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Covid-19: Trump extends physical distancing to 30 April, as cases climb in New York

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1289 (Published 30 March 2020) Cite this as: BMJ 2020;368:m1289

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  1. Janice Hopkins Tanne
  1. New York

President Donald Trump has extended physical distancing guidelines for the US to 30 April, reversing his earlier call for them to end on 30 March and for the nation to “get back to business” by Easter (12 April). He said that that had been “an aspirational goal.”

Trump said that on 31 March he would present a plan for the future approach to the epidemic in the US.

Trump predicted that the peak of US deaths would occur in about two weeks and that by 1 June the nation would be well on the way to recovery. He has apparently abandoned his plan to rank the nation’s 3007 counties as being at low, medium, or high risk and to permit some to reopen soon for business.

The US had 143 055 cases of covid-19, with 2489 deaths, as at the morning of 30 March. New York City has about 56% of newly reported cases of covid-19, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The city had 59 662 cases, with 776 deaths.1 There were many other cases in the city’s suburbs and in the neighbouring states of New Jersey and Connecticut.

Besides the hot spots in Seattle (Washington state) and Los Angeles, new hot spots are emerging in New Orleans, Detroit, Chicago, and several southern states.

The Centers for Disease Control and Prevention issued a travel advisory asking residents of New York, New Jersey, and Connecticut to avoid domestic travel for the next 14 days.2 The CDC’s advisory came after Trump had suggested quarantining the three states.

Fauci said that, on the basis of statistical models and without mitigating the virus’s impact by physical distancing, the US would have faced between 1.6 million and 2.2 million deaths from covid-19. With mitigating efforts, he said the nation faced 100 000 to 200 000 deaths.

Those numbers, which Fauci and Deborah Birx, the White House coronavirus coordinator, discussed with Trump before the press briefing, apparently convinced the president to dramatically change his approach. Birx said that they had brought scientific evidence to the president to save lives and protect healthcare providers.

In his press briefing the president announced that the Food and Drug Administration had approved a 15 minute covid-19 test from Abbott Laboratories. He also said that two major health insurance companies, Humana and Cigna, had waived copayments and deductibles that insured people must pay for testing and treatment of covid-19.

Trump announced that a 2900 bed hospital had been set up in a New York convention centre, that a fully staffed hospital ship with about 100 beds would arrive in New York within days, and that the experimental treatment of hydroxychloroquine and azithromycin was being used, as was convalescent plasma. He also said that General Motors would be making ventilators and described approaches to re-sterilize used masks and a new self-test swab that individuals could use, without the need for healthcare workers in personal protective equipment.

Last week the New York Times described an “apocalyptic” surge in covid-19 patients at Elmhurst Hospital in the borough of Queens, which serves a largely immigrant and poor population.3 It also reported that at Jacobi Medical Center, in the Bronx, obstetrician-gynaecologists and radiologists had been called to work in the emergency department. A nurse at Mount Sinai Medical Center in Manhattan died from covid-19, and some employees posted photos on social media showing nurses using trash bags as protective equipment. New York-Presbyterian Hospital has modified its ventilators so that one machine can serve two patients.

Charitable organisations have set up tents in New York’s Central Park to take overflow patients from nearby Mount Sinai Medical Center.

Trump raised questions about hoarding and asked why an unnamed New York hospital was using about 10 times more masks than previously. He asked New York’s governor, Andrew Cuomo, and New York City mayor, Bill de Blasio, to look into it. He also questioned states’ urgent requests for more ventilators.

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