:lomore-think:
武漢肺炎觀察——美國
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Apr 8, GMT 100
https://www.worldometers.info/coronavirus/country/us/
美國確診患者數目已超過四十萬，死亡近13K其他數據來源：
https://coronavirus.jhu.edu/us-map
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.htmlNews source: State-by-state coronavirus news
下面來關注下疫情最嚴重的幾個州
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New York
確診超過14萬，死亡5K+
https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Map
超過34萬人接受檢測，但最近七日每日陽性率都接近一半，疫情未見樂觀實際上NY的測試率係全美最高，每一百萬人超17K+次檢測，連韓國都得9K+，在確診人數超過一萬的地區中僅次於Swithzerland（19K+）
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New Jersey
確診44K+，死亡1.2K+
https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml
不到10萬人接受檢測（10K+/1M），陽性率接近一半，估計確診人數和死亡人數好快會飆升 -
Michigan
確診近19K，死亡800+
https://www.michigan.gov/coronavirus/
5萬人接受檢測（5K+/1M），陽性率接近四成 -
California
確診近18K，死亡400+
https://www.latimes.com/projects/california-coronavirus-cases-tracking-outbreak/
https://data.chhs.ca.gov/dataset/california-covid-19-hospital-data-and-case-statistics
加州死亡率較低，但衹有14萬人做測試（3.6K/1M），之後好難講會唔會爆發 -
Louisiana
確診16K+，死亡580+
http://ldh.la.gov/Coronavirus/
檢測74K（16K/1M）僅次於NY，陽性率兩成左右
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此回覆已被刪除！ -
另外幾個確診數上萬的州：
Massachusetts
確診15K+，死亡350+，檢測81K（12K/1M）
https://www.mass.gov/info-details/covid-19-cases-quarantine-and-monitoringPennsylvania
確診15K，死亡250+，檢測91K（7K/1M）
https://www.health.pa.gov/topics/disease/coronavirus/Pages/Cases.aspxFlorida
確診15K，死亡290+，檢測140K（6.7K/1M）
https://fdoh.maps.arcgis.com/apps/opsdashboard/index.html#/8d0de33f260d444c852a615dc7837c86Illinois
確診13.5K，死亡380，檢測68K（5.3K/1M）
https://coronavirus.illinois.gov/s/ -
Washington 情況比較有趣，可以講係美國最早的爆發點，特別係老人院群組感染導致幾十人死亡
但而家情況似乎得到控制確診8.6K，死亡400+，檢測91K（12.5K/1M）
https://www.doh.wa.gov/emergencies/coronavirus
高峰期從3月中旬到4月，每日平均確診300+，但4月4日之後確診數急劇下跌，4月7日僅錄得36宗，睇來情況已經受控（不過都有可能係數據更新唔切）
3月下旬開始陽性率基本上在一成左右
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尋日死731，破歷史紀錄
不過州長話情況有好轉，ICU新增病人減少一直下降緊，插管人數都減少緊
“Right now we’re projecting that we are reaching a plateau in the total number of hospitalizations, and you can see the growth and you see it starting to flatten,” Cuomo told reporters Tuesday. “Change in daily ICU admissions is way down, and that’s good news. The daily intubations number is down, and that’s good news. The discharge rate is right about where it was.”
重有其他幾個州向NY捐贈呼吸機：
In another positive sign, several West Coast states announced this week that they are sending ventilators to New York since their need is now less urgent. California Gov. Gavin Newsom (D) said he will send 500; Oregon is contributing 140; and Washington state — which was an early epicenter — is dispatching 400 ventilators.
連Fauci都覺得情況在好轉：
“Everybody who knows me knows I’m very conservative about making projections, but those are the kind of good signs that you look for,” Fauci said of the New York figures. “You never even begin to think about claiming victory prematurely, but that’s the first thing you see when you start to see the turnaround.”
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美國都搞到咁L官僚主義
非常時期都唔曉變通？？Olga Matievskaya and her fellow intensive care nurses at Newark Beth Israel Medical Center in New Jersey were so desperate for gowns and masks to protect themselves from the coronavirus that they turned to the online fundraising site GoFundMe to raise money.
The donations flowed in — more than $12,000 — and Matievskaya used some of them to buy about 500 masks, 4,000 shoe covers and 150 jumpsuits. She and her colleagues at the hospital celebrated protecting themselves and their patients from the spread of the virus.
But rather than thanking the staff, hospital administrators on Saturday suspended Matievskaya for distributing “unauthorized” protective gear.
The hospital told ProPublica in a statement that Matievskaya’s suspension ended Monday. “No employee is allowed to distribute unauthorized medical supplies within the hospital,” the statement said. “The nurse in question was temporarily suspended for inappropriately distributing unauthorized medical supplies, against this policy.”
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有時可能關operation事？譬如員工用自己裝備出事可能保險公司唔賠噉樣……
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Dr. Samantha Houston says she lost her job of four years at Baptist Memorial Hospital-North in late March for “disruptive” behavior. In the weeks prior, Houston, a hospitalist, used Facebook to organize a local donation drive for masks and baby monitors so that hospital staff could cut down on face-to-face interactions with patients.
Houston, 34, also says she sent several emails to colleagues raising concerns about the availability of personal protective equipment, or PPE, for some workers.
Dr. Jennifer Bryan, who chairs the Mississippi State Medical Association board of trustees, told Mississippi Today that she knows of at least one other doctor in the state who was also fired for advocating for stronger safety measures.
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@姬嘉鐸我老婆 都有可能，不過醫院份聲明無講清楚
但而家呢個非常時期咁搞法搞到員工好心寒，醫院提供唔到裝備，又唔畀員工自己買 -
不過加州勝在醫療條件好，病床多(72.8K)，而且而家住院病人得2.6K，怪唔得有多餘呼吸機捐畀NY
https://public.tableau.com/views/COVID-19PublicDashboard/Covid-19Hospitals?:embed=y&:display_count=no&:showVizHome=no
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而家LA感染6K+，市長已經下令去超市和藥房，以及其他必要商業場所要戴口罩
https://www.msn.com/en-us/news/us/l-a-mandates-masks-for-essential-trips/ar-BB12iedU"If you're shopping for groceries, picking up a prescription or visiting any other essential business, and if you're not covering your face, by Friday morning, an essential business can refuse you service," the mayor said.
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從呢篇文章睇來，新澤西都幾大鑊，特別係療養院出現群聚感染，情况好可能進一步惡化
護工話PPE唔夠都要照去，甚至有病都要翻工，可能已經周街播毒
Frontline staff at long-term care centers say they have been forced to work without proper protective gear, compelled to come to work sick or risk termination, and punished for speaking out. They say they have become unknowing carriers of the virus, bringing it back home and fostering its invisible spread.至少有一名院長同兩名護士助理感染武漢肺炎身亡；10%的死者來自療養院
A nursing home administrator and at least two nurses’ aides have died of coronavirus complications since the outbreak began. Nurses, doctors and other aides are hospitalized — some in critical condition — and scores of other employees are infected. Unions representing nursing home workers are demanding that owners be held to account.Of the 1,232 people in New Jersey who have died from coronavirus, 10 percent were long-term care residents.
衛生委員Judith Persichilli話會儘快分流，隔離感染者和非感染者
Alarmed by the disclosures, Persichilli said “we have to develop a statewide plan to assist the nursing homes that are experiencing outbreaks and a shortage of staff and equipment.”The plan she described will designate some nursing homes to care for symptomatic and COVID-positive residents, and others to care for those without symptoms. Residents will be moved within three regions of the state to the appropriate setting to avoid causing further exposures. Staff will work in one type of facility or the other, with no mixing.
因爲拭子唔夠，衹有部分出現症狀的長期住客做咗測試，而且結果重要有延遲，可能會感染埋護工
Only a fraction of long-term-care residents with coughs or fevers have been tested for coronavirus because of the shortage of test swabs, priority given to hospitals and health-care workers, and, at times, the outright refusal of administrators to do so.Delays in receiving results leave staff ignorant of their patients’ viral status as they brush their teeth and feed and bathe them. This has allowed the virus to potentially leap from symptomatic, but untested, residents to their roommates and caregivers.
有護士話拭子被上級鎖起，佢自己已有發燒同腹瀉
Test swabs had been locked away by her supervisor, she said, and "we were told to assume everyone is positive." The nurse, who asked that her name not be used, said she was suffering from a temperature of 103.8 and diarrhea after working with residents at the home. She planned to be tested for coronavirus.有護士助理話醫生建議佢自我隔離，但上級唔畀請假，重話唔翻工就當辭職
A nurse's aide said she had been exposed to the virus by her patients and several co-workers, and as the sole caregiver for her 78-year-old disabled mother, was "terrified" of becoming ill. Her doctor had advised her to self-quarantine, but the physician's note was refused, said LaDawn Chapman. She was told if she didn't show up for work, her resignation letter would be accepted.另一間療養院PPE據説被院長鎖起
At another nursing home in Elizabeth, Plaza Healthcare and Rehabilitation, personal protective equipment is locked in the administrator's office, two employees said. When the staff asks for it the administrator "launches it out the door" at them, because he does not want to come out, said Gabby Niziolek, a nurse's aide, who tested positive after caring for two patients she did not know had the virus.醫護要自製面罩，一個N95口罩甚至要用一周
Workers said they had been taping plastic sheet covers to their glasses to serve as face shields. An aide said she had been given one N95 mask for a week.由於測試不足，死亡人數可能報細：
比如22個死者得12個做了測試呈陽性，最後報13個；
8個死者得2個做測試呈陽性，1個等緊結果，另外5個報猝死
At the Elizabeth Nursing and Rehabilitation Center, 22 people have died, 12 after testing positive for the virus, Elizabeth Mayor J. Christian Bollwage said Tuesday.Sixteen of the remaining 58 nursing home residents currently are ill with the virus, and five are awaiting test results, he said. Yet the current official total of deaths reported by the state for Elizabeth is 13, he said.
At the Alameda Center for Nursing and Rehabilitation in Perth Amboy, eight residents had died as of Friday. Two were known to have the virus, one was awaiting a test result and the deaths of five were considered sudden and unexplained. A nurse's aide, Courlande Dauphin, also has died of complications from the virus.
人手嚴重短缺：有療養院用一個護士和一個助理照顧45個人
At one nursing home this past weekend, two staff members cared for 45 residents."It's ridiculous, the staffing," said an aide. "How can one aide and one LPN [licensed practical nurse] do that?"
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Louisiana確診 17,030 +746， 死亡652 +70 ，檢測81K（17K/1M）
最新政府報告指出因爲測試延誤，至少幾千有症狀嘅病人無列入確診州衛生部指出病人從出現症狀到官方公佈確診，可能經歷大約十日：
On March 13 when Gov. John Bel Edwards ordered school closings and other restrictive measures with 36 cases identified in the state, more than 1,100 sick patients reported experiencing symptoms. By March 22, when the governor issued his stay-home order after the state reported 837 cases and 32 deaths, 8,327 patients showed symptoms and eventually tested positive for COVID-19, the health department's data show.As the state’s confirmed number of patients infected grew to 2,747 by March 27, more than 13,250 people were actually infected with the virus and showing symptoms, based on case studies reported to the state health department.
The lag in test results being returned shows a delay of about 10 days before officially reported numbers of confirmed cases in the state caught up with the number of people who started exhibiting symptoms on a given day and who later tested positive for COVID-19.
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New York 確診151,171 死亡6,268
新增確診8.7K+，新增死亡779，又創新高
不過州長保持樂觀，因爲住院人數持續下降
他和紐約市長同時都提及死亡人數的種群差異黑人和西班牙裔死亡率均高於人口比例，亞裔則偏低
- Hispanics make up 34% of the fatalities (They are 29% of NYC’s population)
- Blacks make up 28% of the fatalities (22% of the population)
- Whites make up 27% of the fatalities (32% of the population)
- Asians make up 7% of the fatalities (17% of the population)
紐約市長提出四項措施解決上述問題：
De Blasio announced a four point plan to confront the racial disparities that includes grassroots outreach and a multimillion dollar ad campaign in 14 languages.De Blasio said the city is responding to those troubling statistics by focusing on supporting public hospitals, launching a multi-million dollar advertising campaign in 14 languages and focusing on communities of color, grassroots outreach to leaders and clinics in those communities and expanding telemedicine. He also said 311 resources needed to expand.
其實黑人患糖尿病和高血壓等慢性病的比例本身就偏高（可能因爲窮和飲食習慣），又中意social，死亡比例偏高都唔出奇
亞裔偏少，除咗收入高有醫保之外，戴口罩應該係重要原因
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New Jersey 47,437 +3,021 1,504 +272
州長話未到高峰，繼續加強管制包括強制商店員工同顧客戴口罩，關閉非必要工地，推遲初選
- All grocery stores have to limit the number of customers in their stores to 50% of their capacity. In addition, all store workers and customers must wear face coverings, and stores must provide special shopping hours for high-risk customers, and erect barriers between cashiers and customers where practical.
- All non-essential construction in the state is being shut down as of Friday
- New Jersey’s primary date is being moved from June 2 to July 7.
- Weight limit on trucks carrying COVID-19 relief has been raised
NJ睇樣重有排升，尋日先關閉所有公園
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新增兩個州過萬
Georgia 確診10,204 +1,048 ，死亡370 +22，檢測38.8K（3.7K/1M）
https://dph.georgia.gov/covid-19-daily-status-reportTexas 確診10,065 +1,126 ， 死亡195 +28，檢測96K（3.4K/1M）
https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83 -
@恆智德 之前喺NYT 見到有個醫生喺醫院public area戴豬咀，跟住醫院管理話佢製造恐慌，唔俾佢戴
,仲要佢開冇人工嘅OT。私立醫院啲管理好似好離地，唔知呢個病傳染性有幾高咁。 -
@沙嶺公墓 其實歐美企業一向好注重員工人身安全，點會用製造恐慌呢種藉口來處罰員工？真係百思不得其解，重以爲自己睇緊中國新聞
今日睇到有新聞話NJ有療養院護士投訴上級收埋測試材料同PPE，帶病都要翻工，真係R曬頭
https://xsden.herokuapp.com/topic/54/武漢肺炎討論-美國/17 -
@恆智德 可能人性之惡唔分人種。極權同民主嘅區別淨係透明、公正嘅制度會令到問題，而唔係提出問題嘅人畀解決。
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@沙嶺公墓 人性之惡確實度度都有；但喺我地印象或者想象中，一個成熟嘅民主制度會用更人性嘅方法去處理問題，特別係好似美國呢種輿論監督咁發達嘅國家（至少按常理都應該做翻多少公關，客套説話都要敷衍幾句，比如話我地會儘快采購PPE等等，唔會做到處罰醫護咁出位）
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似乎美國重心急過中國，想要快脆復工
Update: 財長Mnuchin接受電視采訪表示五月可以復工
CDC發佈新指引，話關鍵行業員工衹要無症狀就唔使隔離，不過要戴口罩量體溫
The new guidelines will allow critical workers who have been exposed go back to work as long as they are asymptomatic and follow conditions like taking their temperature before going to work, wearing a face mask at all times and practicing social distancing at work as much as possible.
The new guidance is intended to allow health care workers, food supply workers, and others in critical industries to go back to work sooner, as long as they do not have symptoms.
華盛頓郵報話侵侵考慮緊組建第二套班子，專注重啓美國經濟
President Trump is preparing to announce as soon as this week a second, smaller coronavirus task force aimed specifically at combating the economic ramifications of the virus and focused on reopening the nation’s economy, according to four people familiar with the plans.
The goal is to get as much of the country as possible open by April 30, the current deadline Trump set for stringent social distancing measures.
前兩日都有消息話侵侵考慮從疫情唔嚴重嘅地區開始重啓經濟：
The White House is developing plans to get the U.S. economy back in action that depend on testing far more Americans for the coronavirus than has been possible to date, according to people familiar with the matter.
The effort would likely begin in smaller cities and towns in states that haven’t yet been heavily hit by the virus. Cities such as New York, Detroit, New Orleans and other places the president has described as “hot spots” would remain shuttered.
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@恆智德 按常理佢哋都唔應該咁樣對醫護，我哋覺得人命關天，佢哋似乎唔係咁。
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@沙嶺公墓 係，所以好難理解。其實醫生喺美國收入好高（最低一級平均工資都超過20萬/年），地位應該都唔低：
According to the Medscape Physician Compensation Report, in 2018, Primary Care Physicians in the United States earned on average $237,000, while Specialists earned $341,000.
注冊護士低好多，不過普遍都有7萬/年
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- 州長反應快，發出全美第一張居家令
- 保證口罩供應：兩周前已派發24.5M個N95，而家每月還可以保證2億個醫用口罩，其中四分三係N95
After announcing two weeks ago that the state had distributed 24.5 million N95 masks, Newsom on Tuesday night told "The Rachel Maddow Show" on MSNBC that California had struck a deal for more than 200 million protective masks per month.
About three-quarters will be N95s, the rest surgical, he told the show.
- LA已經開始大規模測試（人人可申請），並強制員工和顧客戴口罩
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New York 確診161,504 +10,333 ，死亡 7,067 +799
新增死亡連續第三日創新高Amid the horrific death toll, Cuomo announced he’ll issue an executive order to ease licensing rules to help bring out-of-state funeral directors to New York.
“It’s gotten to the point, frankly, that we’re going to go into bring in additional funeral directors to deal with the number of people who have passed," Cuomo said.
Some coronavirus patients who would have been admitted into the emergency department at a New York hospital are being sent home with an oxygen-monitoring device as the city's medical system struggles to reserve resources for only the sickest people.
Since last week, more than 200 people with confirmed or suspected COVID-19, the respiratory illness caused by the virus, have been sent home with a pulse oximeter to track their oxygen levels. A doctor or nurse practitioner follows up with them via video conference.
An oximeter is a small electronic device that clips onto a fingertip to indirectly measure the oxygen saturation of a patient's blood.
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Louisiana 確診 18,283 +1,253 死亡702 +50
感染人數上升，但死亡數減少
有州參議員染病身亡主要集中喺新奧爾良：確診9722，死亡382
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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.
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未有確診病人之前就準備增加病床，取消大型活動
On Feb. 26, two days before President Trump called the coronavirus outbreak the Democratic Party’s “new hoax,” the Cleveland Clinic alerted the public that it was prepared to quickly open 1,000 additional hospital beds should the need arise.On March 4, the day Trump boasted that “we have a very small number” of infected people in the United States, Ohio’s Republican governor, Mike DeWine, shut down a weekend fitness expo expected to draw 60,000 people a day to a Columbus convention center. There were no identified coronavirus cases in the state at the time.
教科書一樣的操作
But an early look at Ohio’s preparations and decision-making shows they reflect textbook recommendations for the way to handle an outbreak. Identify it early. Plan for the worst, hope for the best. Move swiftly because disease expansion will be exponential, not linear. In the absence of testing, assume the virus is spreading through the community. Communicate with the public clearly, and keep the message consistent.結果比其他三個人口相若的州感染病例都偏少，三分一都唔夠
Now, Ohio may be realizing the benefits of early intervention in the pandemic by its government and medical community. With about 5,100 covid-19 cases, it has fewer than a third the number of people with the novel coronavirus in three comparably sized states — Michigan, Pennsylvania and Illinois. And Ohio has just a small fraction of the deaths reported in those states. -
A Detroit hospital has been so overwhelmed by the influx of Covid-19 patients that at least 2 people have died in its emergency room hallways before help can arrive, health care workers there told CNN.
夜班護士靜坐要求加派人手
Conditions are so drastic at Sinai-Grace that on Sunday night, all of the emergency room's night shift nursing staff --seven in total -- staged a sit-in, where they refused to work and demanded that more nurses be sent in to help.插管病人有時都要喺走廊治療
Patients at Sinai-Grace aren't just two-to-a-room -- they have been lining many of the hallways in the emergency room, according to the four health care workers. Two workers said critically ill patients, including ventilated patients, have been at times kept in the hallways. -
New York 確診172,358 +10,854 ，死亡7,844 +777
新增確診繼續上升，新增死亡-22，連續第四日死亡700+The running three-day average of new hospitalizations was 359 on Thursday, down from 481 the day before. The average has also been declining sharply in recent days.
ICU admissions were actually negative on Thursday, Cuomo said, with 17 more people leaving those units than entering. It’s the first time those admissions have been negative since the crisis began, he said.
如果情況持續，州長預計衹需18K病床，遠低於之前140K嘅估計
Fox News主持人Tucker Carlson前兩日屌曬鬼，話專家搞錯曬，預測根本唔準
Initially, the I.H.M.E. predicted that on April 4th, the state of New York would require 65,000 hospital beds to handle infected patients. The low-end estimate of what the state would need was nearly 48,000 beds.
In fact, on April 4th, New York had fewer than 16,000 hospitalizations for coronavirus, and many other states fell far below the model's projections as well -- in many states.Over the weekend, the I.H.M.E. updated its model. Its projections across the country have been scaled back dramatically. And yet, they are still significantly overstated.
For example, as of April 7th, the updated I.H.M.E. model predicts that New York will need 25,000 hospital beds. As of Tuesday morning, the real number was just under 17,500. The new model also predicted that as of today, almost 6,600 people would be in intensive care, and the actual number is just under 4,600.
佢甚至懷疑有唔少死亡個案衹是普通肺炎
For many years, the CDC has tracked the total number of Americans who die every week from pneumonia. For the last few weeks, that number has come in far lower than at the same moment in previous years. How could that be?Well, it seems entirely possible that doctors are classifying conventional pneumonia deaths as COVID-19 deaths. That would mean this epidemic is being credited for thousands of deaths that would have occurred if the virus never appeared here.
佢認爲武肺無咁可怕，喺時候考慮復工啦
Now, it's time to look ahead. If the virus is doing less systemic damage to our system than expected, then presumably, we can begin to consider how to improve the lives of the rest, the countless Americans who have been grievously hurt by this, by our response to this.How do we get 17 million of our most vulnerable citizens back to work? That's our task. Other countries are already hard at work doing it.
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喺周五嘅記者會上，侵侵確認正成立團隊，考慮5月前復工；同時都承認呢個係佢一世人最重大嘅決定，會考慮唔同專家嘅意見
When asked about his thought process for reopening the country, Trump acknowledged that he can listen to dozens of experts, but ultimately, the the decision lies with him.
“The metrics right here,” he said, pointing to his head. That's my metrics. That's all I can do. I can listen to 35 people. At the end, I've got to make a decision," he said.
"I will have to make a decision, and I only hope to God it is the right decision. But I would say without question, it is the biggest decision I'll have ever had to make," he said.
"It's the biggest decision of my life," he repeated.
Fauci認爲如果要逐漸復工，大規模測試必不可少
Dr. Anthony Fauci, the government's top expert on infectious diseases, has cautioned that the virus dictates the timeline and warned that to "gradually" reopen the country widespread testing must be in place, so doctors can better identify, isolate and trace cases.
USPS looking into Wisconsin absentee ballot issues
Nebraska gets $300K from feds for each virus case while N.Y. gets $12KAntibody tests that would verify whether a person recently had the novel coronavirus could be available within a week, according to the nation's top infectious disease expert.
"Within a period of a week or so, we're going to have a rather large number of tests that are available," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN's "New Day" Friday morning.
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New Jersey 確診54,588 +3,627 ，死亡1,932 +232
州長正簽發命令，允許符合條件嘅犯人暫時返家
The governor says he’s signing an executive order to allow certain low-risk inmates to be placed on temporary home confinement or granted parole if eligible amid the pandemic.
其他幾個增長較快，死人較多嘅州：
Michigan 22,783 +1,279 1,281 +205，創單日死亡新高
Massachusetts 20,974 +2,033 599 +96
Pennsylvania 20,340 +1,794 446 +86 -
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