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Republicans in South Carolina, Arizona, Kansas and Nevada have already decided not to hold Republican primaries in 2020, opting instead to automatically declare President Donald Trump the winner of the states' delegates. It is possible more states will decide not to hold GOP primaries.This comes despite a growing field of challengers gunning to upset Trump during the primary season. They include former Massachusetts Gov. Bill Weld, former governor and Rep. Mark Sanford of South Carolina and former Rep. Joe Walsh of Illinois.But there is some precedent for this. "As a general rule, when either party has an incumbent president in the White House, there's no rationale to hold a primary," 706

Scans of the lungs of the sickest COVID-19 patients show distinctive patterns of infection, but so far those clues offer little help in predicting which patients will pull through. For now, doctors are relying on what’s called supportive care that’s standard for severe pneumonia.Doctors in areas still bracing for an onslaught of sick patients are scouring medical reports and hosting webinars with Chinese doctors to get the best advice on what works and what hasn’t.One thing that’s clear around the globe: Age makes a huge difference in survival. And one reason is that seniors’ lungs don’t have as much of what geriatrics expert Dr. Richard Baron calls reserve capacity.“At age 18, you have a lot of extra lung capacity you don’t use unless you’re running a marathon,” explained Baron, who heads the American Board of Internal Medicine. That capacity gradually declines with age even in otherwise healthy people, so “if you’re an old person, even a mild form can overwhelm your lungs if you don’t have enough reserve.”Here’s what scientists can say so far about treating those who become severely ill.HOW DOES COVID-19 HARM THE LUNGS?The new coronavirus, like most respiratory viruses, is spread by droplets from someone’s cough or sneeze. The vast majority of patients recover, most after experiencing mild or moderate symptoms such as fever and cough. But sometimes the virus makes its way deep into the lungs to cause pneumonia.Lungs contain grapelike clusters of tiny air sacs called alveoli. When you breathe, oxygen fills the sacs and passes straight into blood vessels that nestle alongside them. Pneumonia occurs when an infection -- of any sort, not just this new virus -- inflames the lungs’ sacs. In severe cases they fill with fluid, dead cells and other debris so oxygen can’t get through.If other countries have the same experience as China, about 5% of COVID-19 patients could become sick enough to require intensive careHOW DOES THAT DAMAGE APPEAR?Doctors at New York’s Mount Sinai Health System analyzed 121 chest CT scans shared by colleagues in China and spotted something unusual.Healthy lungs look mostly black on medical scans because they’re full of air. An early infection with bacterial pneumonia tends to show up as a white blotch in one section of one lung. Pneumonia caused by a virus can show up as hazy patches that go by a weird name -- “ground glass opacities.”In people who get COVID-19 pneumonia, that haze tends to cluster on the outside edge of both lungs, by the ribs, a distinctive pattern, said Dr. Adam Bernheim, a radiologist at Mount Sinai.As infection worsens, the haze forms rounder clusters and gradually turns more white as the air sacs become increasingly clogged.HOW TO TREAT THE PNEUMONIA?There are no drugs so far that directly attack the new coronavirus, although doctors are trying some experimentally, including an old malaria treatment and one under development to treat Ebola.“The best treatment we have is supportive care,” said Dr. Aimee Moulin, an emergency care physician at the University of California Davis Medical Center.That centers around assistance in breathing when the oxygen levels in patients’ blood starts to drop. For some people, oxygen delivered through a mask or tubes in the nose is enough. More severely ill patients will need a breathing machine.“The goal is to keep the person alive until the disease takes its course” and the lungs begin to heal, explained Mount Sinai’s Dr. Neil Schachter.The very worst cases develop an inflammatory condition called ARDS -- acute respiratory distress syndrome — that floods the lungs with fluid. That’s when the immune system’s attempt to fight infection “is going crazy and itself attacking the lung,” Baron explained.Many things besides the coronavirus can cause the condition, and regardless of the cause, it comes with a high risk of death.WHAT ELSE IS IMPACTED?Severe pneumonia of any sort can cause shock and other organ damage. But in a webinar last week, Chinese doctors told members of the American College of Cardiology to watch for some additional problems in severe COVID-19, especially in people with heart disease. The worst off may need blood thinners as their blood starts to abnormally clot, and the heart itself may sustain damage not just from lack of oxygen but from the inflammation engulfing the body.Another caution: The sickest patients can deteriorate rapidly, something a hospital in Kirkland, Washington, witnessed.Of 21 patients who needed critical care at Evergreen Hospital, 17 were moved into the ICU without 24 hours of hospital admission, doctors reported last week in the 4639

SUMMIT COUNTY, Colorado — A skier was declared dead after he was found unconscious at the bottom of a ski run at Keystone Resort in Colorado on Saturday.Just before 12:30 p.m. local time on Dec. 22, the Summit County Sheriff’s Office responded to a report of a 52-year-old male skier who was found not breathing at the bottom of one of the resort’s runs. There was no indication that he had collided with any object. Skiers on the run had started CPR when authorities arrived. The skier was transported to the Keystone Medical Center where he was later pronounced dead. The identity of the skier is being withheld until notification to the next of kin has been made by the Summit County Coroner. 708

Stocks sank again on Wall Street as more signs piled up of the economic and physical pain being caused by the coronavirus outbreak. The S&P 500 and Dow Jones Industrial Average dropped nearly 5% in afternoon trading on Wednesday after President Donald Trump warned the country to brace for “one of the roughest two or three weeks we’ve ever had in our country.” The selling was widespread, and all 11 sectors that make up the S&P 500 were down. Treasury yields sank as investors moved into safer investments. Stocks worldwide fell following a weak reading on Japanese business sentiment and after big British banks cut their dividends to preserve cash. The Dow Jones Industrial Average lost nearly 1,000 points, which means the index has lost nearly 9,000 points in the last eight weeks. 808

Since yesterday morning, the response to our campaign has been incredible.- million raised-225,000 contributors-Average donation: We are just getting started. Let's stand together to transform this country. https://t.co/6gBtXRTWhf— Bernie Sanders (@BernieSanders) February 20, 2019 298