coaxed into exercising, Kennedy encourages short bursts of about 10 minutes throughout the day rather than one long session so that it’s less daunting. Any movement, Kennedy says, is better than no movement.

Doctors who treat these cancer patients hope that exercise will become a permanent lifestyle change for their patients – and for good reason: With advances in treatment, many cancer patients are living longer. There is evidence that exercise can lower the risk of several cancers and some recurrences.

At the same time, the increased survival rates are happening in part because of powerful chemotherapy drugs that also can cause lasting damage to the cardiovascular system, or cardiotoxicity.

Heart disease and other long-term cardiac issues are the biggest risk factors childhood cancer survivors face after intense chemotherapy, says Kathy Ruble, assistant professor of oncology and director of the Life Clinic and Leukemia Survivorship Program at Johns Hopkins.

“The cardiac mortality rate in cancer survivors is about 10 times greater compared to their healthy siblings and peers,” she says. “We see cardiotoxicity decades after treatment. But the good news is that we have decades to change it,” and lifestyle changes are an important part of that.

When her young patients finish cancer treatment, Ruble sits down with every family and stresses the importance of regular exercise.

“They’re already behind [with their health], so my job is to find the secret formula to get these kids moving again,” she says.

At the Lee Jones Lab at Memorial Sloan Kettering Hospital in New York, researchers are studying the long-term cardiovascular side effects of chemotherapy. They are also exploring the benefits of regular exercise on cancer treatment.

“We know the benefits of exercise on heart disease, so given the cardiotoxicity of chemotherapy [on the heart], we hope to apply it to cancer survivors as well,” exercise scientist Lee Jones says. He also is interested in looking at how patients may be able to use exercise to receive or help them tolerate stronger – and therefore possibly more effective – treatment. Jones hopes exercise will eventually be a regular adjunct to chemotherapy.

But what exercise aims to improve – energy, self-esteem, mood and mobility – is often what makes it difficult to get started: motivation can be low when cancer treatments sap your strength and make you depressed. Enticing patients to overcome those feelings often runs up against a mountain of misinformation.

“Patients are still hearing that they shouldn’t exercise,” says Allison Betof Warner, an oncologist at Memorial Sloan Kettering.

Warner’s goal is to prescribe exercise to make cancer therapy work better.

“There’s still this idea that you should save your energy to fight the cancer,” she says, even though it has been shown that in most cases exercise while undergoing treatment is safe.

Betsy O’Donnell, an oncologist at Mass General, says she would like to see Expresso Go bikes connected in hospitals across the country for all cancer patients.

“My dream is a nationwide social network of cancer patients who ride the bikes,” she says. “Then they could take that network home and let it inspire them. We could have programming just for cancer survivors, even maybe a class for just, say, breast cancer survivors.” That connection would effectively be one giant support group, helping to normalize the lives of patients who are living longer than ever before.

Simon, meanwhile, is back to his regular exercise routine.

At U-Va., he tries to make it to the gym five days a week. He sees a cardiologist twice a year to make sure he has not developed any heart complications from the chemotherapy he completed in 2018. So far, there are none.

“I exercise for the same reasons I did when I was undergoing treatment: to relieve stress and stay healthy,” Simon says. “And to ensure there are no residual side effects from my treatment.”

Covid-19 has now killed patients on four continents, with the global death toll climbing toward 3,000. Countries are tightening travel restrictions, canceling public events and urging people to take health precautions.

In Washington state, health officials said Saturday that a man in his 50s with underlying health conditions died at a hospital in Kirkland after testing positive for covid-19. The patient had no recent travel history or contact with people known to be infected, suggesting he may have been infected through person-to-person transmission, officials said. It was not immediately clear when he was admitted, when his symptoms first appeared or how long it took health officials to test him.

Officials in the Seattle area announced two cases related to a possible outbreak at a long-term nursing home, where people are considered to be especially vulnerable to infection. One patient is a female health care worker in her 40s who was in satisfactory condition, according to state health officials. The other, a female resident in her 70s, is in serious condition.

Jeffrey S. Duchin, the chief health officer for Seattle and King County, identified the nursing home as Life Care Center in Kirkland, and said he would not be surprised to find additional cases at the facility as an investigation continued. Of Life Care’s more than 108 residents and roughly 180 staffers, Duchin said 27 residents and 25 staff members have shown coronavirus symptoms.

The Centers for Disease Control and Prevention said it was sending a team of experts to Washington to support its investigation.

Earlier Saturday, the Trump administration outlined new travel restrictions affecting Iran, Italy and South Korea in response to the outbreak, and President Donald Trump said he was considering further restrictions across the southern border.

As cases mounted, the White House scrambled to gain control of a response defined by bureaucratic infighting, confusion and misinformation. “It’s complete chaos,” one senior administration official said.

The Food and Drug Administration expanded coronavirus testing by speeding up hospitals’ abilities to test, though some worried the changes fell short in reducing logistical burdens.

Misinformation about the disease is proving hard to contain. Roughly 2 million tweets peddled conspiracy theories about the coronavirus over the three-week period when the outbreak began to spread outside China, according to an unreleased report from an arm of the State Department.

In an early morning tweet Sunday, Trump said that people traveling from “high risk countries” will be screened for covid-19 both before they board their flight and once they land in the United States.

The CDC has issued Level 3 warnings and encouraged Americans to avoid nonessential travel to South Korea, Italy, China and Iran.

The announcement appears to be another change in travel protocol surrounding the novel virus outbreak, which is expanding in the U.S. by the day. At a news conference Saturday where Trump spoke on the nation’s first coronavirus death, the president announced other new travel restrictions.

They included an extension to the existing travel ban on Iran, which now applies to any foreign nationals who has been in that country over the past 14 days. Trump raised the warning level for travel to Italy and South Korea, recommending Americans not travel to regions where outbreaks are concentrated. Trump said he is also considering restrictions across the southern U.S. border, though Mexico’s Foreign Ministry later pointed out the country has fewer coronavirus cases than the United States.

Appearing on CNN early Sunday, Randi Weingarten, president of the American Federation of Teachers, criticized Trump and the administration’s response to the coronavirus, saying officials had “pretended this didn’t exist” and put schools at risk.

“We pushed very hard to get the Trump administration, you know, back in January and February to do something as opposed to pretending that this was not real,” she told host Christi Paul.

Weingarten further took shots at the administration over budget and staffing cuts at the Centers for Disease Control and Prevention, saying the White House should be guided by science.

“There are still – I mean, I know that the president basically got rid of all the pandemic experts in the White House – but there are still scientists at the CDC who really understand and know what they’re doing,” the union head said. “There are scientists around the country who know what they’re doing.”

The union has been working directly with officials on the cases in California and Oregon related to schools. Every school should have a plan in place for emergent cases, she said.

The director general of the World Health Organization urged Sunday for global markets to calm down in the face of fears of the spreading coronavirus, while admitting that countries should prepare for a pandemic.

Speaking from a humanitarian forum in Saudi Arabia, Tedros Adhanom Ghebreyesus told CNBC that global markets “should calm down and try to see the reality.” He urged everyone to not be irrational and to deal with facts.

“Based on the facts on the ground, containment is possible,” Tedros said, reiterating that “panic and fear” were the real enemies. The past week registered some of the worst global stock market results since the 2008 financial crisis, including a 12 percent drop in the Dow Jones industrial average.

Tedros has repeatedly praised China’s response to the virus and initially backed its assessment that the virus was under control – before it eventually spread to 60 countries and infected about 85,000 people.

The WHO chief has increasingly been striking a sober note about the spread of the virus, warning that developing nations, especially those in Africa with underdeveloped health sectors, could be badly hit. “The window of opportunity for containing it is narrowing. So we need to be preparing side by side for a pandemic,” he said.

Nike shuttered its enormous campus in Beaverton, Oregon, over the weekend after confirmation of presumptive coronavirus in Washington County.

“While we have no information indicating any exposure to Nike employees, out of an abundance of caution, we are conducting a deep cleaning of campus,” Nike said in a statement, according to local media. “All (world headquarter) buildings and facilities, including fitness centers, will be closed over the weekend.”

An employee of Forest Hills Elementary School in nearby Lake Oswego tested positive for coronavirus, which precipitated the decision by Nike, the company said.

The weekend closure is significant given the size and use of Nike’s world headquarters, which operates like a small town for its 12,000 employees. Staffers traverse miles of running trails, eat at restaurants and use child development centers on-site.

It is unclear whether other companies on the West Coast will follow suit and shut down to rid their facilities of virus remnants. Forest Hills Elementary will reopen Wednesday after an in-depth scrubbing.

The first presumptive positive case of coronavirus in Rhode Island was announced by the state’s Department of Health on Sunday.

The person is in their 40s and had traveled to Italy in mid-February, according to a statement sent to The Washington Post. The patient is being treated in a hospital.

The person had limited travel in Rhode Island since returning from Italy and had not returned to work since being abroad, according to the health department.

Other people who were in direct contact with the patient are quarantined and self-monitoring for symptoms for 14 days. Since the person’s symptoms first emerged, his or her family had been self-quarantined.

Presumptive positive cases must still be confirmed by the Centers for Disease Control and Prevention, but Rhode Island said that “might change in the coming days,” the statement said.

Rhode Island had expedited the final steps of implementation to run the test that identified this case, the state’s public health officials said.

“We fully anticipated having a first case of COVID-19,” Director of Health Nicole Alexander-Scott said in a statement. “We are not seeing widespread community transmission in Rhode Island, and the general level of risk for Rhode Islanders is still low. However, everyone in Rhode Island has a role to play in helping us prevent the spread of viruses, just like the flu.”

Governments across Europe were pushing ahead with plans to contain or slow down the spread of the coronavirus on Sunday, with British Health Secretary Matt Hancock and Germany’s Interior Minister Horst Seehofer both refusing to rule out more extreme measures.

Hancock told the BBC that no measures were “off the table.”

Among discussed measures, said Hancock, were road closures or a plea to recently-retired nurses and doctors to return to work.

Putting entire cities with large outbreaks under lockdown, said Hancock, would pose “a huge economic and social downside,” but he added that “we don’t take anything off the table at this stage.”

Germany’s interior minister similarly indicated that lockdowns could be considered, even though they “would be the last resort,” according to the Bild am Sonntag newspaper.

France on Saturday banned all public interior gatherings with over 5,000 individuals as well as some outside events, forcing the cancellation of numerous upcoming conferences and races, including a half marathon that was supposed to take place in Paris on Sunday.

As staff at the Louvre museum assembled for a coronavirus response meeting in Paris on Sunday, the museum temporarily shut its doors to visitors. It was expected to reopen later on, Reuters reported.

Iran announced another spike in coronavirus infections on Sunday with a total of 978 cases in the country, up from just under 600, and a rise in deaths to 54.

Iran has experienced one of the most rapid growths in the covid-19 disease, with no confirmed cases just 10 days ago and now by far most in the entire Middle East. The number of cases have been jumping by hundreds a day – including even the deputy health minister.

Health Ministry spokesman Kianoush Jahanpour said the cases were mostly concentrated in the city of Tehran and the holy city of Qom, a pilgrimage center, where it was first discovered.

Authorities are struggling to contain the rapid spread of the virus and have ordered all hospitals to admit virus patients and have expanded the number of facilities to carry out testing – which could also be behind the discovery of hundreds of new cases. There have also been efforts to disinfect and fumigate public places.

Iran’s foundation for veterans asked those suffering from the long term effects of exposure to chemical weapons to stay at home. Many Iranians were exposed to poisoned gas during the war with Iraq during the 1980s, which resulted in long-term health conditions.

While rarely fatal, the coronavirus is especially dangerous to the elderly and those with pre-existing respiratory conditions.

Cases from Iran have now been traced to several nearby countries, including Bahrain, Iraq, Kuwait, Lebanon and Oman, prompting several countries to halt flights.

As the number of coronavirus cases in Germany surged on Sunday, German Finance Minister Olaf Scholz suggested the possibility of an economic stimulus package “in case the situation demands it.”

Authorities confirmed 117 cases on Sunday, up from 53 on Friday morning. Most cases were reported in North Rhine-Westphalia, the country’s most populous federal state.

Speaking to the Welt am Sonntag newspaper, Scholz, who is also German vice chancellor, said the country was well prepared for the economic fallout of a wider outbreak, even as analysts warned it could slash growth significantly.

The European Union’s biggest economy is still recovering from a number of recent setbacks, including a weakening economic outlook partially due to Trump’s trade disputes with China and other countries that hit the export-dependent German economy.

Sunday’s suggestion of a stimulus package in Germany came as a top Italian official vowed billions of dollars to help country’s embattled economy, even though it remained unclear how or when that funding would become available.

German officials have said they believe the virus is likely to become an epidemic in the country. There are still far less confirmed cases in Germany than in virus-stricken Italy, where the case tally has crossed the 1,000 threshold. But Germany now has more cases than other major European nations, including France, where more than 100 infections were confirmed Sunday, and Spain with over 70 cases.

German authorities hope new measures could slow down the spreading of the virus.

A major travel trade show in Berlin, ITB, which was set to begin next week, was abruptly canceled. Airlines are now required to report the health status of all travelers from South Korea, Japan, Italy, China and Iran. Some companies have asked their employees to work from home until further notice.

The extent of China’s industrial shutdown in the midst of the coronavirus outbreak is clearly visible from the sky, with NASA and European Space Agency satellites showing pollution almost completely disappearing over China this month.

The images, comparing the periods of Jan. 1-20 and Feb. 10-25, show an astonishing drop in concentrations of nitrogen dioxide, a noxious gas emitted by motor vehicles, power plants, and industrial facilities.

Businesses were already closing down ahead of the Lunar New Year holiday, which officially began Jan. 24, when Chinese authorities began shutting down cities – starting with Wuhan, the epicenter of the outbreak – on Jan. 23.

The reduction in nitrogen dioxide pollution was first apparent near Wuhan, but soon spread across the country with the lockdowns.

“This is the first time I have seen such a dramatic drop-off over such a wide area for a specific event,” Fei Liu, an air quality researcher at NASA’s Goddard Space Flight Center, said in a statement.

The drop was much faster and much more enduring than during other periods of slowdown, like the 2008 economic recession and the Beijing Olympics in 2008, Liu said.

While lower emissions are expected during the holiday, when most businesses close for at least a week, it usually returns soon after. This year, it has not.

“This year, the reduction rate is more significant than in past years and it has lasted longer,” she said. “I am not surprised because many cities nationwide have taken measures to minimize spread of the virus.”

A massively scaled-back Tokyo marathon was held on Sunday on often empty streets, with spectators discouraged, viewing stands dismantled and only a few hundred elite runners allowed to take part.

Meanwhile, Japan’s spring sumo tournament in the western city of Osaka will be held in an empty area, the event’s organizers announced on Sunday. The Japan Sumo Association had been considering canceling the event outright but decided instead to go ahead without spectators, Japanese media reported.

The news underlines the sort of dilemmas that the International Olympic Committee may ultimately have to face over the Summer Games in Tokyo if the virus continues to spread.

Japan’s soccer and rugby leagues have postponed games in March, while two preseason baseball games involving the Yomiuri Giants were played in an empty Tokyo Dome this weekend, after the government asked organizers of mass events to postpone, cancel or scale them back.

Japan has confirmed 242 cases of the new coronavirus, including 14 people who were evacuated from China, but not including more than 700 cases among passengers and crew of the Diamond Princess. In all, 11 people have died, and 56 are in serious condition, according to a tally by public broadcaster NHK.

Ethiopia’s Birhanu Legese won the Tokyo Marathon for the second year in a row.

Members of a religious sect linked to a coronavirus cluster in South Korea visited the Chinese city of Wuhan, the epicenter of the virus outbreak, according to the Korea Centers for Disease Control and Prevention.

More than half of South Korea’s 3,526 coronavirus cases are linked to a branch of Shincheonji Church of Jesus in southern city of Daegu. After authorities identified the church as a hotbed of the coronavirus, Christian churches and Buddhist temples across the country called off meetings and held services online.

KCDC Vice Director Kwon Jun-wook told a briefing on Sunday that members of the church visited Wuhan in January. Kwon said it was unclear how many members traveled to Wuhan and the role of the trip in the outbreak at the South Korean church.

South China Morning Post, citing unnamed sources, reported last weekend that members of the church held meetings in Wuhan until December. Shincheonji said in a statement last month that its branch in Wuhan had been closed several years ago.

South Korean health authorities rolled out a plan to test more than 200,000 members of Shincheonji Church of Jesus, formally known as the Temple of the Tabernacle of the Testimony.

The church said on Sunday that its leader Lee Man-hee will be tested for the virus. Lee, who founded the church in 1984, is equated with second coming of Jesus by his followers.

The United Arab Emirates closed all children’s nurseries for two weeks starting Sunday as part of a raft of new measures to combat the spread of the coronavirus in this Middle East travel hub.

In a news conference on Saturday, Minister of Health Abdul Rahman Al Owais said there were now 21 cases of the virus in the country, including two Italian team members with the UAE Tour who came into contact with 612 people, all of whom are being tested. So far five of those infected with the virus have fully recovered.

The UAE tour has been canceled and 181 students involved in the biking event are being quarantined at home for 14 days.

The minister also said that two aircraft are being readied to evacuate UAE nationals from the Iranian capital of Tehran and the resort island of Qeshm. There have been an explosion of the virus in Iran, just across the Persian Gulf from the UAE, with more than 40 deaths out of nearly 600 cases.

The Education Ministry has also ordered all private schools to cancel field trips and any competitions or festivals involving multiple schools. There are currently no confirmed cases of the virus in the school system.

A fake tweet purporting to be from the education department saying all schools were closed Sunday was vigorously denied and condemned by the government. Reports of a case in a residential compound in the capital Abu Dhabi were also denied.

UAE, which is a travel hub and home to two major international airlines, Emirates and Ettihad, was the first Middle Eastern country to report cases of the virus – a tourist from China.

A 35-year-old Thai man has died of causes related to the coronavirus, becoming Thailand’s first fatality in the outbreak, the country’s health officials said Sunday.

The man, a retail worker, contracted dengue fever and the coronavirus at the same time and had been hospitalized for weeks, Thai health officials said at a briefing, according to Bloomberg.

He tested negative in mid-February, but “the damage was already done to his body,” said Tawee Chotpitayasunondh, adviser to the Department of Disease Control.

Thailand had more than 40 confirmed covid-19 cases as of Sunday.

Armenian authorities Sunday announced the first case of coronavirus in the former Soviet country.

The patient is a 29-year-old Armenian man who Friday returned from Iran with this wife, Armenian Prime Minister Nikol Pashinyan posted on Facebook.

Cases in other former Soviet countries close to Iran, Georgia and Azerbaijan, have also discovered cases in recent days related to the Iranian outbreak of the illness.

As of February 29, 41 Covid-19 cases had been diagnosed in Thailand. No deaths have been reported. Signs and symptoms of Covid-19 include fever, cough and shortness of breath. Preliminary data suggest that older adults and persons with underlying health conditions or compromised immune systems might be at greater risk for severe illness from the virus.

Certainly the best way to prevent the infection is to avoid getting the virus in the first place. However, there is evidence that moderate exercise, adequate sleep and a healthy diet can enhance our immune system and consequently help to reduce the risk of getting the viral infection.

One practical thing we can do to protect ourselves is getting adequate sleep because lack of sleep will weaken our immune system. That’s because the growth hormone, which has tremendous effects on immunity, is normally released during the first period of Stage 3 sleep. Stage 3 sleep, also known as deep sleep, occurs about an hour after you first fall asleep. As such, simply not getting enough sleep may decrease growth hormone secretion. According to the US Centres for Disease Control and Prevention, an adult should sleep 7-9 hours a night.

Sleep and exercise are inextricably linked with each other. Exercise routinely, but finishing it at least one hour before bedtime may enhance the quality of your sleep and offer additional immune system benefits.

Adopting a good and balanced diet high in fruits and vegetables can also boost our immune system as they are sources of vitamins and minerals.

Other tips include sitting or walking in the early morning sun for 10 minutes. Here’s why: The precursors of Vitamin D — that is, molecules that produce the vitamin present in our skin — are activated by the sun, and vitamin D can also boost the immune system.

Besides strengthening our immunity, hygiene habits such as frequent washing of hands with soap and water, or an alcohol hand rub, eating food promptly and using a serving spoon should be maintained during the pandemic period. Regarding smoking, scientists doubt that it increases the risk of people with Covid-19 because China has not reported if any of the infected people were smokers, but previous studies have shown that smoking increases the risk of being hospitalised if you get the flu. Now is a great time to develop healthy habits.

In Thailand, it is recommended to wear a proper face mask in public to protect yourself from viruses, but it isn’t foolproof. Keep a distance from sick people, especially those coughing or sneezing. Also, avoid touching your face with your hands to minimise your exposure to harmful germs. Lastly, if in doubt seek medical attention.

(Dr Thanisorn Thamlikitkul is associated with Romrawin Clinic)

WHO officials said in a Friday briefing that declaring a pandemic would be tantamount to throwing in the towel on containing the virus and signaling to governments that they should focus instead on mitigating its effects. WHO officials said they want countries to pursue containment and mitigation simultaneously, which is the main reason they are not declaring a pandemic.

“To accept that mitigation is the only option is to accept that the virus cannot be stopped,” said Michael Ryan, WHO director for health emergencies. “And we’ve seen evidence from China that this virus can be significantly curbed in its spread if robust measures are taken.”

As the virus has spread from China to Europe and the Middle East and beyond, there are clear instances where containment has failed. But WHO officials said there are also examples where containment has succeeded and they don’t want countries to stop trying. They pointed to countries such as China and Singapore, where new cases have declined, and other countries that detected only one or two cases and have not reported any since.

Public health officials define containment as steps to interrupt transmission, like tracing patient contacts, isolation and quarantine. Mitigation is when you accept that you cannot prevent the virus from spreading, and instead focus on treating patients, vaccines and reducing the strain on health systems and society.

WHO officials said that even if containment efforts in some places fail, they are slowing down the virus and giving countries much-needed time to prepare.

Fears that a coronavirus pandemic could tip the world economy into recession sent global stocks into a tailspin, with markets on track for their worst week since the financial crisis that began in 2008.

The Dow Jones industrial average plunged 1,000 points in the morning, swinging widely throughout the session. It closed down 357 points, or 1.4%. The Standard & Poor’s 500 index shed 0.8% while the Nasdaq rallied to end flat.The 10-year Treasury yield, a key marker in global finance, also hit a record low Friday, a sign that investors are fleeing equities for the safety of bonds. The Cboe Volatility Index, known as the VIX, surged to its highest level since the Great Recession, signalling to investors that more volatility is ahead.

While there were indications that the outbreak may be slowing in China, France and Germany reported upticks in infections and South Korea’s tally surpassed 2,300, as more events were canceled and airlines said they would cut flights. In Japan, officials declared a state of emergency on the northern island of Hokkaido and told residents to stay indoors as the country reported its 10th death from covid-19, as the disease caused by the virus is known.

Investors have watched the outbreak with increasing concern. U.S. oil futures slipped again Friday, raising expectations that officials from oil-exporting nations will cut output after they meet next week.

Here are the latest developments:

– Stocks in Europe and Asia tanked as the specter of prolonged economic disruption haunted investors. Swiss authorities on Friday banned all events with more than 1,000 participants until mid-March, forcing the cancellation of the Geneva International Motor Show, which was scheduled to open next week.

– Japan’s Hokkaido island – where Olympic marathons are due to take place this summer – declared a state of emergency. Olympic organizers indicated that they would announce plans next week to scale back the torch relay.

– An Italian man diagnosed with the virus in Nigeria marks the first confirmed instance of the virus in sub-Saharan Africa.

– Far more coronavirus cases appeared likely to be confirmed outside China, where the crisis originated, than within it. China announced 327 new cases and 44 deaths. South Korea announced 571 new cases Friday, bringing its total to 2,337, while France and Germany confirmed new infections.

Also Friday, President Donald Trump tweeted that the virus was spreading “very slowly in the U.S.” and suggested that his political opponents were blaming him for the outbreak. His remarks came after a whistleblower alleged that the U.S. government sent workers without proper training for infection control or appropriate protective gear to greet evacuees from Wuhan, China.

Acting White House chief of staff Mick Mulvaney sought to downplay the threat of the coronavirus to the United States but acknowledged it could lead to school closures and other disruptions. He made the comments during an appearance in which he also accused the media of hyping coverage to “bring down the president.”

“Is it real? It absolutely is real,” Mulvaney said at the annual Conservative Political Action Conference outside Washington. “But you saw the president the other day — the flu is real. . . . Are you going to see some schools shut down? Probably. May you see impacts on public transportation? Sure. We know how to handle this.”

Mulvaney also accused the media of ignoring the administration’s early planning efforts because they were focused on Trump’s impeachment trial.

“We took extraordinary steps four or five weeks ago. Why didn’t we hear about it? What was going on four or five weeks ago? Impeachment,” Mulvaney said. “And that’s all the press wanted to talk about. So while real news was happening . . . we were dealing with it in a way, I think, that you would be extraordinarily proud of.”

He said the media covered the impeachment process intently because “they thought . . . it would bring down the president.”

“The reason they are paying so much attention to [the coronavirus] today is that they think this is going to bring down the president. That’s what this is all about,” Mulvaney added.

He said a reporter emailed him to ask what the president planned to do to “calm the markets.”

“Turn off your televisions for 24 hours,” Mulvaney said.

Lawmakers and aides said Friday they intend to work through the weekend to get agreement on an emergency spending bill to fight the coronavirus. A vote in the House could come as soon as next week.

“We need to move as quickly as possible,” said Rep. Rosa L. DeLauro, D-Conn., a senior member of the House Appropriations Committee.

Negotiators are circling around a $6 billion to $8 billion commitment, with some officials involved saying they anticipate ending up at the higher end of that range. The final figure will dwarf the $2.5 billion spending plan the White House proposed earlier this week. Also, the White House plan included only $1.25 billion in new funding, while taking more than $500 million from an Ebola response fund and other sums from the National Institutes of Health and elsewhere. The congressional spending bill is expected to be all new money.

“We’re not going to take money from Ebola, we’re not going to take money from NIH and other places for an emergency supplemental,” DeLauro said. The bulk of the spending will be directed to the Health and Human Services Department, which houses NIH and the Centers for Disease Control and Prevention. DeLauro cited a litany of needs, including vaccine development, test kits, and reimbursement to state and local governments.

White House legislative affairs director Eric Ueland told reporters Friday, “We’ve got great interaction with folks here on the Hill, and we’re hopeful they can land a pretty good and responsible package by early next week.”

U.S. officials raced to meet the daunting new challenge of a virus that could be spreading through a Northern California community, even as the covid-19 virus continued its relentless march around the globe. Stock markets continued to plunge, Japan initiated a weeks-long school closure and an Iranian lawmaker contracted the infection. From the Middle East to South Korea to parts of Europe, the number of deaths and infections continued to grow.

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In Washington, Vice President Mike Pence convened his first meeting as the new head of the task force battling the virus. On the other side of the country, California Gov. Gavin Newsom, a Democrat, and state health officials sought to reassure jittery residents that public health officials would be able to handle the first U.S. case of community transmission.

Projecting an air of calm during a moment of rising anxiety over the outbreak, Newsom repeatedly told reporters that methods of tracing a Solano County woman’s contacts have been honed in response to other public health crises, from tuberculosis to the swine flu.

“This is not our first great challenge as it relates to public health,” Newsom said. “Quite the contrary. These protocols have been perfected.”

Federal officials have faced fierce criticism for overly narrow criteria about who should be tested and for shipping coronavirus test kits to public health labs that included a component that in most cases did not work correctly.

But on Thursday, the Centers for Disease Control and Prevention expanded the federal guidelines for testing to include people who have unexplained severe respiratory symptoms and people with symptoms who have recently traveled to Iran, Italy, Japan and South Korea as well as China.

Federal health officials also are moving to try to correct the problems with the test kits. Scott Becker, executive director of the Association of Public Health Laboratories, said that although only eight public health labs are able to run the tests, federal officials have approved a procedural change that may allow about 40 more labs to come online very shortly.

New tests are expected to be sent out to labs next week. That should result in all 100 public health labs across the country being able to run tests by the end of two weeks.

Newsom and state health officials acknowledged the Solano County woman was in the community and showing symptoms of the disease before she was admitted to a hospital here Feb. 15. That is a worrisome prospect because the virus is highly transmissible, especially when someone with the disease has its flulike symptoms. Officials did not share any details about the woman’s family, work or social contacts, citing patient privacy, and declined to say how many people she came in contact with.

At the same time, experts reminded the public that, in other parts of the world at least, most cases of the virus are mild. To date, the coronavirus has killed 2,801 people and sickened more than 82,000, the vast majority of them in China. The United States has seen 60 cases, none fatal, and most of them among people who caught the virus while quarantined on a cruise ship off Japan.

Nevertheless, the CDC warned Americans on Tuesday that community spread is almost certain and that they should prepare for the possibility of significant disruption in their daily lives.

“This virus has adapted extremely well to the human species,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a key member of the coronavirus task force. “This one has the capability of spreading readily from human to human.”

Solano County, where the new case emerged, is home to Travis Air Force Base, where hundreds of Americans repatriated from China and from the Diamond Princess cruise ship have been quarantined. Officials have said the woman had no known contacts with people quarantined on the base.

Newsom said the CDC was sending 10 staffers to aid state and local personnel in tracing the woman’s contacts.

Mark Ghaly, secretary of the California Health and Human Services Agency, described a “robust and first-class reaching out to . . . many, many individuals in all walks of this person’s life.” That includes the people who cared for her at NorthBay VacaValley Hospital here, some of whom have been put on paid leave and are isolated at home monitoring themselves for symptoms, according to Aimee Brewer, president of NorthBay Healthcare, which owns the hospital.

The Solano County woman wasn’t tested for the disease for four days, despite an immediate request to the CDC, because she did not meet the strict criteria for the test, according UC-Davis Medical Center, where she is being treated after spending four days at the community hospital in Vacaville.

The CDC has not responded to that assertion. But federal health officials have said clinicians always have discretion to order the test for people who do not meet the criteria.

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The patient brought herself to NorthBay VacaValley Hospital, a 50-bed community hospital in Vacaville, California, with flulike symptoms on Feb. 15.

Staff members at that hospital questioned the woman about travel and contacts under CDC guidelines, but she did not meet the criteria for someone who should be tested for the virus, because she had not recently traveled to China or had contact with someone who is a confirmed case, according to Brewer.

The hospital is “meticulously tracing” anyone who may have come into contact with the woman there, and monitoring scores of staff members who may have been exposed,” Brewer said in a statement. She added that staffers who had direct contact with the patient have been tested for the virus and are on paid leave, tracking their health at home. So far, there have been no positive tests, she said.

Brewer said in an interview that the woman had a private room, and “we believe strongly that our patients are protected.”

The hospital was going through “records and security footage to make sure we know every person who has been in contact with the patient to determine if they are a low, medium or high risk,” she said. “We did that last night and are finishing it up today.”

Staff at NorthBay inserted a tube in the woman’s lungs to help her breathe, a procedure experts say increases risk of exposure to the virus because it can aerosolize respiratory droplets, according to a person briefed on the case.

When the woman’s health continued to decline, Brewer said, she was transferred to UC-Davis Medical Center in Sacramento, which has more capacity and expertise with pulmonary patients. UC-Davis officials said she arrived there on Feb. 19.

“Contact tracing,” or finding people the woman has come in contact with, “sounds simple,” but “is really a resource-intensive effort, even with a single case” said Thomas Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

“They are going to be working to identify everyone who spent substantial time in close contact – within six feet – during the time the person could have been incubating the virus. Family is fairly straightforward, then close co-workers, but there may have been contacts” that are more difficult for public health workers to track down.

“Standing in line quite briefly next to a person would probably be considered low risk, but sitting next to someone in church for a half-hour might be high risk,” he said.

A pair of colleges in nearby Sacramento said they have sent home two students – one from each school – who came into contact with the infected woman. The students at American River College and Cosumnes River College were exposed during their work as health-care providers.

Like other health-care workers who have had contact with the patient, the students have been asked by county health officials to isolate themselves for 14 days and monitor for symptoms.

Neither school is asking other students to stay home, and classes are continuing as scheduled.

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On Thursday afternoon, UC Davis announced that three students who lived in its Kearney Hall dormitory were in insolation and being monitored for symptoms of coronavirus. One of the three was getting a covid-19 test from the CDC, while the other two had shown no symptoms and would not be tested, per current CDC guidelines. The dorm is located on the main UC Davis campus in Davis, Calif., about 19 miles west of the UC Davis Medical Center.

The university did not say how or where the students were exposed to the virus or where they were staying while in isolation, because they were no longer in their campus housing. The university said it plans to increase daily sanitation procedures in Kearney Hall. No UC Davis classes are being canceled at this time.

UC Davis Medical Center officials sent an email to employees Wednesday that said the woman arrived at the medical center Feb. 19 but was not tested until Sunday because she did not meet the criteria.

“When the patient arrived, the patient had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by David Lubarsky, vice chancellor of human health sciences, and Brad Simmons, interim chief executive of UC Davis Health. “Since the patient arrived with a suspected viral infection, our care teams have been taking the proper infection prevention (contact droplet) precautions during the patient’s stay.”

UC Davis asked the CDC to conduct a test for the virus because local and state labs were not doing so. “Since the patient did not fit the existing CDC criteria for covid-19, a test was not immediately administered. UC Davis Health does not control the testing process,” they wrote.

The CDC ordered a test Sunday and additional precautions were taken, they wrote. The agency confirmed the positive test Wednesday.