Today’s coronavirus pandemic looks eerily similar to the fear experienced in 2009 when the swine flu broke out. Kathleen Struck shares one woman’s story.
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The main Serbian hospital treating patients infected with coronavirus looks like an abandoned building, but it isn’t.
With its rundown facade, peeling walls and rooms crammed with metal beds, the downtown Belgrade clinic for infectious diseases has for decades been a symbol of Serbia’s depleted health system that now has to cope with a major virus outbreak.
“If coronavirus doesn’t kill you, that hospital surely will,” said Bane Spasic, a middle-aged man who recently visited the place for a minor infection.  
Although the COVID-19 pandemic hasn’t hit Eastern and Central Europe with such a force compared to Italy, Spain and France, health officials throughout the region are sounding the alarm about the lack of medical staff, facilities, equipment and enough hospital beds to handle several virus outbreaks simultaneously.
The COVID-19 illness causes mild or moderate symptoms in most of those infected, but severe symptoms are more likely in the elderly or people with existing health problems. The vast majority of those infected recover
The countries in the region have taken a range of restrictive steps, from cutting off travel links to closing down schools and universities. But there are fears that the relatively low number of tests being carried out doesn’t reflect the true scale of the outbreak.
The massive exodus of doctors and nurses to the West, mainly Germany, appears to be a major hurdle in the fight against the outbreak. Now, the medical staff are being called to come out of retirement, graduate medical students are asked to volunteer and officials are promising special bonuses to the overloaded staff.
The government in Slovenia has suspended specialist studies for new doctors and interns so they can join the effort to combat the epidemics. Graduated doctors who still don’t have their licenses will be appointed wherever their help may be needed.
The small country of Slovenia was hit hard by the spreading of the virus from neighboring Italy with 273 confirmed cases and one death, according to the latest figures from Tuesday.
The medical systems in Serbia, Bulgaria, Albania, Bosnia, Northern Macedonia and Romania have all been hit hard by the massive exodus of doctors and nurses over the past several years. The medics have moved to richer countries for better pay, but they are also driven away by the ailing health systems which offer them hours of overwork, modest salaries and chronic shortages of basic medical supplies to treat people.
In Bulgaria, the government has announced financial support for all medics involved in the treatment of coronavirus patients. An additional 500 euros will be paid to every medical worker with their monthly salaries. In Albania, Prime Minister Edi Rama said that starting from March all medical staff will be paid 1,000 euros more a month. Albania’s average monthly salary is 450 euros.
Serbia’s president, Aleksandar Vucic, announced last week that all medical workers were getting a 10% increase in salaries as they face a looming struggle against the coronavirus.  
Faced with low wages and tough working conditions, about 6,000 Serbian doctors and nurses are believed to have left the country in recent years. This has prompted the government to cancel an agreement with Germany on the hiring of nurses from Serbia.
A state of emergency was declared throughout Serbia, including a nationwide dusk to dawn curfew for all citizens and a ban for all those older than 65 from leaving their households.  
Epidemiologist Predrag Kon, who is part of Serbia’s anti-virus team, has explained that the idea of the imposed state of emergency has been to stretch the epidemic as long as possible to avoid choking the clinics and putting too much burden on the health system at once.  
Zlatko Kravic, the head of the general hospital in Sarajevo, said he was concerned about Bosnia’s ability to respond to the major crisis because of the shortage of medical staff.  
“We will need more doctors, our current staffing levels will need to increase by at least a third,” he said, calling on doctors to come out of retirement and “contribute to our fight against this 21st-century menace.”
In Croatia, which also faces a major shortage of medical workers, the struggle against the epidemics is compared to the country’s war for independence from Yugoslavia in the 1990s.
“I believe we are used to all kinds of situations,” said Alemka Markotic, the head of Zagreb’s hospital for infectious diseases.
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 Medicare said Tuesday it will immediately expand coverage for telemedicine nationwide to help seniors with health problems stay home to avoid the coronavirus. The new option will allow millions of older people to take care of ongoing medical problems as well as new concerns, while heeding public health advice to stay home during the outbreak. For example, a patient with diabetes wouldn’t have to postpone a regular follow-up visit with the doctor to keep safe — he or she could do it via Skype. And people concerned they may have the virus could “see” their doctor or nurse practitioner virtually to find out how to get tested in person. “It helps us prevent the spread of the virus,” said Medicare administrator Seema Verma. For seniors who don’t navigate technology, relatives or friends can assist. “If it’s your mom, you may need to go over to her house to help her do this,” said Verma. Bring your smartphone. Risk of serious illness from the coronavirus is greater for older people and those with underlying health problems such as lung conditions, diabetes or heart problems. Many Medicare beneficiaries are managing chronic health issues that put them at heightened risk. The telemedicine expansion is geared directly to this vulnerable group. Current telehealth coverage under traditional Medicare is limited. It’s available in rural areas, and patients need to go to specially-designated sites for their visits. Since last year Medicare has also been paying for brief “virtual check-ins.” Tuesday’s announcement goes beyond that, allowing clinicians and hospitals to bill Medicare for visits via telemedicine that previously had to take place in person, at a medical office or facility.  The policy change carries out a waiver of Medicare rules recently authorized by Congress, and set in motion under emergency declarations from  the Trump administration. Expanded telemedicine coverage will remain in effect during the outbreak. Verma said the federal Centers for Medicare and Medicaid Services is also encouraging states to expand the use of telehealth in their Medicaid programs for low-income people. Separately, Medicare Advantage plans offered by private insurers have been allowed to offer telemedicine as a supplemental benefit, like dental coverage or a gym membership, for several years now. The private plans serve about one-third of Medicare’s 60 million beneficiaries. For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. Worldwide, about 185,000 cases have been reported, and while most people recover in weeks, more than 7,300 have died. Medicare is the government’s flagship health insurance program, covering people age 65 and over, as well as younger people who qualify because of a disability. About 40 million people are in traditional Medicare, the government-administered part of the program that was the focus of Tuesday’s announcement. Doctors’ groups and hospitals had been urging Medicare to make the move. Under Tuesday’s announcement: 1. Patients and clinicians will need a two-way visual and voice connection that allows real-time interaction. Laptops, tablets and smartphones should work. 2. Hospitals and a range of clinicians, including doctors, nurse practitioners, clinical psychologists, nutrition professionals, and licensed social workers will be able to offer telehealth. 3. Standard Medicare copays and deductibles still apply to telemedicine visits. But there’s flexibility. Normally, health care providers charge such copays for telehealth visits. During the coronavirus emergency, health providers will be allowed to waive or reduce cost-sharing for telehealth visits. 4. Legislation authorizing the waiver required medical offices to have an established relationship with a patient to bill for telehealth services. But Medicare said it will refrain from enforcing that requirement via audits during the coronavirus public health emergency. Verma said that’s to allow for circumstances such as a medical practice being forced to close because of the outbreak. “Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered … and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services,” Health and Human Services Secretary Alex Azar said in a statement.  If telemedicine shows its worth in the coronavirus emergency it could lead to permanent changes making it more widely available to seniors.  Telehealth has grown steadily in recent years. Most mid-size or large employers now offer some way to connect patients and health care providers virtually.  But researchers say patients have been relatively slow to try telemedicine, especially if they are used to in-person visits.  The benefits consultant Mercer found that 88% of companies with 500 or more employees offered telemedicine as part of their health benefits last year. But only about 9% of eligible employees used it.  
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British Prime Minister Boris Johnson has set up four new committees to help respond to a growing coronavirus outbreak, focusing on health, public sector preparedness, the economy and the international response to the pandemic.
 
The four committees will feed into a daily meeting on coronavirus, part of new stringent measures to try to tackle an outbreak, and will help “refine” decisions taken at emergency meetings, which will continue to be chaired by Johnson, his office said in a statement. 
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A British citizen appeared at a public hospital in India’s capital with a fever, difficulty breathing and a private clinic’s referral for a coronavirus test. She was turned away.Indian authorities said Tuesday that they are not expanding testing for the virus, as most affected nations are doing, amid mounting criticism from some experts that the limited tests could mask the true toll of the disease in the world’s second most populous country.The World Health Organization has urged countries to test as many people as possible to curb the pandemic, but India has taken a different approach, limiting testing to those who have traveled from affected countries or come in contact with a confirmed case and show symptoms after two weeks of quarantine.  The British patient denied a test last week fulfilled neither criteria.  The woman, who requested anonymity fearing business consequences for her employer, said she told hospital officials that she may have had contact with a coronavirus patient in her job in a hotel, but couldn’t be sure.After trying and failing to be tested a second time, she left India this week for France, where her family lives, and which President Emmanuel Macron said Monday was “at war” with the virus, announcing extreme measures to curb the disease.Indian authorities have justified their strict testing criteria as a way to keep a deluge of people from demanding tests that would cost the government money it needs to combat other diseases such as tuberculosis, malnutrition and HIV/AIDs.  As a result of the stringent criteria, sick people with potential exposure to the new virus are being sent home, and some experts fear that India’s caseload could be much higher than government statistics indicate.  Authorities have confirmed 126 cases, all of which have been “imported” — linked to foreign travel or direct contact with someone who caught the disease abroad. There is so far no documented evidence of spread within communities.But India is conducting only about 100 tests per day, despite having the capacity for as many as 6,000, according to the Indian Council of Medical Research, India’s top medical research body, and concerns of so-far undetected communal spread are growing.”Given the pattern of disease in other places, and given our low level of testing, then I do think that community transmission is happening, ” said Dr. Gagandeep Kang, the director of the Translational Health Science and Technology Institute.In India, where more than 400 million people live in crowded cities, including many without regular access to clean water, local transmission is all but inevitable, experts say.  “Community spread is very likely. But the only way to know for sure is through more expansive testing,” said Dr. Anant Bhan, a global health researcher in Bhopal, India.ICMR chief Balaram Bharghava has said that India has a month-long window of opportunity to try to stop the virus in its tracks, judging from its path in other countries.  If India does determine the disease is spreading communally, it could prove difficult to contain.  The virus causes only mild or moderate symptoms, such as fever and cough, for most people, but severe illness is more likely in the elderly and people with existing health problems.  India has a lower proportion of elderly than other countries, but its health care facilities are limited and already can’t accommodate the large number of patients with other diseases.  “This along with our high population density can be our great challenge,” said public health researcher Oommen Kurian.India has been reluctant to expand testing, not wanting to trigger panic and overwhelm hospitals, but also because of the cost: While the tests are free for patients, each one costs the government about 5,000 rupees ($67).In an already stretched and underfunded public health care system, money spent on the coronavirus leaves less for other public health problems.The coronavirus may also be spreading in India because health officials have struggled to maintain quarantines, with people fleeing from isolation wards, complaining of filthy conditions.  In the central state of Maharashtra, five people, one of whom had tested negative and the rest who were awaiting test results, walked out of an isolation ward last Saturday.India has implemented a 19th century epidemic law that empowers public officials to enforce more rigorous containment measures and impose penalties and punishments for escapes.Lav Agarwal, a health ministry official, rued that authorities “often don’t get enough support from people.”Similarly, in neighboring Sri Lanka, the government has ordered about 170 passengers who evaded airport screening after returning from several affected countries to report to police or face financial penalties and possible imprisonment.Aditya Bhatnagar, an Indian university student who was studying in Spain, described unsanitary conditions at an isolation ward where he and 50 others passengers on a Barcelona flight have been kept since landing in New Delhi on Monday.Bhatnagar said the rooms, shared by around eight people each, lacked basic hygiene features such as clean bed sheets and bathrooms. He said the group, awaiting their COVID-19 test results, was not provided with masks or sanitizer.“I don’t think these measures would be enough to contain the pandemic,” Bhatnagar said, adding that some passengers had opted to move from the wards and into private hotels, paying 4,000 rupees ($55) a night to self-isolate for at least 14 days.
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Several U.S. states are closing dine-in restaurants and bars, limiting the establishments to carry-out or delivery service, in an effort to stem the spread of coronavirus. The governors of California, Connecticut, Ohio, Illinois, New York, New Jersey, Massachusetts and Washington State are among those who have ordered the restrictions. Mayors in some towns across the United States are also putting similar measures in place. “These are very difficult decisions, but hours count here and very strong measures are necessary to slow the spread of the virus,” Washington state Governor Jay Inslee said.Customers order and wait for their food at a restaurant in Chicago, March 15, 2020.Ben Chapman, a professor and food safety specialist at North Carolina State University, says it is important for people to remember that, when it comes to coronavirus, the risks of eating out have nothing to do with the food itself. “I’m worried about someone coughing on surfaces, but food itself has not been identified at all as a risk factor in this outbreak,” Chapman says. “Eating food, handling food, has not been identified as a risk factor in this outbreak, or in any other respiratory virus outbreak.” Health experts are still trying to get a full grasp on how COVID-19 spreads. The Restaurant manager Natalie Marquez sanitizes tables and stacks chairs in Chicago, March 16, 2020.The National Restaurant Association has issued guidelines advising eating establishments in the U.S. on steps they can take to avoid spreading coronavirus. These measures include wiping surfaces down more often and using a list of disinfectants that, according to the Environmental Protection Agency, are effective against coronavirus. “State and local food codes establish strict safe food handling requirements for restaurants,” Larry Lynch, senior vice president of science and industry for the National Restaurant Association told VOA via email. “And operators are being proactive by stepping up existing cleaning and sanitation procedures.”
An area of concern for both restaurants and grocery stores is self-serve food bars where utensils are regularly shared. Chapman advises establishments to regularly clean or swap out shared serving utensils. “I think that restaurants and grocery stores are taking notice of these common high-touch surfaces and best practice would be to clean and sanitize, and/or replace those in at an interval that matches how often they’re being used,” Chapman says. “That’s where it gets a little tough and you kind of have to look at it business by business.” While people can avoid restaurants if they choose to, most will have to eventually go to the grocery store to buy food. A shopper wheels her cart full of groceries in Skokie, Ill., Saturday, March 14, 2020.While the primary risk factor is being around sick people, there is a contamination concern about hard surfaces like grocery carts, tongs and self-serve areas, sliding doors where refrigerated foods are kept, door handles, and going to the restroom. Shoppers can manage that risk by washing their hands, not touching their face, and using hand sanitizer. But what if someone infected with coronavirus sneezes in the produce department where many fruits and vegetables are displayed out in the open? “Even though something like an apple seems like a really hard surface, there are a lot of biological components that can make it not the greatest surface for a virus to survive on,” Chapman says. “The fact that someone even coughs on my food is gross, but doesn’t really, at this point, increase my risk of getting coronavirus because I’m going to eat that produce, and it’s going to go into the high acids environment in my stomach.” And if even carry-out food is a worry for some people, Chapman says consumers can take proper precautions. “If I’m worried about something on a package or on a bag, as soon as I’m finished touching that bag, before I touch my food, I will wash my hands and use hand sanitizer,” he says. “Do not think that you’re not in control of the risk because you do have a step to reduce your individual risk.” 
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The U.S. surgeon general said Monday that the number of coronavirus cases in the United States has reached the level that Italy recorded two weeks ago, a sign that infections are expected to rise in America as the government steps up testing and financial markets continue to fall.        “We are at a critical inflection point in this country, people. We are where Italy was two weeks ago in terms of our numbers,” U.S. Surgeon General Dr. Jerome Adams told Fox News. When you look at the projections, there's every chance that we could be Italy.”       Two weeks ago, there were 1,700 cases of coronavirus in Italy and the country had reported 34 deaths. Now, Italy is reporting an estimated 25,000 cases and more than 1,800 people have died. There are about 3,800 cases reported in the United States and so far, more than 65 people have died from coronavirus.     Adams claims the U.S. has “turned the tide” on testing, a critical part of tracking and containing pandemics. The U.S. effort has been hobbled by a series of missteps, including flaws with the testing kits first distributed by the federal government and bureaucratic hurdles that held up testing by private laboratories.  
       
Adams' details about the capacity of roll-out of drive-through and walk-by testing sites, however, contradicted other administration officials.  
       
Adams said there will be 30 to 40 new testing sites running in 19 states that could each perform 2,000 to 4,000 tests a week. However, Brett Giroir, a senior health administration official, said community testing sites manned by the Federal Emergency Management Agency and members of the U.S. public health service would be capable of testing 2,000 to 4,000 people each day, not every week. He said the federal government would begin deploying these sites on Monday.
       
Asked about the shortage of intensive care beds and supply of ventilators, which are used to treat patients with respiratory problems, Adams told CNN only that supplies were growing. He said there was a bill in Congress to increase supplies of face masks and that there were thousands of ventilators.  
       
Vice President Mike Pence said he and the president would brief the nation's governors on Monday “specifically about our expanding testing to the American people.”
       
Pence said the federal government also on Monday will release updated guidance concerning restaurants, bars and other establishments. California and Illinois are among jurisdictions that have ordered restaurants and bars to close to help slow the spread of the virus.
       
Asked whether restaurants and bars around the nation should close for the time being, Dr. Anthony Fauci, the nation's top infectious disease expert, said he wanted to wait for the guidance to come but allowed, “That could be.”
      
 Fauci said he would like to see more aggressive measures, such as a 14-day national shutdown. Still, Fauci said travel restrictions within the United States, such as to and from hard-hit Washington state and California, probably would not be needed anytime soon.
       
“The worst is yet ahead for us,” Fauci said. “It is how we respond to that challenge that is going to determine what the ultimate endpoint is going to be.'”
       
As President Donald Trump worked to tamp down hysteria over the virus and called on people to stop hoarding groceries and other supplies, officials in Washington were preparing for what was expected to be a long-haul effort to try to stem the virus that has upended life around the globe.  
      
 Trump expressed pleasure that the Federal Reserve announced Sunday it was taking emergency action to slash its benchmark interest rate to near zero. The move intended to help the economy withstand the coronavirus came a day after Trump once again threatened to fire or demote Fed Chairman Jerome Powell.
       
The Fed made an emergency cut to its key interest rate, slashing it by a full percentage point to a range between zero and 0.25%. The central bank said it would stay there until it feels confident the economy can survive a near-shutdown of activity in the United States.
       
The Fed's move did not seem to calm markets. Stocks sunk at Monday's opening, triggering a 15-minute halt in trading as investors worry the virus could lead to a recession.
       
Global stocks also fell sharply Monday after central bank moves to shore up economic growth failed to dispel investor's fears over virus controls that are shutting down global business and travel. European and Asian stock indexes were down as much as 10%, as was the price of oil. Trading in Wall Street futures was halted after they fell by the maximum 5%.
      
 House Speaker Nancy Pelosi, D-Calif., said Congress had started work on a new aid package after the one just approved by the House early Saturday, which provided direct relief to Americans with sick pay and other resources and was pending in Senate.
      
 “We have already begun work to develop a third emergency response package,'”Pelosi wrote in a letter to colleagues.
      
 Senate Majority Leader Mitch McConnell said late Sunday the next package should have even more resources for Americans, the health care industry andsignificant steps to secure our nation’s economy.”
       
With the U.S. Capitol among the many iconic landmarks closed to tours, Pelosi also urged lawmakers to have most of their Washington staff telework from home, as health officials urge social distancing. House lawmakers are away on week-long recess and many have already curtailed office visits at their local offices, as well.
       
For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. The worldwide outbreak has sickened more than 156,000 people and left more than 5,800 dead. The death toll in the United States is more than 50, while infections neared 3,000 across 49 states and the District of Columbia.  
       
The vast majority of people recover. According to the World Health Organization, people with mild illness recover in about two weeks, while those with more severe illness may take three weeks to six weeks to recover.
       
Trump in recent days has imposed sweeping travel restrictions for much of Europe. On Saturday, he added the United Kingdom and Ireland to a list of countries that would face travel restrictions over the next 30 days. The State Department on Sunday said it would allow U.S. personnel to leave their diplomatic or consular posts worldwide if they or family members were medically determined to be at a higher risk of falling very ill if exposed to the virus.
      
 Also, the White House announced Monday that it would cancel the holiday Easter Egg Roll held annually on the South Lawn. 
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Japan plans to widen travel warnings to much of Europe urging people avoid trips there as the coronavirus pandemic spreads, public broadcaster NHK said.
Japan will widen a level three advisory, which already applies to much Italy, to surrounding areas in Europe, NHK reported. That notice urges people to avoid all travel and asks Japanese resident there to prepare for possible evacuation.Other European nations including Germany, France and Norway, although not including Britain, will be subject to a level two advisory, which asks people to avoid non-essential travel, NHK said. 
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Experts say the Coronavirus got its start through animal to human transmission at a live wildlife market in Wuhan, China. In the months since, the deadly virus has rapidly spread throughout the world and the outbreak has been declared a pandemic. The crisis has prompted the Chinese government to impose a ban on consumption and trade of illegal wildlife.  But as VOA’s Julie Taboh reports, not all at-risk countries are following their example.
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The United Nations’ aviation agency has approved restrictions for a global program designed to help airlines offset their carbon emissions, a move that curbs industry funding for older projects whose environmental benefits have been challenged by climate activists.The International Civil Aviation Organization council on Friday approved recommendations to exclude offset projects begun before 2016 while delivering emission reductions through the end of 2020, ICAO said in a statement.ICAO cannot impose rules but sets standards approved by its 193 member countries. Its 36-member council was tasked with weighing which programs would be eligible under the venture for airlines, known as the Carbon Offsetting and Reduction Scheme for International Aviation (CORSIA).The council’s decision to accept credits from six programs for CORSIA’s pilot phase from 2021 to 2023 came despite protests from Brazil, China and India, which wanted older projects to be eligible, said two sources who discussed the private talks on condition of anonymity.Developing countries had hoped a global push by airlines to offset emissions would mop up a glut of carbon credits awarded under earlier climate initiatives.One of the six programs is the United Nations’ Clean Development Mechanism (CDM), the world’s largest offset scheme, set up under the 1997 Kyoto Protocol to help fund emissions reductions in developing countries.Looking for balanceThe fate of billions of older CDM credits, the majority of which come from China and India, was a thorny and unresolved issue for climate negotiators in Madrid in December, raising the stakes for ICAO.ICAO was under pressure to strike a balance between approving enough credit options for airlines to purchase under the plan without squashing supply, which could push up prices.Some environmentalists feared the council would approve weaker standards to help airlines hit hard by the global outbreak of a novel coronavirus that has led carriers
to seek urgent government financial support.“The council’s decision today sends a signal that when we get to the other side of the gut-punch that COVID-19 is delivering to families, communities and the whole travel
sector, nations will move forward to meet the climate challenge,” said Annie Petsonk, international counsel for the Environmental Defense Fund.Aviation accounts for just over 2% of global greenhouse gas emissions, but with air traffic forecast to grow in coming decades, that percentage would rise if left unchecked.
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