Europe faces ICU crunch, rushes to build field hospitals

April 01, 2020

ROME (AP) — Facing intense surges in the need for hospital ICU beds, European nations are on a building and hiring spree, throwing together makeshift hospitals and shipping coronavirus patients out of overwhelmed cities via high-speed trains and military jets. The key question is whether they will be able to find enough healthy medical staff to make it all work.

Even as the virus has slowed its growth in overwhelmed Italy and in China, where it first emerged, hospitals in Spain and France are reaching their breaking points and the U.S. and Britain are bracing for incoming waves of desperately ill people.

"It feels like we are in a third world country. We don't have enough masks, enough protective equipment, and by the end of the week we might be in need of more medication too,” said Paris emergency worker Christophe Prudhomme.

In a remarkable turnaround, rich economies where virus cases have exploded are welcoming help from less wealthy ones. Russia sent medical equipment and masks to the U.S. on Wednesday. Cuba sent doctors to France. Turkey sent masks, hazmat suits, goggles and disinfectants to Italy and Spain.

London is just days from unveiling a 4,000-bed temporary hospital built in a massive convention center to take non-critical patients so British hospitals can keep ahead of an expected surge in demand. Still, there are concerns about finding thousands of medical workers to run it.

Spain, which hit a new record Wednesday of 864 deaths in one day, has boosted its hospital beds by 20%. Hotspots in Madrid and northeast Catalonia have almost tripled their ICU capacity. Dozens of hotels across Spain have been turned into recovery rooms, and authorities are building field hospitals in sports centers, libraries and exhibition halls.

Intensive care units are particularly crucial in a pandemic in which tens of thousands of patients descend into acute respiratory distress. Those ICU units are much harder to cobble together quickly than standard hospital beds.

Milan opened an intensive care field hospital Tuesday at the city fairgrounds, complete with a pharmacy and radiology wards. It expects to eventually employ 900 staff. The move came after the health situation turned extreme in Italy's Lombardy region, where bodies overflowed in morgues, caskets piled up in churches and doctors were forced to decide which desperately ill patient would get a breathing machine.

“We aren’t happy to have done this,” fairgrounds foundation head Enrico Pazzali said. “It's something I never would have wanted to do.” The pressure is easing on hard-hit Italian cities like Bergamo and Brescia as the rate of new infections in Italy slows. Yet many Italians are still dying at home or in nursing homes because hospitals are saturated and they could not get access to ICU breathing machines.

With over 12,400 dead so far, Italy has the most coronavirus deaths of any nation. Italy, Britain and France are among countries that have called in medical students, retired doctors and even laid-off flight attendants with first aid training to help, although all need re-training.

The medical staffing shortage has been exacerbated by the high numbers of infected personnel. In Italy alone, nearly 10,000 medical workers have been infected and more than 60 doctors have died. While Spain's confirmed infections shot past 102,000 Wednesday and its deaths are now beyond 9,000, the increase in infections was less than the previous day, offering some hope that the contagion rate is stabilizing.

Still, COVID-19 patients who need intensive care can occupy a bed for three to four weeks, meaning Spain and other nations will still see increasing pressures on their hospitals for days or weeks to come.

The Paris region more than doubled its ICU capacity over the past week – but the beds are already full. So Paris was sending critically ill patients to less-saturated regions on special high-speed trains Wednesday. Others have been moved by military planes, helicopters or warships.

One reason Germany is in better shape than other European countries is its high proportion of ICU beds, at 33.9 per 100,000 people, compared to 8.6 in Italy. Germany has 775 virus deaths, 16 times fewer deaths than Italy.

Britain still has some free ICU beds available, but the outbreak is likely weeks away from its peak there and the U.K. has one of the lowest number of hospital beds per capita in Europe. The new hospital inside London’s Excel center plans to admit its first patients at the end of this week. Chief operating officer Natalie Forrest warned that it will need thousands of doctors, nurses and volunteers.

“The numbers are scary,” she said. For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with existing health problems, it can cause severe symptoms like pneumonia and lead to death.

U.S. health authorities warned the number of dead could reach up to 240,000 even with social distancing measures in place as the New York region also rushed to set up extra hospital capacity. A 1,000-bed emergency hospital at the mammoth Javits Convention Center began taking non-coronavirus patients on Tuesday to help relieve the city's overwhelmed health system. A Navy hospital ship was expected to accept patients soon, and the indoor tennis center that hosts the U.S. Open is being turned into a hospital.

“I want every American to be prepared for the hard days that lie ahead,” President Donald Trump said Tuesday after he extended social distancing guidelines until April 30. “We're going to go through a very tough two weeks.”

The U.S. recorded a big daily jump of 26,000 new cases, bringing its total infections to more than 189,000, the highest in the world. The U.S. death toll leapt to over 4,000, and refrigerated morgue trucks parked on New York streets to collect the dead.

Worldwide, more than 860,000 people have been confirmed infected and over 42,000 have died, according to a tally kept by Johns Hopkins University. Italy and Spain accounted for half of all the deaths. Everywhere, the real figures are believed to be much higher due to issues in counting infections and deaths.

China, where the outbreak began late last year, on Wednesday reported just 36 new COVID-19 cases. Some people have chosen to ignore social distancing guidelines. In Louisiana, buses and cars filled a church parking lot Tuesday as worshippers flocked to hear a pastor who is facing charges for holding services despite a ban on gatherings. A few protesters also showed up at the Life Tabernacle Church, including one with a sign that read: “God don't like stupid."

Two ships carrying passengers and crew from an ill-fated South American cruise are urging Florida officials to let them dock. Four people aboard with the virus have died and nine have tested positive. Trump said, for humanitarian reasons, Florida should do so.

Charlton reported from Paris. Associated Press writers around the world contributed to this report including Joseph Wilson in Barcelona; Danica Kirka and Jill Lawless in London; Karen Matthews in New York; and Nick Perry in Wellington, New Zealand.

Europe's hospitals among the best but can't handle pandemic

March 31, 2020

LONDON (AP) — As increasing numbers of European hospitals buckle under the strain of tens of thousands of coronavirus patients, the crisis has exposed a surprising paradox: Some of the world’s best health systems are remarkably ill-equipped to handle a pandemic.

Outbreak experts say Europe’s hospital-centric systems, lack of epidemic experience and early complacency are partly to blame for the pandemic’s catastrophic tear across the continent. “If you have cancer, you want to be in a European hospital,” said Brice de le Vingne, who heads COVID-19 operations for Doctors Without Borders in Belgium. “But Europe hasn’t had a major outbreak in more than 100 years, and now they don’t know what to do.”

Last week, the World Health Organization scolded countries for “squandering” their chance to stop the virus from gaining a foothold, saying that countries should have reacted more aggressively two months ago, including implementing wider testing and stronger surveillance measures.

De le Vingne and others say Europe’s approach to combating the new coronavirus was initially too lax and severely lacking in epidemiological basics like contact tracing, an arduous process where health officials physically track down people who have come into contact with those infected to monitor how and where the virus is spreading.

During outbreaks of Ebola, including Congo’s most recent one, officials released daily figures for how many contacts were followed, even in remote villages paralyzed by armed attacks. After the new coronavirus emerged late last year, China dispatched a team of about 9,000 health workers to chase thousands of potential contacts in Wuhan every day.

But in Italy, officials in some cases have left it up to ill patients to inform their potential contacts that they had tested positive and resorted to mere daily phone calls to check in on them. Spain and Britain have both declined to say how many health workers were working on contact tracing or how many contacts were identified at any stage in the outbreak.

“We are really good at contact tracing in the U.K., but the problem is we didn’t do enough of it,” said Dr. Bharat Pankhania, an infectious diseases physician at the University of Exeter in southwestern England.

As cases began picking up speed in the U.K. in early March, Pankhania and others desperately pleaded for call centers to be transformed into contact tracing hubs. That never happened, in what Pankhania calls “a lost opportunity.”

Pankhania added that while Britain has significant expertise in treating critical care patients with respiratory problems, like severe pneumonia, there are simply too few hospital beds to cope with the exponential surge of patients during a pandemic.

“We are already running at full capacity, and then on top of that we have the arrival of the coronavirus at a time when we’re fully stressed and there isn’t any give in the system,” he said, noting years of reductions in bed capacity within Britain’s National Health Service.

Elsewhere, the fact that health care workers and hospital systems have little experience with rationing care because European hospitals are generally so well resourced is now proving problematic. “Part of the issue is that Italian doctors are getting very distressed to make decisions about which patients can get the ICU bed because normally they can just push them through,” said Robert Dingwall, of Nottingham Trent University, who has studied health systems across Europe. “Not having the triage experience to do that in a pandemic situation is very overwhelming.”

In a departure from their normal role as donors who fund outbreak responses in poorer countries, countries including Italy, France and Spain are all now on the receiving end of emergency aid. But Dr. Chiara Lepora, who heads Doctors Without Borders' efforts in the hot spot of Lodi in northern Italy, said the pandemic had revealed some critical problems in developed countries.

“Outbreaks cannot be fought in hospitals,” she said. “Hospitals can only deal with the consequences.” Doctors in Bergamo, the epicenter of Italy's outbreak, described the new coronavirus as “the Ebola of the rich” in an article in the journal NEJM Catalyst Innovations in Care Delivery, warning that health systems in the West are at risk of being as overrun by COVID-19 as West African hospitals were in the devastating 2014-2016 Ebola outbreak.

“Western health systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward community-centered care,” they wrote. That model of community care is more typically seen in countries in Africa or parts of Asia, where hospitals are reserved for only the very sickest patients and far more patients are isolated or treated in stripped-down facilities — similar to the field hospitals now being hastily constructed across Europe.

Even Europe's typically strong networks of family physicians are insufficient to treat the deluge of patients that might be more easily addressed by armies of health workers — people with far less training than doctors but who focus on epidemic control measures. Developing countries are more likely to have such workforces, since they are more accustomed to massive health interventions like vaccination campaigns.

Some outbreak experts said European countries badly miscalculated their ability to stop the new coronavirus. “But I think the fact that this is a new disease and the speed at which it moved surprised everyone,” said Dr. Stacey Mearns of the International Rescue Committee.

Mearns said the current scenes of desperation across Europe — doctors and nurses begging for protective gear, temporary morgues in ice rinks to house the dead — were unimaginable just weeks ago. In Spain, 14% of its coronavirus cases are infected medical workers, straining resources at a critical time.

“We saw hospitals and communities get overwhelmed like this during Ebola in West Africa,” she said. “To see it in resource-wealthy nations is very striking.”

The Associated Press receives support for health and science coverage from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Judges slow abortion bans in Texas, Ohio, Alabama amid virus

March 31, 2020

DES MOINES, Iowa (AP) — Federal judges on Monday temporarily blocked efforts in Texas and Alabama to ban abortions during the coronavirus pandemic, handing Planned Parenthood and other abortion providers a victory as clinics across the U.S. filed lawsuits to stop states from trying to shutter them during the outbreak.

A new Ohio order is also unconstitutional if it prevents abortions from being carried out, a separate judge ruled Monday. The ruling instructed clinics to determine on a case-by-case basis if an abortion can be delayed to maximize resources — such as preserving personal protective equipment — needed to fight the coronavirus. If the abortion is deemed necessary and can’t be delayed, it’s declared legally essential.

The rulings indicated judges were pushing back on Republican-controlled states including abortion in sweeping orders as the outbreak grows in the U.S. In Texas, the ruling came down after state Attorney General Ken Paxton, a Republican, said abortion was included in a statewide ban on nonessential surgeries.

But U.S. District Judge Lee Yeakel said the “Supreme Court has spoken clearly" on a woman's right to abortion. One abortion provider in Texas, Whole Woman's Health, said it had canceled more than 150 appointments in the days after the Texas order went into effect.

“There can be no outright ban on such a procedure," Yeakel wrote. Paxton said the state would appeal. The rulings happened Monday as lawsuits were also filed in Iowa and Oklahoma, after governors in those states similarly ordered a stop to non-emergency procedures and specifically included abortion among them.

The lawsuits were filed by Planned Parenthood, the American Civil Liberties Union, the Center for Reproductive Rights and local lawyers in each state. Their aim, like abortion providers in Texas, is to stop state officials from prohibiting abortions as part of temporary policy changes related to the coronavirus pandemic.

Oklahoma Gov. Kevin Stitt announced Friday that abortions were included in his executive order banning all elective surgeries and minor medical procedures until April 7, unless the procedure was necessary to prevent serious health risks to the mother. Stitt said the order was needed to help preserve the state’s limited supply of personal protective equipment, like surgical masks and gloves.

A spokesman for Stitt referred questions about the challenge to Attorney General Mike Hunter, who vowed in a statement to defend the ban. “My office will vigorously defend the governor’s executive order and the necessity to give precedence to essential medical procedures during this daunting public health crisis," Hunter's statement said. "Make no mistake, this lawsuit will itself drain significant resources, medical and legal, from emergency efforts, and likely, directly and indirectly, bring harm to Oklahomans as a result."

Monday night, U.S. District Judge Myron Thompson issued a temporary restraining order against Alabama's order, saying the ruling with be in effect through April 13 while he considers additional arguments.

Thompson wrote the state’s concerns about conserving medical equipment during the pandemic, does not “outweigh the serious, and, in some cases, permanent, harms imposed by the denial of an individual’s right to privacy."

Attorneys for the Alabama clinics said facilities had canceled appointments for 17 people scheduled this week. “Patients that have already had their appointments canceled have been devastated; in many instances the calls cancelling the appointments have ended in tears,” lawyers for the clinics wrote.

Alabama closed many nonessential businesses with a state health order, effective Saturday. Alabama Attorney General Steve Marshall said earlier Monday the state would not offer a “blanket exemption" to abortion clinics.

In Ohio, Planned Parenthood and abortion clinics that sued last year to try to thwart a law that bans most abortions after a first detectable fetal heartbeat are asking a court to speed up its decision in that case and to consider a recent coronavirus order by the state health director. In filings Monday, the groups’ attorneys argued “the state is again attempting to ban abortions” through Dr. Amy Acton’s directive barring all “non-essential” procedures and Attorney General Dave Yost’s threats that it will be rigidly enforced.

Iowa Gov. Kim Reynolds spokesman Pat Garrett said the governor “is focused on protecting Iowans from an unprecedented public health disaster, and she suspended all elective surgeries and procedures to preserve Iowa’s health care resources.”

Reynolds said Sunday the move was not based on her personal ideology but a broad order to halt nonessential procedures to conserve medical equipment. The Iowa lawsuit said abortion procedures do not require extensive use of medical equipment and do not use N95 respirators, the devices in shortest supply during the COVID-19 pandemic.

“Patients’ abortions will be delayed, and in some cases, denied altogether," the lawsuit states. “As a result, Iowa patients will be forced to carry pregnancies to term, resulting in a deprivation of their fundamental right to determine when and whether to have a child or to add to their existing families.”

The lawsuits seek court orders halting action pertaining to abortions and ask judges for immediate hearings.

Weber reported from Austin, Texas. AP Writers Sean Murphy in Oklahoma City; Kimberly Chandler in Montgomery, Alabama; Julie Smyth in Columbus, Ohio contributed to this story.

Dismantling democracy? Virus used as excuse to quell dissent

March 31, 2020

BELGRADE, Serbia (AP) — Soldiers patrol the streets with their fingers on machine gun triggers. The army guards an exhibition center-turned-makeshift-hospital crowded with rows of metal beds for those infected with the coronavirus. And Serbia’s president warns residents that Belgrade's graveyards won’t be big enough to bury the dead if people ignore his government's lockdown orders.

Since President Aleksandar Vucic announced an open-ended state of emergency on March 15, parliament has been sidelined, borders shut, a 12-hour police-enforced curfew imposed and people over 65 banned from leaving their homes — some of Europe’s strictest measures to combat the COVID-19 pandemic.

The Serbian leader, who makes dramatic daily appearances issuing new decrees, has assumed full power, prompting an outcry from opponents who say he has seized control of the state in an unconstitutional manner.

Rodoljub Sabic, a former state commissioner for personal data protection, says by proclaiming a state of emergency, Vucic has assumed “full supremacy” over decision-making during the crisis, although his constitutional role is only ceremonial.

“He issues orders which are automatically accepted by the government,” Sabic said. “No checks and balances." In ex-communist Eastern Europe and elsewhere, populist leaders are introducing harsh measures including uncontrolled cellphone surveillance of their citizens and lengthy jail sentences for those who flout lockdown decrees.

The human rights chief of the Organization for Security and Cooperation in Europe said while she understands the need to act swiftly to protect populations from the COVID-19 pandemic, the newly declared states of emergency must include a time limit and parliamentary oversight.

“A state of emergency — wherever it is declared and for whatever reason — must be proportionate to its aim, and only remain in place for as long as absolutely necessary," said the OSCE rights chief, Ingibjörg Sólrún Gísladóttir.

In times of national emergency, countries often take steps that rights activists see as curtailing civil liberties, such as increased surveillance, curfews and restrictions on travel, or limiting freedom of expression. China locked down whole cities earlier this year to stop the spread of the virus as India did with the whole nation.

Amnesty International researcher Massimo Moratti said states of emergency are allowed under international human rights law but warned that the restrictive measures should not become a “new normal." “Such states need to last only until the danger lasts," he told The Associated Press.

In European Union-member Hungary, parliament on Monday passed a law giving Prime Minister Viktor Orbán’s government the right to rule by decree for as long as a state of emergency declared March 11 is in effect.

The law also sets prison terms of up to five years for those convicted of spreading false information about the pandemic and up to eight years for those interfering with efforts to contain the spread of the coronavirus, like a curfew or quarantine.

Rights groups and officials say the law creates the possibility of an indefinite state of emergency and gives Orbán and his government carte blanche to restrict human rights and crack down on freedom of the press.

“Orban is dismantling democracy in front of our eyes,"said Tanja Fajon, a member of the European Parliament, “This is a shame for Europe, its fundamental values and democracy. He (Orban) abused coronavirus as an excuse to kill democracy and media freedom."

“This is not the way to address the very real crisis that has been caused by the COVID-19 pandemic,” said David Vig, Amnesty International’s Hungary director. Hungarian Justice Minister Judit Varga said criticism of Hungary's bill were "political attacks based on the wrong interpretation or intentional distortion" of its contents.

Other governments have also adopted extreme measures. In Israel, Benjamin Netanyahu's caretaker government passed a series of emergency executive measures to try to quell the spread of the new virus. These include authorizing unprecedented electronic surveillance of Israeli citizens and a slowdown of court activity that forced the postponement of Netanyahu's own pending corruption trial.

In Russia, authorities have turned up the pressure on media outlets and social media users to control the narrative amid the country's growing coronavirus outbreak. Moscow went on lockdown Monday and many other regions quickly followed suit.

Under the guise of weeding out coronavirus-related “fake news,” law enforcement has cracked down on people sharing opinions on social media, and on media that criticize the government’s response to the outbreak.

In Poland, people are worried about a new government smartphone application introduced for people in home quarantine. Panoptykon Foundation, a human rights group that opposes surveillance, says some users who support government efforts to fight the pandemic worry that by using the app they could be giving too much private data to the conservative government.

While nearly 800 coronavirus cases and 16 deaths have been recorded in Serbia, according to Johns Hopkins University, testing has been extremely limited and experts believe the figures greatly under-represent the real number of victims. Most people suffer mild or moderate symptoms, such as fever and cough, from the virus but for some, especially older adults and people with existing health problems, more severe illness can occur, including pneumonia and death.

Images of the transformation of a huge communist-era exhibition hall in Belgrade into a makeshift hospital for infected patients has triggered widespread public fear of the detention camp-looking facility that is filled with row-upon-row of 3,000 metal beds.

The Serbian president said he was glad that people got scared, adding he would have chosen even a worse-looking spot if that would stop Serbs from flouting his stay-at-home orders. “Someone has to spend 14 to 28 days there,” Vucic said. “If it’s not comfortable, I don’t care. We are fighting for people’s lives."

“Do not Drown Belgrade,” a group of civic activists, has launched an online petition against what they call Vucic’s abuse of power and curtailing of basic human rights. It says his frequent public appearances are creating panic in an already worried society.

“We do not need Vucic’s daily dramatization, but the truth: Concrete data and instructions from experts,” the petition says.

Associated Press writers Jovana Gec, Pablo Gorondi in Budapest, Hungary, and Vanessa Gera in Warsaw contributed to this report.

Hungary approves extra government powers, with no end date

March 30, 2020

BUDAPEST, Hungary (AP) — Hungary's parliament on Monday approved a bill giving Prime Minister Viktor Orban's government extraordinary powers during the coronavirus pandemic, and setting no end date for them.

The bill was approved by Orban's Fidesz party and other government supporters by 137 votes in favor to 53 against. It needed 133 votes to pass. President Janos Ader signed the bill into law shortly after its approval in parliament and it will take effect from Tuesday.

The legislation has been criticized by opposition parties, international institutions and civic groups for failing include an expiration date for the government's ability to rule by decree. It also includes measures against false information which have raised concerns they they could be used by the government to muzzle independent media.

“The extraordinary measures are related to the pandemic, to its prevention, its elimination and the prevention of the damaging economic consequences,” said Csaba Domotor, a deputy minister in Orban's Cabinet Office. “A time limit cannot be declared in this situation because there is no one ... who can say how many months of struggle we have to prepare for.”

Opposition lawmakers said they were willing to give the government the requested powers, but only if they were set for a certain period, with the possibility of extensions. “The opposition is united on the issue of giving the government powers which are significantly more extensive than the authority in the Constitution,” said Tamas Harangozo, a lawmaker with the opposition Socialist Party." The opposition's request is that “the government accept that it can only do this within time limits.”

The human rights chief at the Organization for Security and Co-operation in Europe also expressed concerns about the new legislation. “It is clear that states need to act swiftly in order to protect their populations from the COVID-19 pandemic, and I understand that extraordinary measures may be required to do so,” said Ingibjorg Solrun Gisladottir, director of the OSCE Office for Democratic Institutions and Human Rights.

“However, a state of emergency — wherever it is declared and for whatever reason — must be proportionate to its aim, and only remain in place for as long as absolutely necessary.” The opposition criticized as insufficient the government's economic measures meant to alleviate the effects of the pandemic. While Orban has announced numerous tax breaks and the postponement until 2021 of debt payments by households and companies, critics have cited the lack of direct payments to employers to save jobs. Opposition parties have also called on salaries to be doubled for workers in the health sector.

Orban said the government would announce a package of economic measures on April 6 or 7 to boost growth. He said it would be the largest action of its kind in Hungarian history. A rights group known in part for its advocacy for refugees and asylum-seekers said that checks on the government's rule by decree would now have to come from external institutions to a greater extent.

“Parliament, as the legislative body representing the people, practically will be in recess from now on. Law will be essentially made by the government,” the Hungarian Helsinki Committee said. “In the absence of the proper function of parliament, civic control of the government and its institutions — especially by the press, civic groups, and human rights watchdogs — becomes more valuable.”

The opposition parties were also critical of the government's refusal to consider allowing lawmakers to vote from home. Hungary's Constitution does not allow parliamentary sessions or votes to be held via teleconferencing or other remote methods and the government said it has no plans for a Constitutional amendment needed to create the option.

“If we’re asking the whole country to stay home, then the Hungarian parliament should be able to do the same if the virus situation justifies it,” said independent lawmaker Bernadett Szel. A decree setting restrictions on leaving home, with exceptions for going to work or for essential needs like food shopping, took effect on Saturday.

Hungary declared a state of emergency on March 11 due to the spread of coronavirus. So far 447 cases have been confirmed in the country, with 15 deaths.

With more infections than China, Spain tightens lockdown

March 30, 2020

MADRID (AP) — Spain enforced even tighter stay-at-home rules Monday for its 47 million people, as the country overtook China as the nation with the third-highest number of reported infections in the world, after the United States and Italy.

But the new measures, which confused many Spaniards, came under attack from business leaders who say the government is hurting the economy beyond repair, and opposition parties who accuse it of improvising in its response to the outbreak.

Already stretched beyond breaking point in at least one third of the country, hospitals are seeing scores of medical workers falling ill and requiring quarantine, while the arrival of protective gear is suffering delays.

The government's decision to impose a two-week halt effective Monday to all non-essential economic activity. came even as authorities claimed that the previous two weeks of confinement were starting to pay off with a slower pace of the pandemic’s expansion,

The president of Spain's main business association, CEOE, warned that the stricter measures would create “a very grave economic problem that can lead to a social problem” through potential job and income losses.

Hundreds of thousands of Spaniards have already applied for unemployment subsidies since the confinement measures began in mid-March, and a 200-billion euro aid package, much of it from public funds, has been rolled out to help workers and companies cushion the drop in production.

"If you stop the country, we'll have a huge social problem within five months," Antonio Garamendi told Spain's public broadcaster, TVE. Only workers in hospitals, pharmacies, the food supply chain and other essential industries are required to work until the end of Easter, in mid-April. In a call for Spaniards to “hibernate,” as described by a Cabinet member of Spain's left-wing coalition government, the rest were asked to scale back operations to weekend-level.

But the new measures surprised and confused many Spaniards, who woke up on Monday not knowing whether their jobs were part of the exceptions to the government's new emergency decree that wasn't fully published until midnight on Sunday.

“Spaniards don't deserve more lies, incompetence and internal fighting,” opposition conservative Popular Party leader Pablo Casado said on Monday. In hard-hit Madrid, which has seen nearly half of the country’s deaths, flags flew at half-staff for an official mourning period that began Monday. During a minute of silence observed for the dead, bells tolled across the Spanish capital's empty Puerta del Sol central square. Speakers blasted U.S. composer Samuel Barber's Adagio for Strings.

With a population thirty times smaller than China’s 1. 4 billion, Spain's official tally of infections was for the first time higher: more than 85,000, an 8% rise from the previous day but smaller than earlier increases that had rocketed up to 20%. The health ministry also reported 812 new deaths, raising its overall confirmed death toll to 7,340.

Crews of workers and soldiers were frantically building more field hospitals in the capital and surrounding towns. The region is among six of Spain's 17 regions at their limit of ICU beds. Three more, according to officials, are close to it.

Spanish health official Dr. Maria José Sierra said there's no end to the stay-at-home restrictions yet in sight. “Reducing the pressure on the ICUs will be important for considering de-escalation measures,” said Sierra, who took over Monday as the health emergency center's spokesperson after its director tested positive.

Nearly 15% of all those infected in Spain, almost 13,000 people, are among the country's 646,000 health care professionals. This hampers hospitals' efforts to help the tsunami of people gasping for breath.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with existing health problems, the virus can cause severe symptoms like pneumonia and can be fatal. More than 155,000 people have recovered, according to Johns Hopkins.

Moscow goes into lockdown, rest of Russia braces for same

March 30, 2020

MOSCOW (AP) — The Russian capital, Moscow, on Monday woke up to a lockdown obliging most of its 13 million residents to stay home, and many other regions of the vast country quickly followed suit to stem the spread of the new coronavirus.

A stern-looking President Vladimir Putin warned his envoys in Russia's far-flung regions that they will be personally responsible for the availability of beds, ventilators and other key equipment. “We have managed to win time and slow down an explosive spread of the disease in the previous weeks, and we need to use that time reserve to the full,” Putin said.

Russia so far has been relatively spared by the outbreak, with 1,836 confirmed cases and nine deaths, but the number of people testing positive has risen quickly in recent days and authorities are bracing for the worst.

Putin has declared that only people employed by essential sectors should work this week, leaving it to regional authorities to spell out the details. Moscow Mayor Sergei Sobyanin followed up by ordering Muscovites to stay home starting Monday except for medical emergencies and runs to nearby shops. He said the city will issue special passes for those who need to keep working and track all others with electronic surveillance.

“We will steadily tighten controls," Sobyanin told a Cabinet meeting. “I hope that by the week's end we will have information systems allowing us to fully control citizens' movements and prevent possible violations.”

On Tuesday, the Russian parliament is scheduled to approve a bill that imposes prison terms of up to seven years and fines of up to 2 million rubles (about $25,000) — a huge sum in a country where an average monthly salary hovers around $500 — on violators of the lockdown.

Moscow has a sprawling system of surveillance cameras complete with facial recognition technology, which were tested during anti-Kremlin rallies last year to track down protesters. City authorities have also used cell phone location data from mobile providers to monitor those who were ordered to self-quarantine for two weeks after arriving from abroad.

Russia took early steps to counter the outbreak, closing the borders with China and then barring access to Chinese citizens last month when China was still the world's hottest coronavirus spot. Authorities followed up by screening arrivals from Italy, France, Spain and other countries worst-affected by the outbreak, and obliging them to self-quarantine. Last week Russia cut all international commercial flights and finally fully closed its borders effective Monday, with the exception of diplomats, truck drivers and a few other categories.

Russian officials said those measures helped slow down the spread of COVID-19, but acknowledged that the disease is accelerating rapidly and relatively low numbers of confirmed cases could be explained by insufficient screening.

For most people, the coronavirus causes mild or moderate symptoms such as fever and cough. But for others, especially older adults and people with prior health problems, it can cause severe symptoms like pneumonia and can be fatal.

Authorities have converted several hospitals in Moscow to treat coronavirus patients and thousands of construction workers labored around the clock at a construction site on Moscow's outskirts to build a new specialized hospital to be ready in a few weeks.

The Defense Ministry also launched a massive effort to build 16 hospitals across the country in a matter of weeks. Last week, the military also conducted massive drills across Russia to disinfect and quarantine broad areas.

Despite those efforts, many in Russia worry that the nation's underfunded health care system that just recently underwent massive cuts could be easily overwhelmed by the crisis. Putin told his envoys in the regions Monday that they must quickly report the real situation with ventilators and other essential equipment, prepare for moving seriously ill patients between regions and mobilize medical personnel, including medical students. He also ordered a sharp increase in screening. Until last week, just one laboratory in Siberia was analyzing the coronavirus tests.

In a move reflecting the gravity of the crisis, Putin last week postponed a vote on constitutional amendments that would allow him to stay in office until 2036 if he chooses. Russian authorities haven’t restricted travel to and from the capital city. Many residents of the Moscow region commute to work in the capital.

In a sign of lack of sync between various state agencies amid quick-paced developments, police in the Moscow region on Sunday night announced a curfew on top of the lockdown, but the authorities quickly denied the announcement.

Putin has hailed Moscow's lockdown as “necessary and justified." St. Petersburg, Russia's second largest city, and over a dozen other regions from the westernmost exclave of Kaliningrad to Tatarstan on the Volga River to the Yekaterinburg region in the Urals quickly followed Moscow's example and imposed similar lockdowns.

Russia's leading opposition figure, Alexei Navalny, on Monday blasted the Kremlin for longtime neglect of the country's hospitals and called for public donations to help them. He posted a letter from a doctor at one of Moscow's hospitals treating coronavirus patients who said staff have run out of protective suits and have to reuse those they have worn.

Kremlin critics also voiced concern that the government would use the lockdown to further tighten political controls and crack down on dissent. The authorities already have declared a campaign against “fake news” about the coronavirus, tracking down social media users making claims that contradict official figures on coronavirus figures. Some already have been given heavy fines.

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