Having just ONE underlying health condition raises your risk of being admitted to intensive care or dying with coronavirus by almost 80%

• The odds are higher for those with two health conditions, China data shows
• Scientists looked at almost 1,600 patients who had been hospitalised
• A fifth of those with a health condition had adverse outcomes 
• Cancer was identified as the most unfavourable pre-existing illness
• Half of those with COPD had severe outcomes, and a quarter with diabetes

By VANESSA CHALMERS HEALTH REPORTER FOR MAILONLINE

PUBLISHED: 12:37 EDT, 9 April 2020 | UPDATED: 13:22 EDT, 9 April 2020

 
 
 
 
 
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Having an underlying health condition raises the risk of being admitted to ICU or dying by almost 80 per cent, a study has found.

The odds are even higher for those with two conditions, according to research of almost 1,600 hospital patients in China. 

Overall, 20 per cent of patients with any health condition ended up either in ICU, needing ventilation or dying compared to five per cent of healthy people. 

Scientists identified cancer and chronic obstructive pulmonary disease (COPD) as the riskiest pre-existing conditions to have prior to catching the life-threatening coronavirus. 

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Half of the patients with COPD in this study were moved into intensive care or died. In comparison, the rate was a fifth for those with high blood pressure, diabetes or cardiovascular disease.  

The findings are the result of a global scientific effort to understand who are the most vulnerable to serious illness from COVID-19. 

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Having just one underlying health condition raises the risk of being admitted to ICU, needing ventilation, or dying by almost 80 per cent, a study has found. The risk is 250 per cent times higher for those with a cancerous tumour compared to those without

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Scientists identified lung disease as the most unfavourable pre-existing condition to have prior to catching coronavirus. Each of these outcomes is broken down in the graphic. For example, a quarter of all patients with COPD died. Three in ten were admitted to ICU, which may or may not have included patients who died, as the outcomes cross-over each other

The risk of severe outcomes for total patients (left), patients without a condition (centre) and patients with a condition (right). The number in brackets is the percentage. The 'composite endpoint' consists of the number of patients who were admitted to intensive care unit, or had invasive ventilation, or died

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The clinical characteristics of patients with one (left, 269 people) or more than two health conditions (right, 130 people). The number in brackets is the percentage

OUTCOMES FOR EACH HEALTH CONDITION 

The following figures are a percentage of the total patients in that category: 

Cancer

Died: 17 per cent

ICU: 28 per cent

Ventilation: 11 per cent 

Any end point above:  39 per cent

COPD

Died: 25 per cent

ICU: 29 per cent

Ventilation: 21 per cent

Any end point above: 50 per cent

Heart/cardiovascular disease

Died: 14 per cent

ICU: 14 per cent

Ventilation: 10 per cent

Any end point above: 22 per cent

Diabetes

Died: 10 per cent

ICU: 15 per cent

Ventilation: 9 per cent

Any end point above: 24 per cent

High blood pressure

Died: 10 per cent

ICU: 14 per cent

Ventilation: 8 per cent

Any end point above: 20 per cent 

The research was the work of the China Medical Treatment Expert Group for Covid-19.

Lead study author Wei-jiie Guan, of Guangzhou Medical University, and colleagues analysed information for 1,590 hospitalised patients between December 2019 and January 2020.

The patients, with an average age of 49 years, were being cared for across 575 hospitals in 31 provinces or regions in mainland China. It means the study did not look at people with mild symptoms who recovered at home. 

Findings show 16 per cent of the patients ended up with severe COVID-19, and 8.2 per cent reached ‘composite endpoints’, which was either intensive care, ventilation, or death.

Fifty patients died, giving a mortality rate of 3.1 per cent for patients hospitalised. 

But the odds of death were clearly higher among those with a health condition - 8.8 per cent compared to 1.3 per cent in those without.  

Patients with two or more comorbidities had significantly escalated risks of becoming critically-ill, compared with those who had a single comorbidity, and even more so as compared with those without.

The likelihood raised by 160 per cent for those with two or more conditions, and 80 per cent for those with one.

Patients with COPD - a type of lung disease that causes chronic breathing problems – also had a 170 per cent increase in risk of serious outcomes, affecting half of the group. 

ICU, ventilation or death risk rose by 60 per cent for patients who had diabetes or high blood pressure.

But it was cancer that put patients most at risk. Those with a tumour had a 250 per cent increase in adverse outcomes.

Overall a quarter of the hospitalised patients had at least one underlying health condition, the most common of which was high blood pressure (17 per cent).

It’s unclear if this means those with hypertension are more likely to catch the coronavirus, are more likely to be hospitalised, or simply because the condition is more common.

Eight per cent had two or more conditions. Sometimes conditions co-exist together, with the authors noting diabetes and COPD specifically. 

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Another study from China published in February found similar results, showing that heart disease particularly put patients at a disadvantage if they caught coronavirus 

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This chart shows how most Italian coronavirus victims had pre-existing health conditions, with almost half of them suffering from three or even more illnesses before they were infected 

The team broke down how many people got seriously ill or succumbed to the disease for each health condition, but not by age bracket. 

A quarter of all patients with COPD died. Three in ten were admitted to ICU, which may or may not have included patients who died, as the outcomes cross-over each other. 

99% OF ITALIAN COVID-19 VICTIMS HAD A HEALTH CONDITION 

99 per cent of coronavirus deaths in Italy are patients with existing medical problems, a study by the country's health service revealed in March.

Research into 355 deaths found that only three of the victims, 0.8 per cent, had been clear of illnesses before they were infected.

Nearly half of them - 48.5 per cent - already had three or even more health conditions before they were diagnosed with Covid-19.

Another 25.6 per cent had two other 'pathologies', while 25.1 per cent had one.

The research by Italy's National Institute of Health is consistent with previous findings that people with existing illnesses are more likely to die from coronavirus. 

According to the study, the most common of these problems in Italy include high blood pressure, heart disease and diabetes.  

Some 76.1 per cent of the patients who died of Covid-19 had previously had problems with high arterial blood pressure, the study found. 

More than a third - 35.5 per cent - had diabetes, while 33.0 per cent had suffered from ischemic heart disease.

Nearly a quarter, 24.5 per cent, had suffered from atrial fibrillation. Less common examples included dementia and liver disease. 

Scientists have not yet established why people with high blood pressure are more vulnerable to the coronavirus. 

The Centers for Disease Control and Prevention in the U.S. says it needs 'more data to become available' to investigate the link properly.  

Following COPD, 14 per cent of heart disease patients died, and 14 per cent were admitted to ICU.

Diabetes and high blood pressure had similar outcomes. One in ten patients died, while 14 per cent were admitted to ICU.

The study didn't assess whether smokers are more or less likely to suffer adverse outcomes, amid growing concerns for those with the habit. 

It did show, however, that smoking - either in the past or currently - was more common in those with health conditions.  

Writing in the European Respiratory Journal, the authors said: ‘Among laboratory-confirmed cases of Covid-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.' 

The patients with at least one comorbidity showed more symptoms than those who did not, which suggests the virus is attacking their system more rapidly as their body tries to fight back.

Shortness of breath, nausea and abnormal chest X-rays were particularly more common than those who are typically healthy.   

The team theorised that the coronavirus infection may cause prolonged inflammation in those with pre-existing conditions, based on evidence from the SARS epidemic. 

They also said those with conditions already have a 'poorer baseline well-being'. It means their immune system isn't quite as prepared to fight an infection as someone who is healthy. 

Depending on what condition they have, it can hamper the ability of their immune cells' function in some way.

It takes longer for the cells to acknowledge a virus is in the body, and a delay in reaching it and attacking it.

For example, diabetics may have weakened immune cells as a result of the high amount of sugar in their blood.

Meanwhile, those with high blood pressure have damaged or narrow arteries, making it difficult for blood to travel effectively throughout the body.

But the exact mechanisms linking the coronavirus and poor outcomes in people who suffer health conditions warrants more research. 

Overall the findings have echoed other recently published studies. One of the first studies to indicate the risk of serious COVID-19 in vulnerable groups was in February, using data from more than 72,000 patients.

Its findings included that 10.5 per cent of COVID-19 patients with heart disease died, and six per cent of high blood pressure patients. 

The fatality rate was 7.3 per cent for diabetics and 6.3 per cent among people with chronic respiratory diseases, such as asthma. 

It looked at cases more broadly than the study published today, including those that were confirmed, suspected, clinically diagnosed, and asymptomatic.   

American health chiefs have also attempted to decipher who is most at risk in the US, where almost 435,000 cases have been diagnosed.

Among 7,162 cases, the Centers for Disease Control and Prevention found that 38 per cent had a health condition. 

Among 457 ICU admissions and 1,037 hospitalisations, 78 per cent and 71 per cent respectively occurred among people with one or more reported underlying health condition, according to their report.  

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One underlying health condition raises risk of intensive care or death with coronavirus by 80%

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Worldwide Virus Battle Rages On Amid Small Signs of Hope Scientists said drastic shifts in behavior appear to be having an effect, though the death toll will continue to mount.UPDATES

Bernie Sanders Drops Out of 2020 Democratic Race for President

Mr. Sanders, a democratic socialist making his second run for the White House, withdrew after a series of losses to Joseph R. Biden Jr., who emerges as the presumptive nominee for the general election.



Republicans Pursue Limits on Voting by Mail, Despite the Coronavirus

Trump and his Republican allies are launching an aggressive strategy to fight what many of the administration’s own health officials view as one of the most effective ways to make voting safer amid the deadly spread of Covid-19: the expanded use of mail-in ballots.

The scene Tuesday of Wisconsinites in masks and gloves gathering in long lines to vote, after Republicans sued to defeat extended, mail-in ballot deadlines, did not deter the president and top officials in his party. Republican leaders said they were pushing ahead to fight state-level statutes that could expand absentee balloting in Michigan, Minnesota, Arizona and elsewhere. In New Mexico, Republicans are battling an effort to go to a mail-in-only primary, and they vowed on Wednesday to fight a new move to expand postal balloting in Minnesota.

The new political effort is clearly aimed at helping the president’s re-election prospects, as well as bolstering Republicans running further down the ballot. While his advisers tend to see the issue in more nuanced terms, Mr. Trump obviously views the issue in a stark, partisan way: He has complained that under Democratic plans for national expansion of early voting and voting by mail, “you’d never have a Republican elected in this country again.”

In their efforts to fight expanding vote-by-mail, Republican officials are counting on a crucial and powerful ally: like-minded judges. This week, conservative majorities on the U.S. Supreme Court and the highest court in Wisconsin indicated they did not view the pandemic as cause to yield on ideology, issuing party-line rulings rejecting Democratic efforts to defer Tuesday’s vote or extend mail-in balloting.
The decisions seemed to augur a hard road for Democrats in the looming court fights over how to proceed with voting in this crisis moment.

The push to limit voting options is in keeping with Republicans’ decades-running campaign to impose restrictions that disproportionately affect people of color, the poor, and younger voters, under the banner of combating voter fraud — which is exceedingly rare. Democrats have more core constituencies among the nation’s disenfranchised, and both parties have long believed that easier voting measures will benefit Democrats.

But the current public health crisis brings new urgency to the battle, as Democrats and some Republican state officials turn to expanded voting by mail as an important way to avoid the serious health hazard of crowded polling stations amid a pandemic.

The president has embraced some of the most outlandishly false claims about voter fraud, at times proclaiming that the popular vote in the 2016 election — which he lost — was “rigged.” He has long impugned voting by mail, which, while more vulnerable to fraud than in-person voting, has proved overwhelmingly secure in states with mail-in elections, including Colorado and Washington State. (Mr. Trump had formed a special commission to investigate voter fraud in 2016 but it produced no evidence before he shut it down in 2018.)

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It's what it looks like: A refrigerated trailer serving as a temporary morgue in Brooklyn on Tuesday.Credit...Demetrius Freeman for The New York Times

In New York, ‘the bad news is actually terrible.’

New York, the hardest hit state in America, reported its highest number of coronavirus-related deaths in a single day on Wednesday, announcing that another 779 people had died. That brought the virus death toll to 6,268 in New York State, which Gov. Andrew M. Cuomo noted was more than twice as many people as the state had lost in the Sept. 11, 2001, attacks.

The number of hospitalizations had fallen in recent days, he said, suggesting that social distancing measures were working to flatten the steep curve of the virus’s spread, at least for now. The rates depend not only on the number of new arrivals but also on hospital admission standards.

“If we stop what we are doing, you will see that curve change,” Mr. Cuomo warned. Mr. Cuomo said that the staggering death toll could continue to rise even as hospitalization rates were falling, because it reflected people who had been on ventilators for long periods of time.

Then he pivoted to a more somber tone. “The bad news isn’t just bad,” he said. “The bad news is actually terrible.” New York State now has more confirmed cases than any single country in the world outside of the United States.



Never Seen Anything Like It’: Cars Line Up for Miles at Food Banks
Millions are flooding a charitable system that was never intended to handle a nationwide crisis.
Food banks are being squeezed by rising hunger and dwindling resources.

Demand for food assistance in the United States is rising at an unprecedented rate, as millions of Americans find themselves out of work and school closures mean that many families who counted on them for free or subsidized meals need to turn elsewhere.

The surge in need is coming just as food banks face shortages of both donated food and volunteer workers.

It’s a nationwide phenomenon:



Most New York Coronavirus Cases Came From Europe, Genomes Show

New research indicates that the coronavirus began to circulate in the New York area by mid-February, weeks before the first confirmed case, and that travelers brought in the virus mainly from Europe, not Asia.

“The majority is clearly European,” said Harm van Bakel, a geneticist at Icahn School of Medicine at Mount Sinai, who co-wrote a study awaiting peer review.

A separate team at N.Y.U. Grossman School of Medicine came to strikingly similar conclusions, despite studying a different group of cases. Both teams analyzed genomes from coronaviruses taken from New Yorkers starting in mid-March.

The research revealed a previously hidden spread of the virus that might have been detected if aggressive testing programs had been put in place.

On Jan. 31, President Trump barred foreign nationals from entering the country if they had been in China during the prior two weeks.

It would not be until late February that Italy would begin locking down towns and cities, and March 11 when Mr. Trump said he would block travelers from most European countries. But New Yorkers had already been traveling home with the virus.

“People were just oblivious,” said Adriana Heguy, a member of the N.Y.U. team.

Dr. Heguy and Dr. van Bakel belong to an international guild of viral historians. They ferret out the history of outbreaks by poring over clues embedded in the genetic material of viruses taken from thousands of patients.

While conspiracy theories might falsely claim the virus was concocted in a lab, the virus’s genome makes clear that it arose in bats. There are many kinds of coronaviruses, which infect both humans and animals. Dr. Boni and his colleagues found that the genome of the new virus contains a number of mutations in common with strains of coronaviruses that infect bats.

The most closely related coronavirus is in a Chinese horseshoe bat, the researchers found. Dr. Boni said that ancestral virus probably gave rise to a number of strains that infected horseshoe bats, and perhaps sometimes other animals.

It’s entirely possible, Dr. Boni said, in the past 10 or 20 years, a hybrid virus arose in some horseshoe bat that was well-suited to infect humans, too. Later, that virus somehow managed to cross the species barrier.

“Once in a while, one of these viruses wins the lottery,” he said.



C.D.C. issues new back-to-work guidelines for essential workers.

The Centers for Disease Control and Prevention published new guidelines on Wednesday detailing how essential employees can go back to work even if they have been exposed to people infected by the coronavirus, provided they do not feel sick and follow certain precautions.

Those employees can return if they take their temperature before heading to their workplaces, wear a face mask at all times and practice social distancing while on the job, Dr. Robert Redfield, the C.D.C. director, said at the White House briefing. They should not share headsets or other objects that touch their faces, and they should not congregate in break rooms or crowded areas, he said. Dr. Redfield said that employers should send workers home immediately if they developed any symptoms. He also said they should increase air exchange in their buildings and clean common surfaces more often.

["Is this for real?" asked esco20.]



A jail in Chicago is now the largest-known source of U.S. infections.

The Cook County Jail in Chicago, a sprawling facility that is among the largest jails in the nation, has emerged as the largest-known source of U.S. virus infections, according to data compiled by The New York Times.

At least 353 cases can be linked to the jail — more than have been connected to the U.S.S. Theodore Roosevelt; a nursing home in Kirkland, Wash.; or the cluster centered in New Rochelle, N.Y.

The Cook County Sheriff’s Office, which operates the jail, said 238 inmates and 115 staff members had tested positive as of Wednesday. The outbreak appears to confirm the concerns of many health officials, who warned that America’s overcrowded and unsanitary jails and prisons could be a major source of spread.

Hundreds of diagnoses have been confirmed at local, state and federal correctional facilities — almost certainly an undercount, given a lack of testing and rapid spread — leading to hunger strikes in immigrant detention centers and demands for more protection from prison employee unions.

In New York City, jails like Rikers Island are also seeing infection rates grow exponentially. City and state officials have promised the mass release of inmates. But many say they are not moving quickly enough, putting inmates, staff and the city at risk.
‘

Union for food workers asks for ‘mandatory’ guidance to protect its members.

The nation’s largest union representing grocery store and pharmacy workers asked the Centers for Disease Control and Prevention on Wednesday to issue “immediate and mandatory guidance” to protect the workers, and others at food processing and meatpacking facilities.

The union president, Anthony Perrone, also asked for the C.D.C.’s help improving safety conditions at food processing facilities — for example, by requiring them to provide protective gear to their workers.

Several big supermarket chains have reported deaths of employees from Covid-19; they include workers at a Trader Joe’s in New York, a Giant in Maryland and a Walmart outside Chicago.

The C.D.C. did not immediately respond to a request for comment on the letter, and it was unclear if the agency could require such actions. Its guidance is generally not mandatory.



Some college students don’t want to pay in-person tuition for online classes.

Students at the University of Chicago are organizing a tuition strike, threatening to withhold their payments for the spring quarter if the school doesn’t give them a hefty discount.

That cry is being heard on other campuses as well, as students complain that online classes don’t measure up to the real thing and say they shouldn’t have to pay the full load for a subpar experience, especially at a time when more are facing financial uncertainties.

While a number of colleges are offering refunds of room and board charges, students in a number of schools are asking them to lower tuition as well.

At the New School in New York City, students have called for a boycott of online classes this week if the school didn’t refund part of their spring tuition. Students at Stanford, the University of California at Berkeley and New York University’s Tisch School of the Arts have all started online petitions calling for partial refunds.

Black Americans Face Alarming Rates of Coronavirus Infection. 41 Transit Workers Dead: Crisis Takes Staggering Toll on Subways.

NY TIMES
The coronavirus is infecting and killing black people in the United States at disproportionately high rates, according to data released by several states and big cities, highlighting what public health researchers say are entrenched inequalities in resources, health and access to care.

The statistics are preliminary and much remains unknown because most cities and states are not reporting race as they provide numbers of confirmed cases and fatalities. Initial indications from a number of places, though, are alarming enough that policymakers say they must act immediately to stem potential devastation in black communities.

The worrying trend is playing out across the country, among people born in different decades and working far different jobs.

“This is a call-to-action moment for all of us,” said Lori Lightfoot, the mayor of Chicago, who announced statistics of the outbreak in her city this week. African-Americans account for more than half of those who have tested positive and 72 percent of virus-related fatalities in Chicago, even though they make up a little less than a third of the population. “Those numbers take your breath away, they really do,” said Ms. Lightfoot, who is the city’s first black woman elected as mayor. She added in an interview that the statistics were “among the most shocking things I think I’ve seen as mayor.”

In Illinois, 43 percent of people who have died from the disease and 28 percent of those who have tested positive are African-Americans, a group that makes up just 15 percent of the state’s population. African-Americans, who account for a third of positive tests in Michigan, represent 40 percent of deaths in that state even though they make up 14 percent of the population. In Louisiana, about 70 percent of the people who have died are black, though only a third of that state’s population is.

On the South Side of Chicago, LaShawn Levi, a medical assistant who rides the bus to work each day, turned to tea and cough syrup — “everything your grandma taught you” — to treat a headache and a cough. Ms. Levi, thinks that her daily bus ride to work could have been the source of her exposure. Or, she said, she could have picked it up in the hospital where she works, at the grocery store, or from food served to her.

Donations of personal protective equipment were collected to distribute to medical workers in Chicago.

North Carolina and South Carolina also have reported a ratio of black residents to white residents who have tested positive for the virus that well exceeds the general population ratio. Black people are overrepresented among those infected in the Las Vegas area and among people who have tested positive for the virus in Connecticut. In Minnesota, black people have been infected with the coronavirus at rates roughly proportionate to their percentage of the state’s population.

For many public health experts, the reasons behind the disparities are not difficult to explain, the result of longstanding structural inequalities. At a time when the authorities have advocated staying home as the best way to avoid the virus, black Americans disproportionately belong to part of the work force that does not have the luxury of working from home, experts said. That places them at high risk for contracting the highly infectious disease in transit or at work.

Longstanding inequalities also make African-Americans less likely to be insured, and more likely to have existing health conditions and face racial bias that prevents them from getting proper treatment. Many black residents live in segregated neighborhoods that lack job opportunities, stable housing, grocery stores with healthy food and more.

High levels of segregation in large urban counties lower the life expectancies of African-American residents but have little effect on the life expectancies of white residents, according to an analysis of the County Health Rankings by the University of Wisconsin Population Health Institute. Before the pandemic hit, officials had calculated that white Chicagoans had an average life expectancy of 8.8 years longer than black residents.

Initial indications are that doctors are less likely to refer African-Americans for testing when they visit a clinic with symptoms of Covid-19, the disease caused by the virus. The death toll has been particularly devastating among African-Americans.

One factor that might make the coronavirus more devastating for African-Americans is that they experience high levels of stress-mediated wear and tear known as “weathering,” said Arline Geronimus, a professor of public health at the University of Michigan who studies the concept.

Stresses like exposure to toxins, lack of sleep and racial discrimination, Dr. Geronimus said, can cause a kind of accelerated aging. The coronavirus is most lethal in people over 65.



NY TIMES

At least 41 transit workers have died, and more than 6,000 more have fallen sick or self-quarantined. Crew shortages have caused over 800 subway delays and forced 40 percent of train trips to be canceled in a single day. On one line the average wait time, usually a few minutes, ballooned to as high as 40 minutes.

Since the coronavirus pandemic engulfed New York City, it has taken a staggering toll on the Metropolitan Transportation Authority, the agency that runs the subway, buses and commuter rails and is charged with shuttling workers — like doctors, nurses and emergency responders — who are essential to keeping the city functioning.

But the transit agency may have deepened its work force crisis by not doing more during the early stages of the outbreak to protect its employees and delaying some steps laid out in a plan the M.T.A. had developed for dealing with a pandemic.

The transit agency was late to distribute disinfectant to clean shared work spaces, struggled to keep track of sick workers and failed to inform their colleagues about possible exposure to the virus, according to interviews with two dozen transit workers.

As the virus spread, many workers became so concerned that they took measures into their own hands: They cordoned off seats with duct tape to distance drivers from riders and used their own masks and homemade disinfectant at work, only to be reprimanded by supervisors.

Patrick J. Foye, the M.T.A. chairman, who himself tested positive for coronavirus, said the M.T.A.  provided 460,000 masks to workers, in addition to thousands of face shields and 2.5 million pairs of gloves.

Still, around 1,500 transit workers have tested positive for the coronavirus, and 5,604 others have self-quarantined because they are showing symptoms of the infection. Absenteeism is up fourfold since the pandemic began, officials say.

Transit officials have repeatedly pledged to keep the system running as smoothly as possible to ferry people who continue to rely on public transit.

But already, the absences have crippled the agency’s ability to operate its sprawling public transit network, the largest in North America. It has been forced to slash service beyond what was laid out in its initial emergency plan, which reduced service by 25 percent at the end of March.

That plan also cut in half the number of workers needed each day, in an effort to help to promote social distancing in shared work spaces, officials say.

Now transit workers warn that the worsening staffing shortage will make it increasingly difficult to keep even a diminished system running. The authority is disinfecting train cars and buses every three days and has urged riders to wait for empty trains to mitigate the overcrowding problems caused by reduced service.

The M.T.A have also given out the 2.5 million pairs of gloves, hand sanitizer, cleaning supplies and sanitizing wipes to workers in recent weeks, officials said, and have eliminated cash transactions between booth clerks and riders. Still, safety concerns continue. With trains running less frequently, platforms and subway cars have become overcrowded at times, making social distancing impossible.


In March, bus drivers began cordoning off the front of their buses with tape and instructing riders to enter through the back door — a strategy the M.T.A. later formally adopted.

By the end of March, the virus had infiltrated the agency’s work force: On March 24, M.T.A. officials said 52 transit workers had been infected. A week later, the number jumped to 333, with seven workers dead.

The true number of sick workers was most likely higher than official counts, but the authority was having trouble keeping track.

The M.T.A. had set up a hotline for workers to report positive test results and to receive guidance on whether they should self-quarantine. But it had become so overwhelmed — with 7,000 to 8,000 calls per day — that it took some workers days to get through

In response to complaints, the agency increased the number of workers assigned to the hotline to 200, from 50. Now 95 percent of calls are answered, and average wait times on the line are about a minute, according to a transit agency spokeswoman.

With the agency initially struggling to notify workers about sick colleagues they might have been exposed to, employees came to rely on Facebook groups to share information. And as the pandemic rolled into its second month in New York, multiple posts reporting sicknesses or deaths were flooding in each day.

“We’re seeing a lot of our co-workers getting sick or dying. The morale is down. It is very, very bad,” said Nasar Abdurrahman, a bus operator. A colleague at his bus depot, Ernesto Hernandez, died from the virus at the end of March.

At one train terminal, every train dispatcher had fallen ill, leaving supervisors to take their place.Some employees stopped showing up altogether, opting to burn through their personal and vacation days.

Daniel Cruz, a bus operator who has worked at the M.T.A. for three years, tested positive for the coronavirus on March 29 — three days after he learned that a friend and colleague, Oliver Cyrus, had died from the virus. “I love my job, but I’m not looking forward to going back to work. I feel like we’ve been left to defend ourselves,” Mr. Cruz said. “At this point, we’re just transporting the virus.”

N.Y. Virus Deaths Hit New High, but Hospitalizations Slow. UPDATES

New Jersey and Connecticut also had one-day highs in coronavirus-related deaths. Officials in the three states still saw reason for hope.

Five weeks into the coronavirus outbreak, officials in New York and New Jersey, the two states hit hardest by the pandemic, hoped that the number of virus-related deaths had reached a peak and would flatten or drop for a third straight day.
It did not happen.

Gov. Andrew M. Cuomo said on Tuesday that 731 people had died of the virus since Monday, the state’s highest one-day total yet by more than 100.

More people have died in New York and New Jersey, by far, than in any other state. The two states together account for more than half of the virus-related deaths in the United States. New York’s toll was 5,489 as of Tuesday; New Jersey’s was 1,232. In Connecticut, where the virus appears to have been slower to spread, 277 people have died.

Mr. Cuomo described death as a lagging indicator in the fight against the virus: People are often ill with it for a long time before they die, he said. By other measures, he said, the curve of infection was flattening in New York,  even as the number of critically ill patients kept rising.

The number of virus patients in hospitals increased 4 percent since Monday, the fourth straight day that it had grown 7 percent or less after growing at least 20 percent a day for weeks. The number of patients on ventilators in intensive-care units increased, too, but at the smallest one-day rate in weeks, up 2 percent since Monday.

As of Tuesday, there were nearly 4,600 patients on ventilators in New York, far fewer than pessimistic projections in recent weeks had said there might be. That has helped keep the state from exhausting its supply of ventilators.

And as in New York, New Jersey officials noted that the numbers of people in critical care and on ventilators were far below their worst-case scenarios.

For the number of people in hospitals to stop increasing, he said, New Yorkers must continue to vigilantly practice social distancing and other behavior that reduce the virus’s spread. “To the extent that we see a flattening or a possible plateau, that’s because of what we are doing and we have to keep doing it,” the governor said.

Virus deaths may be undercounted as more people die at home.

The official death figures, awful as they are, may not actually reflect the virus’s true toll Around the country, according to experts and officials, virus-related deaths  are being undercounted because of inconsistent protocols and limited resources.

In New York City, the leader of the City Council’s health committee, Mark Levine, wrote on Twitter that people were dying at home at about 10 times the normal rate, presumably in large part because of the virus, but that many deaths were not being counted as virus deaths.

According to the news site Gothamist, the city medical examiner’s office has not been testing dead bodies for the virus and has instead referred what it considers “probable” virus deaths to the city’s health department.

But the health department counts only confirmed virus cases in its official death tally, Gothamist reported, suggesting that many virus deaths were being missed.

In N.Y.C., the coronavirus is killing men twice as often as women.

In its inexorable spread across New York City, the coronavirus is exacting a greater toll on men than women. Not only are men infected in greater numbers, new data show, but they are also dying at nearly twice the rate of women.

To date, there have been nearly 43 Covid-19 deaths for every 100,000 men in the city, compared with 23 such deaths for every 100,000 women, according to figures reported by the city’s health department. And men are being hospitalized with severe disease at higher rates.

Possible explanations for the disparity have ranged from differences in behavior — smoking rates among men exceed those among women in much of the world, for example — to biological differences.

Women have more robust immune systems, some scientists have noted, that provide an edge in fighting off infections — although it also makes them more susceptible to autoimmune disorders.

“I’m in the emergency room, and it’s remarkable — I’d estimate that 80 percent of the patients being brought in are men,” said Dr. Hani Sbitany, a reconstructive surgeon at Mount Sinai Health Systems who has been treating Covid-19 patients in Brooklyn. “It’s four out of five patients.”

New York says it has enough ventilators for now.

It had been a constant refrain through the weeks of the outbreak.

Mr. Cuomo and Mr. Bill de Blasio had both repeated daily that the city and state faced a desperate need for ventilators to help virus patients in intensive care keep breathing. But on Monday, both said that, for the moment, that need had been met.

Mr. de Blasio said Monday night on NY1 that after receiving another 500 ventilators from the state, “The situation related to the number of I.C.U. beds and ventilators has appeared to change meaningfully.” He said the city now had enough ventilators to last through the end of the week.

Mr. Cuomo said earlier on Monday that the state had received ventilators from California, Oregon and elsewhere, adding, “We don’t need any additional ventilators right now.”

De Blasio urges focus on feeding New Yorkers in need.
Mr. de Blasio said on Tuesday that, along with struggling to halt the virus’s spread, New York City was increasingly focused on helping the growing number of people who were unemployed and unsure of where their next meal would come from.“There’s a new front opening up and we have to be there for people who need food,” the mayor said.

According to a Siena College Research Institute poll published on Monday, 49 percent of city residents worry about putting food on the table.

A separate survey by the CUNY Graduate School of Public Health and Health Policy, published on Tuesday, found that for more than half of New Yorkers, the virus and its effects had hurt their households’ ability to get the food they need. Around one in five said their ability to procure food had been reduced “a lot.” Mr. de Blasio said that in the past three weeks, city programs had served 2.6 million meals to New Yorkers who needed food “and that is just the beginning.”

He cited a projection that showed at least 500,000 New Yorkers had either lost their jobs or soon would.

John Prine, folk singer and songwriter, dies of complications of Covid-19.

John Prine, the raspy-voiced country-folk singer whose ingenious lyrics to songs by turns poignant, angry and comic made him a favorite of Bob Dylan, Kris Kristofferson and others, died Tuesday at Vanderbilt University Medical Center in Nashville, Tenn. He was 73.

The cause was complications from Covid-19, his family said.

Mr. Prine underwent cancer surgery in 1998 to remove a tumor in his neck identified as squamous cell cancer, which had damaged his vocal cords. In 2013, he had part of one lung removed to treat lung cancer.

Mr. Prine was a relative unknown in 1970 when Mr. Kristofferson heard him play one night at a small Chicago club called the Fifth Peg, dragged there by the singer-songwriter Steve Goodman. Mr. Kristofferson was performing in Chicago at the time at the Quiet Knight. At the Fifth Peg, Mr. Prine treated him to a brief after-hours performance of material that, Mr. Kristofferson later wrote, “was unlike anything I’d heard before.”

His debut album, called simply “John Prine” and released in 1971, included songs that became his signatures. Some gained wider fame after being recorded by other artists.

Mr. Dylan, listing his favorite songwriters for The Huffington Post in 2009, put Mr. Prine front and center. “Prine’s stuff is pure Proustian existentialism,” he said. “Midwestern mind trips to the nth degree. And he writes beautiful songs.”

U.S. reports highest daily coronavirus death toll

The daily death toll from coronavirus in the United States surpassed 1,800 on Tuesday, marking a new global high for the number of deaths linked to the virus in one country in a single day. The grim figure emerged as Wuhan, the Chinese city where the outbreak was first recorded late last year, reopened after nearly 11 weeks of lockdown. Outbound traffic was permitted beginning at midnight local time, although schools and many businesses remain closed.

Combative in public, Trump administration and congressional leaders negotiate behind the scenes on coronavirus relief.

The core five leaders in Washington — President Trump, House Speaker Nancy Pelosi (D-Calif.), Senate Majority Leader Mitch McConnell (R-Ky.), House Minority Leader Kevin McCarthy (R-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) — and their interactions with one another have come under scrutiny amid the coronavirus outbreak, as the pandemic continues to swamp the nation, killing thousands of Americans and plunging the U.S. economy into crisis.

Yet for all the public signs of discord, communications and coordination between congressional leaders and the Trump administration have hummed along, compensating for the dysfunctional relationship — or the outright lack of one — between Trump himself and the top two Democrats on Capitol Hill.

Since the massive $2 trillion rescue package was signed into law March 27, Schumer has spoken on the phone with Trump about a half-dozen times, but also directly with Vice President Pence and with newly minted White House chief of staff Mark Meadows several times, according to an official familiar with the calls, who spoke on the condition of anonymity to discuss them. And already this week, the official said, Pelosi has spoken to Treasury Secretary Steven Mnuchin multiple times to discuss the rocky implementation of the stimulus bill and what Washington will need to do in the next phase of coronavirus legislation.

Who gets a shot at life if hospitals run short of ventilators?

States, hospitals scramble to set guidelines that could prioritize pregnant women, health-care workers — and even some politicians

Pregnant women would get extra priority “points” in most if not all plans, U.S. hospital officials and ethicists say. This is not controversial. There also has been some discussion about whether high-ranking politicians, police and other leaders should be considered critical workers at a time when the country is facing an unprecedented threat.

Pennsylvania officials recently adopted new guidelines giving doctors, nurses and others fighting covid-19, the disease caused by the novel coronavirus, preferential access to scarce ventilators in a shortage.

Some bioethicists have called for a national plan for rationing that would resolve disagreements and prevent “hospital shopping” by patients seeking care in a place that might favor their survival. But others believe a single standard is an impossible ask, given the nation’s deep ideological and religious divisions on life-or-death issues.

Bioethicist Brendan Parent, who worked for a New York state task force that developed a highly regarded framework for rationing, sees hospitals and states following two paths.

One group takes a utilitarian view of doing “the greatest good for the greatest number,” giving preference to those with the best chance of surviving the longest. Others are more focused on ensuring social justice and ensuring vulnerable groups have an equal chance.

Parent said there may be acrimony over various plans but that the alternative of treating everyone exactly the same — for instance, by using a lottery system — is not compatible with saving the most lives. At Ronald Reagan UCLA Medical Center in Los Angeles, patients with a life expectancy of one year or less — such as some with advanced cancer, or severe heart failure combined with other conditions — would be assigned a lower priority than those with a longer life expectancy, according to the documents.

Robert Cherry, chief medical and quality officer for UCLA Health, said that while the plan doesn’t list a specific age as a benchmark, age is “an indirect marker for chronic illness. The older you get, the more you are likely to have heart disease and other things that impact your survival.”

To protect Trump, White House among first to use rapid coronavirus tests sought by communities

As communities across the country desperately seek access to emerging rapid-turnaround covid-19 tests, one place already using them is the White House, where guests visiting President Trump and Vice President Pence have been required to undergo the exams since last week.

The procedure is the latest of new safeguards aimed at protecting the health of the nation’s top elected officials from the novel coronavirus, which has sickened some prominent global leaders. Among them is British Prime Minister Boris Johnson, a Trump ally, who was moved to intensive care this week in a London hospital due to complications of the illness.

White House visitors said they have been administered the test developed by Abbott Laboratories at the Eisenhower Executive Office Building, the complex across the street from the West Wing where Pence has an office and the staff of the National Security Council is based.

Abbott, which is producing 50,000 tests per day, began shipping supplies to the White House last week, though a spokesman for the company declined to say how many of the kits were sent.

One recent visitor to the White House described his experience, saying a nurse swabbed both of his nostrils in less than a minute and inserted them into the Abbott machine for an assessment. This person noticed administration officials, including a couple Cabinet members, waiting to get tested, and he was told that every visitor meeting the president would get a test, even if they felt healthy.

UPDATES: NY Deaths relatively flat across the region.

For days, officials in and around New York sought indications that the coronavirus was nearing a peak in the region — the U.S. epicenter of the pandemic — and might start leveling off. And for days, the death toll climbed faster and faster.  In New York State, for instance, it rose by more than 200, then more than 400, then 630 people in a single day.
But on Monday, for the second day in a row, officials found reasons for hope even as hundreds of people continued to die and thousands clung to life on ventilators. On both Sunday and Monday, fewer than 600 deaths from the virus were reported in New York: 594 on Sunday, 599 on Monday, Gov. Andrew M. Cuomo said. Mr. Cuomo said the data suggested that the spread of the virus in New York was nearing its apex, but he emphasized that the state remained in a dire, unsustainable state of emergency. “If we are plateauing, we are plateauing at a very high level and there is tremendous stress on the health care system,” he said.

Here were the latest numbers from the day:

Deaths in New York State: 4,758, up 599 from 4,159 on Sunday morning.

Confirmed cases: 130,689, up from 122,031 in New York.

Hospitalized in New York State: 16,837, up 2 percent from 16,479 on Sunday. It was the third straight day of single-digit percentage growth, after a long period when hospitalizations were growing 20 to 30 percent a day.

In intensive care: 4,504, up 2 percent from 4,376 on Sunday. The day-over-day increase, 128, was the smallest in at least two weeks. Last week, the number of people in intensive care beds, which have ventilators, was growing by more than 300 people a day.

In New York City, officials said later on Monday that the number of virus cases had reached 68,766, that an estimated 15,333 virus patients were hospitalized and that the death toll was 2,738.

Even if the  infection curve is flattening, the virus’s daily toll remains horrific.
New York City reported a one-day total of 219 deaths on Monday morning, bringing the city’s death toll to 2,475.

In a notable shift from previous weeks, when he pleaded for more ventilators from the federal government and other states, he said New York was now adequately stocked.

Later in the day, Mr. Cuomo said in an interview on MSNBC that President Trump had approved his request for the U.S.N.S. Comfort, a 1,000-bed Navy hospital ship that arrived in New York last week, to begin treating virus patients.

In New Jersey, Gov. Philip D. Murphy reported 71 reported deaths on Monday, and 86 on Sunday, after a three-day streak when deaths had broken triple digits. And in Connecticut, Gov. Ned Lamont on Monday reported a one-day death toll of 17, the smallest number since last Wednesday.

Donald Trump's top economic adviser Peter Navarro warned White House officials in January and February that coronavirus could kill up to two million Americans and cost the economy $5.7 Trillion

 President Donald Trump's trade adviser Peter Navarro issued his first grim warning in a memo dated January 29 - just days after the first COVID-19 cases were reported in the US. At the time, Trump was publicly downplaying the risk that the novel coronavirus posed to Americans - though weeks later he would assert that no one could have predicted the devastation seen today. Navarro penned a second memo about a month later on February 23, in which he warned that as many as two million Americans could die from the virus as it tightened its grip on the nation. The memos were obtained by the New York Times and Axios on Monday, as the number of COVID-19 cases nationwide surpassed 368,200 with at least 11,000 deaths.

 

Prime Minister Boris Johnson of Britain has been moved to intensive care.

Prime Minister Boris Johnson was moved into intensive care on Monday, a worrisome turn in his 10-day battle with the coronavirus and the starkest evidence yet of how the virus has threatened the British political establishment and thrown its new government into upheaval.

In a sign of how grave the situation had become, Downing Street said in a statement on Monday that Mr. Johnson had asked the foreign secretary, Dominic Raab, to deputize for him “where necessary.” The pound fell against the dollar after investors reacted to the news.

After noting earlier in the day that the prime minister was still getting official papers, Mr. Johnson’s aides said he had been moved to the intensive care unit in case he needed a ventilator to help his recovery. Not every patient in critical care is ventilated, medical experts said, but many are — or are at least given oxygen. Mr. Johnson remains conscious, officials said.

Worried that $2 trillion law wasn’t enough, Trump and congressional leaders converge on need for new coronavirus economic package

Political leaders say more aid is needed to confront mounting economic problems

Congressional leaders and the White House are converging on the need for a new assistance package to try to contain the coronavirus pandemic’s economic devastation, fearful that a $2 trillion bailout law enacted last month will have only a limited effect.

House Democrats are eyeing a package of spending increases that would “easily” cost more than $1 trillion, Speaker Nancy Pelosi (D-Calif.) told lawmakers Monday, according to two officials on the conference call who spoke on the condition of anonymity to discuss it. Democrats are looking to extend unemployment aid and small-business assistance for additional months, as well as authorize another round of direct checks to taxpayers.

Trump has signaled support for some of the ideas that Democrats back, such as expanded help for small-business owners and new bailout checks for households. Republican leaders, meanwhile, have also called for more corporate aid and money to boost the overwhelmed health-care system.

Although there is some overlap in the political ideas, significant differences remain, and it’s unclear whether the sides will be able to reach a deal in the coming weeks. In a sign that lawmakers might be preparing to cut a deal, Pelosi has backed away from some of her recent proposals that Republicans found most objectionable, including a multi-trillion-dollar infrastructure plan. And Senate Majority Leader Mitch McConnell (R-Ky.) has said he believes that Congress will have to act again to address health-care needs, among other things, opening the door to a pact. The two leaders spoke Thursday.

Their work to mobilize new legislation came amid growing signs that the economy is deteriorating much faster than expected and that the initial $2 trillion law is proving insufficient. Former Federal Reserve chair Janet L. Yellen told Pelosi and House Democrats on their conference call that the actual unemployment rate is probably 13 percent, not the 4.4 percent the Bureau of Labor Statistics reported Friday.

Households and businesses are confronting so much turmoil that the new assistance programs are overwhelmed. State unemployment offices have been bombarded with people seeking help. And Bank of America said Monday that it had received 178,000 applications from firms seeking $32.9 billion in loans as companies clamor to qualify for the $349 billion Small Business Administration program.

The Senate has tentatively scheduled votes for the week of April 20, and the House leadership has also targeted that week for potential votes. But aides say the legislative schedule is entirely dependent on the course of the pandemic and whether the two chambers and Trump can come together on workable legislation.

As the virus spreads, crime plunges across New York

.

Crime has plummeted in New York City and across the state since the governor announced a stay-at-home order more than three weeks ago, data released on Monday shows.

In New York City, the number of felony and misdemeanor cases dropped a collective 43.3 percent from March 18 to March 24, compared with the same period in 2019, according to the New York State Division of Criminal Justice Services.

All other regions in the state experienced an even greater decline over the same period: a drop of nearly 69 percent in misdemeanors and felonies.

Saudi Arabia locks down more cities amid steep increase in infections

Saudi Arabia announced late Monday that nine more cities would be added to the list of those on 24-hour lockdown, including the the capital, Riyadh, and the Red Sea port city of Jeddah.

Previously just the holy cities of Mecca and Medina, international pilgrimage destinations that had seen large numbers of cases, were subjected to these 24-hour curfews, along with some Jeddah neighborhoods. The rest of the country just had to stay inside at night.

Sabato's Chrystal Ball: Electoral College and Senate

Democrats edge slightly ahead, but presidential race still a Toss-up; upper chamber battle gets closer; governors face what likely will be the biggest test of their tenures

LARRY SABATO

KEY POINTS FROM THIS ARTICLE

— We are not dramatically revising our outlook for the presidential election, at least not yet.

— That said, several rating changes in the Electoral College and Senate generally benefit Democrats.

— Many governors are getting high marks for their responses to the crisis; even for those elected in 2018, the most consequential and high-profile test of their tenures is probably happening right now.

Table 1: Crystal Ball Electoral College rating changes

State	Old Rating	New Rating
Colorado	Leans Democratic	Likely Democratic
Maine	Leans Democratic	Likely Democratic
North Carolina	Leans Republican	Toss-up

Table 2: Crystal Ball Senate rating changes

Senator	Old Rating	New Rating
Martha McSally (R-AZ)	Toss-up	Leans Democratic
David Perdue (R-GA)	Leans Republican	Likely Republican
Susan Collins (R-ME)	Leans Republican	Toss-up

The Electoral College

While the public health crisis has complicated the president’s path to a second term, we think it’s premature to make dramatic changes to our assessment of the presidential election. We’ve long thought the president’s chances of reelection have been around 50-50. In light of recent developments, it may be that the president’s odds are a little bit lower now, but we don’t think the data suggest going further than that at this time.

This slight change in our overall assessment is reflected in the new ratings, which are shown in Map 1. We are moving North Carolina from Leans Republican to Toss-up, and also moving Colorado and Maine’s two statewide electoral votes from Leans Democratic to Likely Democratic.
Map 1: Crystal Ball Electoral College ratings

Joe Biden has consistently led Donald Trump in North Carolina polling, albeit only by a few points. Trump won it by about 3.5 points in 2016, about the same as Arizona, another historically Republican presidential state we rate as a Toss-up.

Trump’s win in the Tar Heel State, particularly the margin, was somewhat surprising: Many plugged-in observers were very pessimistic about Trump’s odds in North Carolina in 2016, owing to their belief that Trump would underperform typical GOP performance in the state’s population centers, namely Charlotte and Raleigh. That did in fact happen, although not as sharply as some expected, but Trump more than compensated for that by improving on usual Republican performance outside of those urban centers, most notably in more sparsely-populated western and southern North Carolina. We think the Democrats have room to keep growing in the big metro areas, and perhaps also in the African-American vote if Democrats can generate better turnout from this group of voters. Then again, Trump may have room to grow in outstate areas as well. Overall, the state is competitive enough that we think Toss-up is the better rating.

Meanwhile, Colorado’s trajectory has been similar to that of Virginia’s: Both states have been becoming more Democratic thanks in large part to the continued shift of many white voters with four-year college degrees into the Democratic column (both states have higher-than-average formal education levels). One of the consequences of Trump’s behavior in office is that while he has held the GOP coalition together, he hasn’t really expanded his appeal all that much among voters who were skeptical of him in 2016. Trump lost both Colorado and Virginia by five points in 2016. That’s a big gap to make up: too big, we think, given the present circumstances.

Maine was closer in 2016 — a three-point margin — and while Trump is probably still on track to win the single electoral vote in Maine’s Second Congressional District, we don’t see him making up much if any ground in the First District, which casts more votes than the Second District and is more liberal. That should be enough to give the Democratic nominee three of the four electoral votes in Maine. The only other state that splits its electoral votes this way is Nebraska, where the Second District is also a Toss-up while the rest of the state is Safe Republican. We looked at both states in depth earlier this year.

This puts our Electoral College tally as 248 for the Democrats, 233 for the Republicans, and 57 electoral votes in the Toss-up category (Arizona, North Carolina, Pennsylvania, Wisconsin, and the aforementioned single electoral vote in the Omaha-based NE-2).

While the Democrats are nominally ahead now, these ratings reflect a presidential race that we would still characterize as a Toss-up overall. Based on our ratings, both sides are still multiple states away from an Electoral College majority.

The Senate
The battle for the Senate is getting more competitive, with Democrats pushing the overall map more into Toss-up territory. Two of our rating changes reflect that overall picture this week.
Map 2: Crystal Ball Senate ratings

First of all, we’re moving the special election in Arizona from Toss-up to Leans Democratic this week. Likely Democratic nominee Mark Kelly (D), a former astronaut who is the husband of former Rep. Gabrielle Giffords (D-AZ), has consistently led appointed Sen. Martha McSally (R-AZ) in polling, and not just by a little: four surveys in March showed Kelly up anywhere from five to 12 points, a better margin than Biden enjoys in the state (he has led Trump there in polling, but by smaller margins).

We came away from 2018 a bit skeptical of McSally as a candidate: She lost to now-Sen. Kyrsten Sinema (D-AZ) by about 2.5 points, and McSally was not quite able to translate her impressive background as an accomplished Air Force pilot into an appealing persona as a candidate. She has spent much of her time as a Senate appointee trying to consolidate support on the right, a task she apparently has not yet accomplished given that Trump appears to be doing better in the state than she is. Kelly also has a considerable fundraising advantage on McSally.

Surely some Republicans will think we’re being too bullish on Democratic Senate odds in Arizona, just like some believe we’re too bullish on Democrats in Colorado, another GOP Senate state we rate as Leans Democratic. But we would just rather be the Democrats in both states at this point in time; that of course can change.

We are also moving Sen. Susan Collins (R-ME) from Leans Republican to Toss-up. We’ve resisted this change for a while, but it’s become apparent to us that Collins is in for a very close race, even if she may retain a lead at this precise moment. Her likeliest opponent is state House Speaker Sara Gideon (D).

There is one positive rating change for Republicans. We have not been very impressed by Democratic recruitment for both Senate races in Georgia, and we’re upgrading Sen. David Perdue (R-GA) from Leans Republican to Likely Republican. We’re also tempted to move the Senate special election there to Likely Republican, but we’re going to hold off in light of the potential for appointed Sen. Kelly Loeffler (R-GA) to be damaged by recent reporting that she benefited from a stock sell-off before the markets took a dive as the coronavirus pandemic emerged, prompting accusations of a form of insider trading. She has denied any wrongdoing and argued that she has outsourced her investment decisions to an investment firm. It’s possible that if the story has an impact, it could help Rep. Doug Collins (R, GA-9), Loeffler’s GOP rival, as much or more than the Democrats; all candidates are running together in a special election this November, with a January 2021 runoff looming in the likely event no one gets over 50% in the special.

These rating changes help clarify tiers of targets for Democrats in November. Assuming that Republicans defeat Sen. Doug Jones (D-AL), which we see as likely, Democrats need to win at least four currently Republican seats to get to a 50-50 tie in the Senate, which the incoming vice president would break.

We have Democrats favored in two Republican seats, Arizona and Colorado. Then there are two genuine Toss-ups, Maine and North Carolina, followed by Leans Republican states Iowa and Montana, along with the Georgia Senate special. These states are where the Senate majority will be won, in all likelihood.

This generally reflects some of the early ad bookings from two of the major outside Senate campaign groups, Senate Leadership Fund (pro-Republican) and Senate Majority PAC (pro-Democratic). Both booked close to $70 million in ad spending in five of the six same states: Arizona, Colorado, Iowa, Maine, and North Carolina. The one outlier was that SLF, the pro-GOP group, also booked time in Kentucky, where Senate Majority Leader Mitch McConnell (R-KY) is seeking a seventh term. We rate Kentucky as Likely Republican. These bookings are always interesting because they telegraph the races that party operatives are prioritizing the most. But they also are subject to cancellation — or enhancement.

We’ll have more to say specifically on the House next week, but Democrats continue to be favored to hold their House majority. One of the many aftereffects of the coronavirus crisis may be that it could give Democrats in Trump-won districts an opportunity to emphasize their own responses to the disaster after Republicans were hoping to use impeachment as a way to tie these Democrats to national Democratic leaders.

We were skeptical even during impeachment that it would be a major focus of the fall campaign; coronavirus is likely pushing that battle even further out of the public consciousness. That’s probably a net-positive for the most vulnerable House Democrats.

Governors generally getting high marks
While the ultimate effects of the pandemic on the presidential race may be somewhat nebulous, from a polling standpoint, perhaps the biggest beneficiaries out of this episode will be the nation’s governors. Last week, national polling from Monmouth University showed that 72% approved of how their state’s chief executives were handling the outbreak, compared to 50% for the president. Wednesday morning, Politico/Morning Consult found that 43% of voters said that Trump was doing an “excellent” or “good” job handling coronavirus, but 62% gave those high marks to their governor. On Wednesday afternoon, Wisconsin’s respected Marquette Law School poll showed a similar gap between Gov. Tony Evers (D-WI) and Trump in the electorally vital state, with 76% of respondents saying they strongly or somewhat approve of how Evers has dealt with coronavirus, with 51% saying the same of Trump.

Although the news cycle is increasingly driven by the events in Washington D.C., governors are often the foremost elected officials in their states. Perhaps two of the most visible governors during this crisis have been Govs. Mike DeWine (R-OH) and Andrew Cuomo (D-NY) — both now sport roughly 70% approval/favorable ratings, according to recent state-level polling. Cuomo’s favorability is up roughly 25 points from where it was earlier this year in polling from Siena College, which has regularly polled the governor throughout his nearly decade-long governorship.

Still, some examples from recent decades illustrate pitfalls for governors. Politically, this pandemic could play out much like a natural disaster. In 2005, during the aftermath of Hurricane Katrina, Gov. Kathleen Blanco (D-LA), fairly or unfairly, was blamed for the state’s slow response. This ultimately made her a nonstarter for reelection in 2007, and she retired after one term. Much like how Trump quarreled with Gov. Gretchen Whitmer (D-MI), referring to her as that “woman in Michigan,” Louisiana Democrats accused the George W. Bush White House of undermining Blanco.

In 2016, Gov. Pat McCrory (R-NC) was in a competitive reelection race but trailed in most polls. A month before the election, Hurricane Matthew blew through North Carolina. Even after he received roundly positive press for his handling of the storm, he was defeated, although by just two-tenths of a percentage point.

In 2014, an Ebola outbreak in Africa became a topic in the closing weeks of the campaign season. Though it figured most prominently into Senate campaigns that year, it became a gubernatorial issue in the state geographically closest to Africa: Maine. Then-Gov. Paul LePage (R-ME) made headlines with his handling of the threat, as he insisted on quarantining a nurse who had just returned from treating patients in West Africa. Despite criticism that his antics were heavy-handed, he was reelected by a surprisingly comfortable 48%-43% margin; it’s hard to argue that the late-breaking controversy hurt him.

In 2011, then-Gov. Jay Nixon (D-MO) was widely credited for a good response to a deadly tornado in southwest Missouri, and it may have helped his 2012 reelection, at least in the places most affected by the disaster.

The lion’s share of the nation’s governors are up for reelection in 2022 — our ratings for the scattered races on the ballot this year are shown in Map 3.

Even though many of the most notable governors who have emerged in this crisis are less than mid-way through their terms, it stands to reason that the most trying and memorable event of their governorships is happening right now. That could be a reelection asset for governors running for new terms in 2022, assuming voters look back on their responses favorably.