Maggots, Rape and Yet Five Stars: How Nursing Homes Mislead the Public

 

The Clove Lakes Health Care facility on Staten Island, rated five stars, reported only 15 out of 72 serious falls between 2011 and 2015.

Credit...Olga Ginzburg for The New York Times

NY TIMES

Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating — one being the worst, five the best — the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics.

The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable.

Carrie Johnson said that Brookdale’s Richmond Place Ky was so short-staffed that she had to sit for hours in her own feces and urine. Credit...Jessica Ebelhar for The New York Times

But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken.

Despite years of warnings, the system provided a badly distorted picture of the quality of care at the nation’s nursing homes. Many relied on sleight-of-hand maneuvers to improve their ratings and hide shortcomings that contributed to the damage when the pandemic struck.

More than 130,000 nursing-home residents have died of Covid-19, and The Times’s analysis found that people at five-star facilities were roughly as likely to die of the disease as those at one-star homes.

The ratings program, run by the U.S. Centers for Medicare & Medicaid Services, relies on a mix of self-reported data from more than 15,000 nursing homes and on-site examinations by state health inspectors. Nursing homes receive scores based on how they fare in those inspections; how much time nurses spend with residents; and the quality of care that residents receive. Those three grades are then combined into an overarching star rating for each nursing home.

Kathleen DeVito, 78, shattered her ankle after she said she was left alone in the bathroom. Credit...Ty Wright for The New York Times“I think about how much better I’d be if I had never gone there,” said Ms. DeVito, 78, a retired paralegal.

To evaluate the ratings’ reliability, The Times built a database to analyze millions of payroll records to determine how much hands-on care nursing homes provide residents, combed through 373,000 reports by state inspectors and examined financial statements submitted to the government by more than 10,000 nursing homes.

The Times obtained access to portions of the ratings data that aren’t publicly available from academics who had research agreements with the Centers for Medicare & Medicaid Services, or C.M.S.

Among The Times’s findings:

Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are.

Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported.

In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.

Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings.

At homes whose five stars masked serious problems, residents developed bed sores so severe that their bones were exposed. Others lost the ability to move.

But the most important impact may be that the nursing home industry was ill equipped for the pandemic. The rating system allowed facilities to score high grades without upgrading the care they provided.

“They were working to improve their ratings, but not their quality,” said Charlene Harrington, who sits on a board that advises C.M.S. on the ratings system.

“The problems with the five-star system left these homes less prepared in the pandemic,” she said. “They were allowed to not have enough staffing, and they were allowed to ignore infection-control deficiencies, so they had poorer quality than the public knew about, and they were in the worst position to manage Covid.”

 NYS HLTH COMM ZUCKER HITS BACK AT CRITICS OVER COVID-19 NURSING HOME DEATH DATA CONTROVERSY

BROOKLYN PAPER

At the center of Governor Cuomo’s alleged mismanagement of COVID-19 in nursing homes, his critics charge, was a March 25 executive order to send COVID-19 patients into nursing homes — which led to several outbreaks inside the facilities, where residents are particularly vulnerable due to their age. 

Joining Cuomo’s Friday press conference, however, New York State Health Commissioner Dr. Howard Zucker defended the order, saying it was the right decision at the time. 

“You can only review the decision with the facts that you had at the time. With the facts that we had at that moment in time, it was the correct decision from a public health point of view,” Zucker said.

In an effort to free up hospital beds and flatten the curve “to protect the hospital system as a whole,” the state health guidance was designed to “send people home if they didn’t need to be in the hospital,” Zucker said — which led officials at the time to send COVID-positive patients back to nursing homes.

Additionally, the commissioner added, studies have shown that many of the COVID-19 outbreaks in nursing homes were caused by asymptomatic staff members.

“98 percent of the nursing homes that accepted a hospital patient, already had COVID in that facility,” Zucker said. “132 nursing homes facilities that never took a COVID admission from a hospital still had COVID fatalities.” 

Cuomo also argued that the “rate of COVID deaths in nursing homes was the same before the March 25 memo, as it was after” — and other states which did not have similar policies still had similar rates of infection in nursing homes.

Still, even with Zucker’s defense of the state’s actions, many politicos have trained their outrage at Cuomo’s alleged lack of transparency around the number of nursing home deaths. 

One of the governor’s predecessors, former Governor George Pataki, called Cuomo’s actions a “cover-up” and “one of the worst things I have seen in state government,” during an interview on AM 570 WMCA radio. 

REOPENING FOR VISITS

Over the next several weeks, the debate over both Cuomo’s handling of nursing homes, and the subsequent reporting, will surely heat up even further — with multiple investigations, legislative hearings, and a bipartisan push to limit Cuomo’s authority.  

And yet, amid the controversy and in between his staunch efforts at defense, Cuomo also announced on Friday that long term care facilities can reopen for visitations — allowing many families to see their elderly loved ones for the first time in nearly a year. 

“Reopening visitation — this is going to be a very big deal for a lot of New Yorkers,” the governor said. 

The move comes nearly two months after the COVID-19 vaccines began rolling out to nursing home residents and the support staff, and as nearly three-fourths of all residents and staffers have been inoculated.

“100 percent of nursing home residents and staff have been offered the vaccine, and 73 percent of them have been vaccinated,” Cuomo said. “That is the largest ‘sub-group,’ if you will.”

This story first appeared on AMNY.com.

Is Virus Death Rate in U.S. on a Slow Descent? Virus Rages at City Jails, Leaving 1,259 Guards Infected and 6 Dead. UPDATES

U.S. deaths reported per day

The novel coronavirus has taken a heartbreaking health and 

economic toll in America. But the course of the pandemic isn’t 

the same as it was a few months ago.  There are encouraging signs

all over the country — but no early indications of an overall

reopening. Nate Silver pointed out that the seven-day rolling 

average for deaths is 1,362, down from 1,761 the week prior and a

 peak of 2,070 on April 21. That’s still too much too high, but 

the trend is favorable.

Correction officers in New York City live in fear of bringing the virus home to families. They say the city has not protected them.

NY TIMES

For one Rikers Island correction officer, the low point came when he and his wife were both extremely sick with the coronavirus. She could hardly breathe and begged him to make sure she was not buried in a mass grave, he recalled. He was sure he had contracted the disease working in the jailhouse, where supervisors had discouraged him from wearing a mask.

“I’m looking at the person I care most about possibly dying from this thing I brought home,” he said, choking back tears. “That to me is the scariest thing I ever faced.”

Another officer at the Rikers jail said he worked for nearly two weeks while feeling ill but received no help from the jail’s administrators in getting a test. A third, who delivered mail to people in custody, some of them sick, was told he could not use a mask that he had at home but had to wait for a city-issued one. He, too, became infected.

The coronavirus has wreaked havoc on New York City’s 9,680 correction officers and their supervisors, who, like the police and firefighters, are considered essential workers. So far, 1,259 have caught the virus and six have died, along with five other jail employees and two correctional health workers. The officers’ union contends that the death of one other guard is also the result of Covid-19.

The virus has sickened more correction officers in New York, the center of the pandemic in the United States, than in most other large American cities, including Chicago, Houston, Miami and Los Angeles combined, according to data collected by The New York Times.

A majority of the officers in New York City are black and Hispanic and come from neighborhoods with high rates of Covid-19. Inmates also have also been hit hard: 545 have tested positive for the virus since the pandemic started, officials said. Three have died in custody, and two succumbed within hours of being released.

Correction officers and union officials have blamed the jail system’s management for the high number of infections. The union points to the department’s practice of asking officers to return to work after they recovered from the illness even if they had not yet tested negative for the virus. And they cited delays in providing many officers with protective gear during the critical month of March and failures to notify guards about colleagues who tested positive for Covid-19.

More than 160 inmates and 130 staff members at the Rikers Island jail complex have been infected with the virus.Credit...Todd Heisler/The New York TimesThey also have said that extra-long work shifts — sometimes 24 hours at a stretch — contributed to the epidemic among officers. At the peak of the epidemic, 36 percent of the uniformed jail staff called in sick, leading to long shifts for those still on the job.

https://www.instagram.com/p/B_Si7AzhExB

Coronavirus ‘does not spread easily’ on contaminated surfaces: CDC

DAILY NEWS

The uncertainty surrounding coronavirus has been a huge source of anxiety throughout this pandemic, as scientists have struggled to uncover not just a treatment for the disease, but also basic facts about its existence.

Though many have been concerned about infection through items like groceries or mail deliveries, the Centers for Disease Control and Prevention has recently issued updated guidance saying that coronavirus “does not spread easily” from touching surfaces or objects.

“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes,” the CDC says. “This is not thought to be the main way the virus spreads, but we are still learning more about this virus.”

The Striking Racial Divide in How Covid-19 Has Hit Nursing Homes

Homes with a significant number of black and Latino residents have been twice as likely to be hit by the coronavirus as those where the population is overwhelmingly white.

The coronavirus pandemic has devastated the nation’s nursing homes, sickening staff members, ravaging residents and contributing to at least 20 percent of the nation’s Covid-19 death toll. The impact has been felt in cities and suburbs, in large facilities and small, in poorly rated homes and in those with stellar marks.

But Covid-19 has been particularly virulent toward African-Americans and Latinos: Nursing homes where those groups make up a significant portion of the residents — no matter their location, no matter their size, no matter their government rating — have been twice as likely to get hit by the coronavirus as those where the population is overwhelmingly white.

More than 60 percent of nursing homes where at least a quarter of the residents are black or Latino have reported at least one coronavirus case, a New York Times analysis shows. That is double the rate of homes where black and Latino people make up less than 5 percent of the population. And in nursing homes, a single case often leads to a handful of cases, and then a full-fledged outbreak.

Disparity in the share of nursing homes hit

In many states, facilities with a population of at least a quarter black and Latino residents were more likely to have at least one coronavirus case.

The nation’s nursing homes, like many of its schools, churches and neighborhoods, are largely segregated. And those that serve predominantly black and Latino residents tend to receive fewer stars on government ratings. Those facilities also tend to house more residents and to be located in urban areas, which are risk factors in the pandemic.

Yet the disparities in outbreaks among homes with more Latino and black residents have also unfolded in confusing ways that experts say are difficult to explain.

The race and ethnicity of the people living in a nursing home was a predictor of whether it was hit with Covid-19. But the Times analysis found that the federal government’s five-star rating system, often used to judge the quality of a nursing home, was not a predictor. Even predominantly black and Latino nursing homes with high ratings were more likely to be affected by the coronavirus than were predominantly white nursing homes with low ratings, the data showed.

Cuomo: Westchester to reopen Tuesday as COVID-19 deaths drop below 100 for first time since March

The death toll dropped to 84 people Friday, the first time it’s dipped below 100 since the pandemic slammed the city and surrounding suburbs more than two months ago.

Cuomo called it a bittersweet benchmark that shows how far New Yorkers have come.

“It doesn’t do any good for those 84 families that are feeling the pain,” Cuomo said. 'But we are making progress and that feels good."

In the city, 52 people died of coronavirus in the 24 hours ending Friday evening. The total death toll rose to 21,138. There have been nearly 195,000 COVID-19 cases in the five boroughs.

Gov. Cuomo gave Westchester and the Hudson Valley the green light to reopen starting Tuesday as the coronavirus death toll dipped below 100 for the first time since the crisis erupted in March.

The governor also suggested hard-hit Long Island could start the reopening process on Wednesday if the death toll and case numbers keep dropping in Nassau and Suffolk counties.

U.S. government scientists finally publish remdesivir data.

Nearly a month after U.S. government scientists claimed that an experimental drug had helped patients severely ill with the coronavirus, the research has been published.

The drug, remdesivir, was quickly authorized by the Food and Drug Administration for treatment of coronavirus patients, and hospitals rushed to obtain supplies.

But until now, researchers and physicians had not seen the actual data.

The long-awaited study, sponsored by the National Institute of Allergy and Infectious Diseases, appeared on The New England Journal of Medicine’s website on Friday evening. It confirmed the essence of the government’s assertions: Remdesivir shortened recovery time from 15 days to 11 days in hospitalized patients. The study defined recovery as “either discharge from the hospital or hospitalization.”

The trial was rigorous, randomly assigning 1,063 seriously ill patients to receive either remdesivir or a placebo. Those who received the drug not only recovered faster but also did not have serious adverse events more often than those who were given the placebo.

Congress Passes a $484 billion coronavirus aid package. Another 4.4 million file for unemployment, making for a total over 26 million. UPDATES.

A $484 billion coronavirus aid package is headed to Trump’s desk.

The House on Thursday gave resounding approval to a $484 billion coronavirus relief package to restart a depleted loan program for distressed small businesses and provide funds for hospitals and coronavirus testing, and moved to increase oversight of the sprawling federal response to the pandemic.

President Trump said he was “grateful” for the action to refill the loan program and indicated he would sign the measure. It was the latest installment in a government aid program that is approaching $3 trillion, which passed with broad bipartisan support even as some Democrats condemned it for being too stingy. But the fight over what should be included foreshadowed a pitched partisan battle to come over the next round of federal relief, which is likely to center on aid to states and cities facing dire financial straits.

Even as they dispensed with another nearly half-trillion taxpayer dollars, Democrats were moving to scrutinize the administration’s handling of the funds. Just before the aid package passed, they pushed through a measure creating a special committee to investigate the Trump administration’s response to the pandemic and the array of federal spending measures enacted to address it, defying objections from Mr. Trump and Republicans.

The committee, which will have the power to subpoena documents and witnesses, is charged with examining how the coronavirus relief packages were rolled out, and scrutinizing “preparedness for and response to the coronavirus crisis.”

The vote took place in a House chamber transformed by the pandemic. It was an impassioned debate as lawmakers, most of whom covered their faces with blue surgical masks or homemade swaths of fabric in an array of colors, patterns and glitter, reflected on the effect of the pandemic on their individual districts. Speaker Nancy Pelosi donned purple latex gloves to cast a vote.


A line of cars waiting to receive items from a food distribution drive in Hialeah, Fla., on Wednesday. Hundreds of thousands of unemployed people in the state have been waiting for weeks for a check.Credit...Joe Raedle/Getty Images

As another 4.4 million file for unemployment, help is slow to arrive.

Nearly a month after Washington rushed through an emergency package to aid jobless Americans, millions of laid-off workers have still not been able to apply for those benefits — let alone receive them — because of overwhelmed state unemployment systems.

Across the country, states have frantically scrambled to handle a flood of applications and apply a new set of federal rules even as more and more people line up for help. On Thursday, the Labor Department reported that another 4.4 million people filed initial unemployment claims last week, bringing the five-week total to more than 26 million.

Nearly one in six American workers has lost a job in recent weeks.

According to the Labor Department, only 10 states have started making payments under the federal Pandemic Unemployment Assistance program, which extends coverage to freelancers, self-employed workers and part-timers. Most states have not even completed the system needed to start the process.

As Florida’s unemployment website became unusable under the weight of the traffic, the state agreed this month to accept paper applications, a tacit acknowledgment that the system was all but broken. Florida’s breakdown became a national symbol of distress, when footage of a snaking line for those applications outside the public library in Hialeah, a blue-collar city outside Miami, drew wide attention online.

The debacle has become an embarrassment for Gov. Ron DeSantis, a Republican. He called the system “cumbersome” last week and acknowledged that only 4 percent of 850,000 pending claims had been paid. He appointed an unemployment czar and signed executive orders waiving some requirements to ease the traffic on the website. The number of paid claims has slowly inched up.



One in five who were tested for antibodies in New York City had them.

About 21 percent of about 1,300 people in New York City who were screened for virus antibodies tested positive, Governor Andrew M. Cuomo said on Thursday.

The results come from a state program that randomly tested 3,000 supermarket customers across New York State this week. Nearly 14 percent of those tests came back positive, he said.

If those numbers translate to the true incidence of the virus, they would mean that more than 1.7 million people in New York City, and more than 2.4 million people statewide, have already been infected. These numbers are far greater than the 250,000 confirmed cases of the virus that the state has recorded.

If those numbers translate to the true incidence of the virus, they would mean that more than 1.7 million people in New York City, and more than 2.4 million people statewide, have already been infected. These numbers are far greater than the 250,000 confirmed cases of the virus that the state has recorded. It would also mean that the fatality rate from the virus was relatively low, about 0.5 percent, Mr. Cuomo said.

Mr. Cuomo also released the state’s daily figures of deaths and hospitalizations:

Deaths are falling: 438 deaths were reported on Thursday, down from 474 on Wednesday. The number of deaths in the first four days of this week is down 33 percent compared with the first four days of last week. The state’s death toll is now 15,740.

New hospital admissions remain flat: The number of virus patients entering hospitals has stayed around 1,360 a day for the last three days. That is down from around 3,000 a day at the start of the month.



Most N.Y.C. patients hospitalized with the virus had a chronic condition, a study found.

A new study of thousands of people who were hospitalized in New York City after contracting the coronavirus found that more than nine in 10 had at least one chronic health condition and that most had at least two.

The findings were included in a paper published in the Journal of the American Medical Association that describes the characteristics of thousands of Covid-19 patients admitted from March 1 to April 4 at a dozen hospitals in New York City and Westchester County and on Long Island that are operated by Northwell Health.

The researchers found that dozens of children and teenagers were hospitalized with the virus, but survived it, and that women had a clear edge in beating the virus. Fewer of them were hospitalized to begin with, and they were more likely to survive. One in five hospital stays ended in death. The mortality rate for those who were placed on ventilators and were no longer in the hospital was 88 percent.

Given that the length of hospital stays in the Northwell cases was relatively short, four days on average, it is possible that those who died were mainly patients who were so ill that any treatment was unlikely to help them.

Like several other reports on smaller patient groups at area hospitals, the Northwell research indicated that obesity, high blood pressure and diabetes were common risk factors for severe Covid-19 disease requiring hospitalization. One of the most striking findings: only 6 percent of hospitalized patients had no underlying health conditions at all.

Cuomo said New York nursing homes would be investigated.

Mr. Cuomo said on Thursday that nursing homes in New York would be investigated to ensure that they were following strict rules that had been put in place during the outbreak.

More than 3,500 people have died in nursing homes since the outbreak began, according to state data. That is roughly 20 percent of all virus-related deaths in New York.

Nursing homes have been required to:

Have their staffs undergo regular temperature checks and wear protective personal equipment.

Quarantine patients infected with the virus.

Assign specific staff members to residents who are infected, and to transfer any infected patients to other homes if providing appropriate care where they are is not possible.

Notify residents and family members within 24 hours if a resident tests positive or dies because of the virus.

Readmit those infected only if homes can provide the adequate level of care as dictated by the Centers for Disease Control and Prevention and the state Health Department.

New U.S. Jobless Claims Push 4-Week Total to 22 Million. UPDATES

Jobs Figures Show the Breadth of the Economic Ruin

The data underscore the impact on every corner of the economy: hotels and restaurants, retailers, manufacturers and white-collar strongholds.

Even as political leaders wrangle over how and when to restart the American economy, the coronavirus pandemic’s devastation became more evident Thursday with more than 5.2 million workers added to the tally of the unemployed.

In the last four weeks, the number of unemployment claims has reached 22 million — roughly the net number of jobs created in a nine-and-a-half-year stretch that began after the last recession and ended with the pandemic’s arrival.

The latest figure from the Labor Department, reflecting last week’s initial claims, underscores how the downdraft has spread to every corner of the economy. The mounting unemployment numbers seem certain to add to pressure to lift some restrictions on business activity. President Trump on Thursday announced new guidelines for states eager to reopen, but many governors and health experts are more cautious.

If quarterly unemployment hits 30 percent — as the president of one Federal Reserve Bank predicted — 15.4 percent of Americans will fall into poverty for the year, researchers found, even in the unlikely event that the economy immediately recovers. That level of poverty would exceed the peak of the Great Recession and add nearly 10 million people to the ranks of the poor.

Trump says governors can reopen sooner than May 1.

Trump told the nation’s governors on Thursday that they could begin reopening businesses, restaurants and other elements of daily life by May 1 or earlier if they wanted, abandoning his threat to use what he had claimed was his absolute authority to impose his will on them.

On a day when the nation’s death toll from the coronavirus increased by more than 2,000 for a total over 30,000, the president released a set of nonbinding guidelines that envisioned a slow return to work and school over weeks or months. Based on each state’s conditions, the guidelines in effect guarantee that any restoration of American society will take place on a patchwork basis rather than on a one-size-fits-all prescription from Washington that some of the governors had feared in recent days.


Protesters in MAGA hats and flying Confederate flags swarm Michigan, North Carolina, Ohio, Utah, Wyoming and Virginia to demonstrate 'tyrannical' and 'unconstitutional' lockdown orders that are 'worse than the virus'



Protesters have continued to gather across the United States, ignoring social distancing rules to demonstrate against lockdown orders they call 'tyrannical' and 'worse than the virus'. Thousands of protesters drove to Michigan's State Capitol to protest Democratic Gov Whitmer Wednesday. In Utah protesters held signs that read 'Resist like it's 1776' and 'America will never be a socialist country'. And in Kentucky protesters shouted out as Democratic Governor Andy Beshear spoke to the state. A Reopen North Carolina Facebook page has 42,000 members; a protester was arrested there Wednesday. And a startling image from Ohio shows a baying crowd at the window of the Statehouse Atrium on Monday. In Virginia a protest against Democratic Gov. Ralph Northam's lockdown is scheduled for Thursday. In Wyoming protesters led calls to 'defend liberty' and urged Gov. Mark Gordon to not 'flatten the economy'.



Early research suggests that obesity is a big risk factor, but not asthma.


Early research on underlying health conditions associated with the virus has highlighted that obesity appears to be one of the most important predictors of severe cases of the coronavirus illness, but asthma does not.

New studies point to obesity as the most significant risk factor, after only older age, for patients being hospitalized with Covid-19, the illness caused by the virus. Some 42 percent of American adults — nearly 80 million people — live with obesity. Young adults with obesity appear to be at particular risk, studies show.

The research is preliminary, and not peer reviewed, but it buttresses anecdotal reports from doctors who say they have been struck by how many seriously ill younger patients of theirs with obesity are otherwise healthy.

For people with asthma, the outbreak of a disease that can lead to respiratory failure was particularly worrisome. Many health organizations have cautioned that asthmatics are most likely at higher risk for severe illness if they get the virus.

But data released this month by New York State shows that only about 5 percent of Covid-19 deaths in New York were of people who were known to also have asthma, a relatively modest amount. Nearly 8 percent of the U.S. population — close to 25 million people — has asthma, according to the Centers for Disease Control and Prevention.



Death tolls are growing at nursing homes in New York, New Jersey and Virginia.

The virus has been sweeping through nursing homes across the country and claiming the lives of thousands of residents who are particularly vulnerable — older people, many with underlying health issues, who are living in close quarters, as well as the people who care for them.

In New York and New Jersey, funeral directors have been unable to keep up with the death toll at one nursing home after another. In New York City, the administrator for a home in Queens said that 29 residents have died, but other workers said the toll was considerably higher. In a small New Jersey township, the police on Monday found 17 dead bodies inside a nursing home morgue designed to hold four people. This brought the death toll at the long-term care facility to 68, including 26 people who tested positive.
The $349 billion lending program for small businesses has run out of funds.
A federal loan program intended to help small businesses keep workers on their payrolls has proved woefully insufficient, with a staggering 22 million Americans filing for unemployment in the last four weeks.

The program, called the Paycheck Protection Program, was in limbo as the Small Business Administration said on Thursday that it had run out of money. Millions of businesses were unable to apply for the loans while Congress struggled to reach a deal to replenish the funds.

Congress initially allocated $349 billion for the program, which was intended to provide loans to businesses with 500 or fewer employees. The money went quickly, with more than 1.4 million loans approved as of Wednesday evening.





China’s economy shrinks, ending nearly half a century of continuous growth.

Chinese officials on Friday said the world’s second-largest economy had shrunk in the first three months of the year, ending a streak of untrammeled growth that survived the Tiananmen Square crackdown, the SARS epidemic and even the global financial crisis.

The data reflects China’s dramatic efforts to stamp out the coronavirus, which included shutting down most factories and offices in January and February as the outbreak sickened tens of thousands of people.

The stark numbers make clear how monumental the challenge of getting the global economy back on its feet will be, and may help to explain why world leaders — including President Trump — are so eager to restart their own economies. Since it emerged from abject poverty and isolation more than 40 years ago, China has become perhaps the world’s most important growth engine.

Now China is trying to restart its $14 trillion economy, an effort that could give the rest of the world a much-needed shot in the arm. The coronavirus’s spread to the United States and Europe, which froze the economies there, has led to forecasts that the world’s output could shrink far more this year than it did even during the financial crisis.