The country set a record for the sixth time in nine days. The Supreme Court granted Alabama’s request to restore voting restrictions during the pandemic. Mike Pence changed his travel plans in Arizona after Secret Service agents set to accompany him tested positive for the virus.
Miami-Dade and Broward counties had already announced they were closing beaches for the busy Fourth of July weekend.
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By a 5-to-4 vote, the Supreme Court on Thursday blocked a trial judge’s order that would have made it easier for voters in three Alabama counties to use absentee ballots in this month’s primary runoff election.
In March, Gov. Kay Ivey, a Republican, postponed the election because of the pandemic. At the same time, the Republican official who oversees the state’s elections, John H. Merrill, Alabama’s secretary of state, expanded the availability of absentee ballots to all voters who concluded that it was “impossible or unreasonable to vote at their voting place.”
But Mr. Merrill did not relax two of the usual requirements for absentee voting: submission of a copy of a photo ID with a voter’s application for a ballot and submission of an affidavit signed by a notary public, or two adult witnesses, with the ballot itself.
Four voters and several groups sued to challenge those restrictions, saying that, in light of the health crisis, they placed an unlawful burden on the right to vote. Making a copy of a piece of identification, for instance, may be difficult and dangerous during the pandemic, they said.
Officials in Alabama, which has more than 40,000 confirmed coronavirus cases and nearly 1,000 deaths, have dismissed that concern.
In asking the Supreme Court to intervene, state officials said an order by an Alabama judge — which, among other things, blocked election officials in two counties from enforcing the ID requirement for voters who are disabled or 65 or older — had come too close to the election and threatened its integrity.
In their brief, the state officials discussed ways in which voters could safely comply with the witness requirement.
In response, lawyers for the voters said the state had offered no good reasons “to justify the application of the witness or photo ID requirements to high-risk voters in the middle of a pandemic.”
The mayor and the governor sow confusion about reopening New York City’s schools.
Mayor Bill de Blasio said Thursday that New York City schools would open in some form come September — only for Gov. Andrew M. Cuomo’s office to describe the mayor’s announcement as “premature.”
The lack of coherent communication from the state and the city about the nation’s largest school system sowed further confusion among public school parents eager for clarity about the coming school year. Some private schools are also are likely to follow the public school path.
The mayor said that students and teachers would be required to wear masks, that schools would get daily deep cleanings, and that each school would welcome the maximum daily number of students possible, given social distancing and other health requirements.
He cited a recent survey of public school parents finding that 75 percent of them want their children to return to class this year. The survey got 400,000 responses.
On Thursday, the schools chancellor, Richard A. Carranza, met with principals to discuss plans for reopening. The schools will be able to reopen only with buy-in from unionized teachers and staff members.
Here’s What Recovery From Covid-19 Looks Like for Many Survivors
Continuing shortness of breath, muscle weakness, flashbacks, mental fogginess and other symptoms may plague patients for a long time.
Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge: recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives.
Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues.
And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought.
“It’s not just, ‘Oh, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, ‘I just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’”
It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.
There are many. Patients may leave the hospital with scarring, damage or inflammation that still needs to heal in the lungs, heart, kidneys, liver or other organs. This can cause a range of problems, including urinary and metabolism issues.
Dr. Zijian Chen, the medical director of the new Center for Post-Covid Care at Mount Sinai Health System, said the biggest physical problem the center was seeing was shortness of breath,
Some have an intermittent cough that doesn’t go away that makes it hard for them to breathe,” he said. Some are even on nasal oxygen at home, but it is not helping them enough.
Some patients who were on ventilators report difficulty swallowing or speaking above a whisper, a usually temporary result of bruising or inflammation from a breathing tube that passes through the vocal cords
Dr. Chen said that Mount Sinai’s post-Covid center has referred nearly 40 percent of patients to neurologists for issues like fatigue, confusion and mental fogginess.
“Some of it is very debilitating,” he said. “We have patients who come in and tell us: ‘I can’t concentrate on work. I’ve recovered, I don’t have any breathing problems, I don’t have chest pain, but I can’t get back to work because I can’t concentrate.’” said Dr. Lauren Ferrante, a pulmonary and critical care physician at Yale School of Medicine
What makes someone more likely to face recovery challenges?
Studies of people hospitalized for respiratory failure from other causes suggest recovery is more likely to be harder for people who were frail beforehand and for people who needed longer hospitalizations, Dr. Ferrante said.
But many other coronavirus patients — not just those who are older or who have other medical conditions — are spending weeks on ventilators and weeks more in the hospital after their breathing tubes are removed, making their recovery hills steeper to climb.
Another factor that can extend or hamper recovery is a phenomenon called hospital delirium, a condition that can involve paranoid hallucinations and anxious confusion. It is more likely to occur in patients who undergo prolonged sedation, have limited social interaction and are unable to move around — all common among Covid-19 patients.
Studies, including one by a team at Vanderbilt University Medical Center, have found that I.C.U. patients who experience hospital delirium are more likely to have cognitive impairment in the months after they leave the hospital.
Ups and downs are common. “It’s absolutely not a linear process, and it’s very individualized,” Dr. Needham said.
Perseverance is important. “What we don’t want is for patients to go home and lie in bed all day,” Dr. Ferrante said. “That will not help with recovery and will probably make things worse.”
Patients and their families should realize that fluctuations in progress are normal.
“There are going to be days where everything’s going right with your lungs, but your joints are feeling so achy that you can’t get up and do your pulmonary rehab and you have a few setbacks,” Dr. Putrino said. “Or your pulmonary care is going OK, but your cognitive fog is causing you to have anxiety and causing you to spiral, so you need to drop everything and work with your neuropsychologist intensively.”
Research led by Dr. Needham of Johns Hopkins found that “patients have prolonged muscle weakness that lasts months or longer and that muscle weakness is not just limited to their arms and legs — it’s also their breathing muscles,” he said.
Another study by Dr. Needham and his colleagues found that about two-thirds of ARDS patients had significant fatigue a year later.
Psychological and cognitive symptoms can also linger. About half of the patients in the 2011 Canadian study reported at least one episode of “physician-diagnosed depression, anxiety, or both between two and five years of follow-up.” And a study of patients treated in the 2003 outbreak of SARS, another type of coronavirus, found that a year later many had “worrying levels of depression, anxiety, and post-traumatic symptoms.”
What are the consequences?
Among other things, patients may have trouble going back to their jobs. A team led by Dr. Needham found that nearly one-third of 64 ARDS patients they followed for five years never returned to work.
Medication may not be necessary, or may not work, for many issues. Practicing breathing exercises and using a spirometer, a device that measures how much air a person can breathe and how quickly, can improve respiratory issues. Physical therapy can help restore muscle strength, movement and flexibility. Occupational therapy can help people regain the ability to do everyday tasks, like grocery shopping and cooking. Speech therapy can help with swallowing and vocal cord issues.