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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

SALEM, Ma. – To say legends never die in Salem would be an understatement. The crisp leaves and the sound of the harbor embraces you in its Americana state that you can’t help but fall in love with.And embracing that legacy, is what truly makes this town alive.“In October, it’s what we call the fifth season,” said Jill Christiansen, the assistant education director of the Salem Witch Museum.Every October, people are in Salem celebrating Halloween – every day of the month.But what is it about this place that draws us in? Why are we obsessed with the history, the secrets and the mystery?“Salem is most known today for the witch trials of 1692,” Christiansen said. “The twenty people who were executed in 1692 were innocent people. They were accused of witchcraft for any number of reasons, but they were innocent people.”People come from all over the country and the world to see the history of the witch trials. For Tina Fogel, Salem means so much more. “Is the history but it’s also my fifty ninth birthday today and it’s always been on my bucket list to come to Salem,” Fogel said while getting emotional. “We’ve had a rough couple of years. My daughter took her own life and I got the inheritance from her and that’s why I was able to come here. She would be so excited to know that I’m here.”History can be appreciated year-round, but Salem’s true colors are seen in the fall. The streets are filled with the wicked, the terrifying and just straight weird. People are wearing costumes, vendors are on the streets, hotels are almost always full, and restaurants packed.But it wasn’t always this way. Some say Salem is what it is today because of the very thing that legends say cursed it. “People kept asking me why I keep going back to Salem,” said a man who goes by the name Bubble Bob. “They say it’s a gutter. I say ‘yeah, but it’s my gutter.’ Fifteen to twenty years later, it’s a tourist entertainment spot. So, in a place where it was maybe not so healthy to get brought up is now a healthy environment. When I say it use to be a gutter, I mean a lot of people were dying from drugs and suicide. Twenty years later – nothing but improvement.”“In 1969, the show Bewitched came and filmed several episodes,” said Christiansen. “Because of that, it really put Salem back on the map again as connected to the witch trials. The tourism industry and many people attribute the town starting to grow right after that.” According to Destination Salem, from September to November about 500,000 people visit from all over the world. 9 million a year is generated through tourism alone, and thirty percent of that comes in the month of October.“We see approximatively 60,000 people in the month of October,” Christiansen said. “I believe the population of Salem at this point is 43,000. That gives you some perspective on just how many people come through here.”So why are we so drawn to this place? It’s the curiosity, the obsession, the wildly weird that allows this town to not be afraid to just be itself. And maybe, we envy that. So, to say Salem is embracing its legacy would be an understatement. 3122

South Korea has reported its biggest jump in coronavirus cases in more than 50 days. Health officials say the resurgence is getting harder to track and social distancing and other steps need to be taken. The health minister pleaded for people to avoid unnecessary gatherings and urged companies to keep sick employees off work. Dozens of infections were linked to an e-commerce warehouse that may not have used prevention measures. In other developments in Asia, India reported a surge of cases before new guidelines are made this weekend on the country's lockdown. 577

Smoking even one cigarette a day during pregnancy can double the chance of sudden unexpected death for your baby, according to a new study analyzing over 20 million births, including over 19,000 unexpected infant deaths.The study, published Monday in the journal Pediatrics, analyzed data on smoking during pregnancy from the US Centers for Disease Control and Prevention's birth/infant death data set between 2007 and 2011 and found that the risk of death rises by .07 for each additional cigarette smoked, up to 20 a day, a typical pack of cigarettes.By the time you smoke a pack a day, the study found, your baby's risk of unexpected sudden death has nearly tripled compared with infants of nonsmokers."One of the most compelling and most important points that I would take away from the study is that even smoking one or two cigarettes still had an effect on sudden infant death," said pulmonologist Dr. Cedric "Jamie" Rutland, a national spokesman for the American Lung Association."Every cigarette counts," said lead study author Tatiana Anderson, a neuroscientist at the Seattle Children's Research Institute. "And doctors should be having these conversations with their patients and saying, 'Look, you should quit. That's your best odds for decreasing sudden infant death. But if you can't, every cigarette that you can reduce does help.' "SIDS and SUIDSudden infant death syndrome, known as SIDS, was a frightening, unexplained phenomenon for parents for decades until research discovered a connection between a baby's sleeping position and the sudden deaths. If babies between 1 month and 1 year of age were put to sleep on their stomachs, the risk of dying of SIDS doubled, according to the American Academy of Pediatrics.The introduction of the "back to sleep" campaign in 1994 educated parents about the dangers, and the rate of deaths dropped by about 50% when parents began putting babies to sleep on their backs. That was soon followed by recommendations to remove bumpers, blankets, toys and other potentially suffocating clutter from the crib.By 2010, the rates of SIDS in the United States had fallen to about 2,000 a year, compared with nearly 4,700 in 1993, the American Academy of Pediatrics says.But while the numbers of babies dying of SIDS decreased, two other types of sudden infant death -- ill-defined causes and accidental suffocation -- have risen over the past two decades, Anderson said, bringing total deaths to approximately 3,700 a year.Today, researchers combine the three types of death and call it SUID, short for sudden unexpected infant death.The link to smokingResearch has shown a direct link between mother's smoking and SUID. According to the 2699

ROCKY MOUNTAIN NATIONAL PARK, Colo. – Rocky Mountain National Park is now closed to all visitors until further notice to help prevent the further spread of the novel coronavirus in Colorado. The closure went into effect Friday at 7 p.m. and will remain in effect 24 hours a day, 7 days a week, according to Rocky Mountain National Park spokeswoman Kyle Patterson, who added access will not be permitted to the national park during this time. The official announcement of the closure came several after 514

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