Coronavirus (COVID-19): Anxiety and How to Cope During a Pandemic

The World Health Organization has officially declared new coronavirus (COVID-19) a pandemic. Empower yourself to put your mental health first to help manage anxiety during this stressful outbreak.

Learn strategies for managing stress during a pandemic

It’s terrifying to learn that an illness such as coronavirus (COVID-19) is spreading across the globe. The early stages of a pandemic can be especially anxiety-provoking. During this time, you don’t know how widespread or deadly the illness is going to end up being.

Feelings of fear, anxiety, sadness, and uncertainty are normal during a pandemic. Fortunately, being proactive about your mental health can help to keep both your mind and body stronger.

Ways to take care of yourself include:

• 1. Reading the news from reliable sources (and take breaks from the news)
• 2. Recognizing the things you can control, like having good hygiene
• 3. Taking measures only if recommended by the CDC
• 4. Practicing self-care
• 5. Seeking professional help from a licensed mental health professional if necessary

A Timeline of Coronavirus (COVID-19)

The new coronavirus disease, called COVID-19, has appeared and spread extremely quickly, making its way to over 100 countries since its December 2019 discovery in China. This particular type of respiratory disease is caused by a virus called SARS-CoV-2. It’s part of a larger family of coronaviruses, the majority of which cause only the common cold. 

More dangerous types of coronavirus include the Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV). Like these more serious strains, COVID-19 can cause anything from mild respiratory problems to pneumonia or death.

Citing a mortality rate of 3.4%, the World Health Organization has declared COVID-19 a public health emergency.

How Many People Have Coronavirus? 

As of March 18, 2020, the World Health Organization has confirmed 179,111 cases of COVID-19 worldwide.3

• Cases in the United States: 3,503
• Cases in the Western Pacific Region: 91,779
• Cases in the European Region: 64,188
• Cases in South-East Asia: 508
• Cases in the Eastern Mediterranean Region: 16,786
• Cases in the Regions of the Americas: 4,910
• Cases in the African Region: 228

Pandemics by their very nature expand exponentially.  Already at the time of this writing, the number of cases exceeds 6,000 known cases (those that have been diagnosed with covid-19 tests.  In reality, the case number far exceeds 10,000.

Ways to Manage Stress

The way you cope with stress can go a long way toward ensuring that you’re taking helpful action in managing your mental health. Here are ways to help you ease anxiety surrounding coronavirus.

Read news from trustworthy sources.

Avoid media outlets that build hype or dwell on things that can’t be controlled. Instead, turn to sources that give reliable information about how to protect yourself, such as the Centers for Disease Control and Prevention (CDC).

Develop an action plan.

There are always some steps you can take to decrease risk. It may be as simple as washing your hands well and limiting travel. But recognizing these can remind you to focus on things you have control over. Just make sure the steps you’re taking are actions recommended by reputable sources.

Set limits on your media consumption.

Tuning into media stories that talk about how fast an illness is spreading, or how many people are getting sick, will increase your anxiety. Limit your media consumption to a certain time frame or a certain number of articles.

While it’s helpful to stay informed, it’s also important you don’t allow yourself to be bombarded with anxiety-provoking news all day.

Avoid the herd mentality.

Be aware that many people take action that doesn’t help. Don’t jump on a bandwagon just because other people are wearing masks or performing specific cleaning rituals (unless those things are recommended by the CDC). Otherwise, your actions could prove to be unhelpful—or perhaps even destructive.

Practice good self-care.

Eating a balanced diet, getting plenty of sleep, and engaging in leisure activities are always key to helping you stay as physically and psychologically healthy as possible during stressful times. Good self-care also keeps your immune system robust.

Seek professional help.

If your mental health is being impacted by the stress of the coronavirus, then you may want to seek professional help. A licensed mental health professional can help you manage your fears while also empowering you to make the best decisions for you and your family.

Should You Use Antiviral Medications for the Flu?

Mental Health Concerns

The 9 Best Online Therapy Programs of 2020

This link will bring you to the most highly recommended programs, with reviews

In addition to mental health concerns that may arise as a result of anxiety surrounding a pandemic, it's important to monitor existing mental health conditions to ensure they don't worsen.

Depression and Anxiety

Researchers have found that some individuals may experience mental health problems for the first time during a pandemic. Adjustment issues, depression, and anxiety may arise.

A study from the Ebola virus outbreak in Sierra Leone,1 indicated that increased numbers of people reported mental health and psychosocial problems. A study from the H1N1 influenza outbreak in 20092 indicated an increase in a variety of emotional symptoms, including somatoform disorders (symptoms such as pain and fatigue that can't be fully explained by a physical cause).

Additionally, some existing mental health conditions may get worse. Research suggests that individuals who are especially vulnerable to stress and anxiety may be at the highest risk.

Severe anxiety may also cause an increase in substance use. Individuals who have been in recovery may become more likely to relapse as their stress levels increase.

Researchers from Carleton University in Ottawa, Canada, found that people who were the least able to tolerate uncertainty experienced the most anxiety during the H1N1 pandemic.3 Those individuals were also less likely to believe they could do anything to protect themselves.

Caretakers may be at especially high risk for emotional symptoms during a pandemic as well. They may experience:

• increased depression and anxiety
• increased concerned about protecting their loved ones
• guilt about causing/not preventing a loved one's illness if they become sick

In turn, children often adopt the coping strategies they observe in their parents. Parents who grow anxious during a pandemic may end up witnessing their children develop anxiety right along with them.

High anxiety and feelings of helplessness can encourage some individuals to adopt unproven remedies or prevention methods. Some of these methods may be harmful both to individuals and to the community as a whole. So it’s important to ensure that any actions you take are actually helpful.

Coronavirus (COVID-19): Anxiety and How to Cope During a Pandemic:

President Trump set to unveil plan to help 'change the narrative' on healthcare

President Trump has promised he'll unveil a "phenomenal" healthcare plan in the coming weeks, and Rep. Chip Roy of Texas said he stands ready to be part of the conversation.

"We need to change the narrative," Roy, a freshman representative, told the Washington Examiner of the need for more Republicans to get on the same page about the party's healthcare platform. "We need to go on offense. I do think there is an interest in doing that."

As part of his commitment to this goal, Roy has introduced legislation that would expand health savings accounts, tax-free funds people can use to pay for healthcare. Under his proposal, the accounts would be renamed to "Health Freedom Accounts," with employers and charitable organizations allowed to contribute.

Like Trump, Roy believes that Republicans need to go on the offense on healthcare, rather than simply attacking Obamacare and the Medicare for All Act, the bill from Sen. Bernie Sanders, I-Vt., that would roll everyone living in the United States into a government plan and do away with private insurance. Republicans have been searching a conservative foil on healthcare that would do the opposite, chipping away at government involvement.

Roy believes the arrangement he came up with will help lower medical costs by unleashing a more free-market approach, rather than the current system where people pay into a plan that decides which doctors and hospitals they cover, and which negotiate rates on behalf of patients.

He is opposed to Obamacare's approach, which extends Medicaid to low-income people. Instead, he said, states should be provided a block grant to set up their own safety nets.

GOP freshman congressman unveils plan to help 'change the narrative' on healthcare:

Zero Harm in Health Care | NEJM Catalyst

How a comprehensive systems-focused approach can help to prevent all types of harm in health care

Despite some real success in improving patient safety in recent years, achieving the goal of zero harm to patients, families, and the health care workforce is a massive undertaking that requires a comprehensive effort. A robust systems-focused approach to improving safety requires four interdependent elements: 

Effectively managing change by tending to the psychology of change; creating and sustaining a culture of safety; 
Developing and leveraging an optimal learning system,  
Engaging patients in the codesign of care and improvement.





Zero Harm in Health Care | NEJM Catalyst

ECDC: COVID-19 not containable, set to overwhelm hospitals | CIDRAP

Johns Hopkins University COVID-19 Global Case Map

Doctors in Italy face grim decisions about whom to save.

Update today, the European Centre for Disease Prevention and Control (ECDC) said that, in a few weeks or even days, other countries in the region may face huge surges that mirror those of China and Italy.

It advised countries to quickly shift to mitigation strategies to protect vulnerable people and prevent overwhelmed hospitals.

Reports of dire conditions in hospitals in Italy's hot spots have been circulating on social media for the past few weeks and are now appearing in a medical journal and media reports. The ECDC acknowledges that high numbers of patients needing ventilation have exceeded the intensive care unit (ICU) capacity in some healthcare facilities in northern Italy.

Life-and-death decisions in Italy's inundated hospitals

In a Lancet report today, two authors from Italy said the percentage of COVID-19 patients needing ICU treatment has ranged from 9% to 11% and that ICUs will be at maximum capacity if that trend continues for 1 more week. They predicted that Italy will need 4,000 more ICU beds over the next month, a challenge given that the country has about 5,200 ICU beds.

Countries on track for Hubei scenarios, ECDC warns

In its assessment today, the ECDC said the risk of severe disease is moderate for the general population but high for older people and those with underlying medical conditions. Increased community transmission may exceed health system capacities in the coming weeks, it said, and countries should act now to step up hospital infection control and surge capacity.

The ECDC said estimates for hospital care suggest that most European countries could reach Hubei province scenarios by the end of March, with all countries reaching that point by mid-April.

The group urged member countries to implement social distancing measures such as canceling mass gatherings and cordoning off hotspots early to slow outbreaks and give health systems more time to prepare for an influx of patients.

Italy's health ministry today reported 2,651 new cases and 189 more deaths, raising its respective totals to 15,113 cases and 1,016 deaths. Spain's total today rose to 3,126 cases, with the addition of 782 more today. France's total rising to 2,876, with the addition of 595 more. The United Kingdom reported 134 new cases, boosting its total to 590.

South Korea cases decline again

South Korea today reported 114 new cases, with 6 more deaths, raising its overall respective totals to 7,869 and 66, according to the Korea Center for Disease Control. It said 80% of cases are linked to clusters, including 99 illnesses recently linked to an insurance company call center in Seoul.

In other developments in Asia:

Japan today reported 55 more cases, 6 of them listed as asymptomatic carriers, from 11 prefectures, according to the country's health ministry. Its overall total is 602, plus 72 asymptomatic carriers.

Singapore today reported 9 more cases, 3 linked to a dinner function, 5 imported, and 1 under investigation, raising the total to 187, the health ministry said in an update. In a separate statement, the country's Islamic Religious Council announced the temporary closure of mosques after 90 citizens attended a mass event in Kuala Lumpur, where several tested positive for COVID-19.

China today reported 15 new cases, 8 from Hubei province, as well as 11 more deaths, raising its overall total to 80,793, which includes 3,169 deaths, according to the country's National Health Commission.

ECDC: COVID-19 not containable, set to overwhelm hospitals | CIDRAP:

'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus

'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus

According to Dr. Marty Makary, a public health professor at Johns Hopkins University, the coronavirus is something that “people need to take seriously.”


In the U.S. there are over 1,600 confirmed cases, according to the Centers for Disease Control and Prevention (CDC), with 41 deaths. Makary said that the number of cases, though, is likely much higher. 

“Don’t believe the numbers when you see, even on our Johns Hopkins website, that 1,600 Americans have the virus,” he said. “No, that means 1,600 got the test, tested positive. There are probably 25 to 50 people who have the virus for every one person who is confirmed.” 

In the U.S. there are over 1,600 confirmed cases, according to the Centers for Disease Control and Prevention (CDC), with 41 deaths. Makary said that the number of cases, though, is likely much higher. 

“Don’t believe the numbers when you see, even on our Johns Hopkins website, that 1,600 Americans have the virus,” he said. “No, that means 1,600 got the test, tested positive. There are probably 25 to 50 people who have the virus for every one person who is confirmed.” 

He added: “I think we have between 50,000 and half a million cases right now walking around in the United States.”

Part of the reason the number of cases might be higher without people realizing it is because of the shortage of coronavirus testing kits from the CDC. Between Jan. 18 and March 12, there were 13,624 tests for COVID-19 conducted in the U.S. Meanwhile, South Korea has conducted over 100,000 tests, and the U.K. has tested nearly 25,000 people.

He added: “I think we have between 50,000 and half a million cases right now walking around in the United States.” For those of us who may remember This may be the worst scenario since Polio in the 1950s.

Part of the reason the number of cases might be higher without people realizing it is because of the shortage of coronavirus testing kits from the CDC. Between Jan. 18 and March 12, there were 13,624 tests for COVID-19 conducted in the U.S. Meanwhile, South Korea has conducted over 100,000 tests, and the U.K. has tested nearly 25,000 people.





'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus: 

#97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment - Peter Attia

#97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment - Peter Attia: “The next two weeks will be the critical period where we may start to see this reach a peak.”  —Peter Hotez, M.D., Ph.D.

Hospitals prepare for the worst on coronavirus, and it’s not a pretty picture

Hospitals prepare for the worst on coronavirus, and it’s not a pretty picture: Medical facilities are taking precautions to protect their staff while preparing for a spike in patients that has overwhelmed the health care systems of other countries.

Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First | The White House

Does your hospital post their charges and fees for patients to see ?  If not then this Presidential Executive Order should be brought to their attention. You may also report te hospital  to the White House

Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First | The White House

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: (brief summary)

Section 1.  Purpose.  My Administration seeks to enhance the ability of patients to choose the healthcare that is best for them.  To make fully informed decisions about their healthcare, patients must know the price and quality of a good or service in advance.  With the predominant role that third-party payers and Government programs play in the American healthcare system, however, patients often lack both access to useful price and quality information and the incentives to find low-cost, high-quality care.  Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.

Sec. 2.  Policy.  It is the policy of the Federal Government to ensure that patients are engaged with their healthcare decisions and have the information requisite for choosing the healthcare they want and need.  The Federal Government aims to eliminate unnecessary barriers to price and quality transparency; to increase the availability of meaningful price and quality information for patients; to enhance patients’ control over their own healthcare resources, including through tax-preferred medical accounts; and to protect patients from surprise medical bills.

Sec. 2.  Policy.  It is the policy of the Federal Government to ensure that patients are engaged with their healthcare decisions and have the information requisite for choosing the healthcare they want and need.  The Federal Government aims to eliminate unnecessary barriers to price and quality transparency; to increase the availability of meaningful price and quality information for patients; to enhance patients’ control over their own healthcare resources, including through tax-preferred medical accounts; and to protect patients from surprise medical bills. 

Sec. 3.  Informing Patients About Actual Prices.  (a)  Within 60 days of the date of this order, the Secretary of Health and Human Services shall propose a regulation, consistent with applicable law, to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals. 

Sec. 4.  Establishing a Health Quality Roadmap.  Within 180 days of the date of this order, the Secretaries of Health and Human Services, Defense, and Veterans Affairs shall develop a Health Quality Roadmap (Roadmap) that aims to align and improve reporting on data and quality measures across Medicare, Medicaid, the Children’s Health Insurance Program, the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System.  

Sections 5 and 6 may read at the link below, which encompasses the entire order

Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First | The White House:

Sec. 7.  Addressing Surprise Medical Billing.  Within 180 days of the date of this order, the Secretary of Health and Human Services shall submit a report to the President on additional steps my Administration may take to implement the principles on surprise medical billing announced on May 9, 2019.

Health Care Social Media

Dr Damian Roland (pictured), Honorary Senior Lecturer in the Department of Health Sciences, has won an international award for his research into social media and healthcare.

Dr Damian Roland (pictured), Honorary Senior Lecturer in the Department of Health Sciences, has won an international award for his research into social media and healthcare.

The consultant in pediatric emergency care at Leicester’s Hospitals has been awarded first prize in the Stanford Medicine X | Symplur Signals Research Challenge 2015 and will present his work to the Medicine X conference at Stanford University in California on Sunday 27 September 201

Doctor wins international award for social media and healthcare research — University of Leicester

The Challenge is a joint venture by Stanford University and healthcare social media analysts Symplur. The competition aims to encourage research into social media, healthcare and the benefits this can offer to patients.

Dr Roland, who is part of the SAPPHIRE (Social Science APPlied to Healthcare Improvement REsearch) group teamed up with Dr Daniel Cabrera, of Mayo Clinic College of Medicine, and Jesse Spur BN, of the Royal Brisbane and Women’s Hospital, to secure the top prize. The trio impressed judges with their research which used social media analytics to interrogate Twitter data and give credence to an online healthcare community – to the extent that it can be defined as a community of practice.

The team focused on the Free Open-Access Medical education (FOAM) community of healthcare professionals who collaborate online to share knowledge. They interrogated the Twitter #FOAMed hashtag using the Symplur Signals analytics tool.

Sir William Osler, one of the first progenitors of Social Media

Dr Roland said: “The analytics showed millions of impressions recorded over a set period and also revealed it is a community that is growing. The #FOAMed community has proved very popular and uses the power of social media. It is truly what a community of practice can be defined as.  It shows that through Twitter healthcare professionals are educating each other and this is benefiting the patients they work with.”

FOAMed slide deck

Why FOAM?... Facts, Fallacies and Foibles

1. 1. FREE OPEN ACCESS EDUCATION
2. 2. h"p://lifeinthefastlane.com/foam/  
3. 3. h"p://www.kevinmd.com/blog/2013/03/flipped-­‐classroom-­‐future-­‐medicine.html  
4. 4. “…and to teach them this art — if they desire to learn it — WITHOUT fee and covenant” h"p://lifeinthefastlane.com/from-­‐Hippocrates-­‐to-­‐Osler-­‐to-­‐foam/  
5. 5. Photo from  h"ps://www.mcgill.ca/library/branches/osler/oslerbio  
6. 6. Taking  the   world  by   STORM (in  a  small  way) Photo  by  JD  Hancock  
7. 7. 230 EMCC  blogs      in  24 Countries   h"p://lifeinthefastlane.com/emcc-­‐blog-­‐update-­‐2013/  
8. 8. IT  KEEPS  GETTING  BIGGER…   >30,000  page  views  daily  
9. 9. Your  students  will     leave you behind
10. 10. FOAM     =   Social Media
11. 11. FOAM     =   Social Media
12. 12. FREE OPEN ACCESS EDUCATION
13. 13. A  waste of  Mme?  
14. 14. Photo  from  smacc.net.au  
15. 15. #Hashtags          #FOAMed   #FOAMcc   #smaccGOLD  
16. 16. #smacc2013
17. 17. No   Peer Review =    Bad?
18. 18. Image from     http://rationally speaking.blogspot.com.au/2012/01/radical-­‐reform-­‐for-­‐peer-­‐review.html  
19. 19. Publish then     Filter  
20. 20. Translate and disseminate knowledge
21. 21. Source  unknown  
22. 22. Flip  the  Classroom   h"p://lifeinthefastlane.com/2009/07/web-­‐20-­‐for-­‐emergency-­‐physicians/  
23. 23. That’s just in time…
24. 24. Tacit  knowledge   sharing   Photo  credit:     Stefan  
25. 25. Nothing  replaces  the     bedside mentor Photos  of  Sir  William  Osler  from  www.collecMonscanada.gc.ca  
26. 26.   License   Image  credit:  zipckr  
27. 27. Filter  Failure https://litfl.com/
28. 28. “I  don’t  have  time  not   to  use  social  media”   Bertalan  Mesco https://litfl.com/
29. 29. CAVEAT EMPTOR   Think  rationally
30. 30. Lobotomise, blood let, and perform EGDT!
31. 31. A jackass in the real world will be a jackass online Photo  by  public energy  
32. 32. Photo  by  MisterSnappy  
33. 33. Photo  from  The  Matrix  
34. 34. TO  GET  #FOAMed
35. 35. https://litfl.com/
36. 36. http://googlefoam.com  
37. 37. h"p://iteachem.net/2013/06/ten-­‐Mps-­‐for-­‐foam-­‐beginners/  
38. 38. InfoamaMca.org  
39. 39. It is up to us to save the world! The  22nd  of  Peter  Safar’s     Laws  for  the  Navigation  of  Life   https://litfl.com//2009/04/laws-­‐for-­‐the-­‐navigation-­‐of-­‐life/   https://litfl.com//2009/04/laws-­‐for-­‐the-­‐navigation-­‐of-­‐life/ 

Coronavirus: Extraordinary Decisions For Doctors - The Atlantic

Will it come to this?

One week ago, Italy had 2,502 cases of the virus, which causes the disease known as COVID-19. At that point, doctors in the country’s hospitals could still perform the most lifesaving functions by artificially ventilating patients who experienced acute breathing difficulties.

Today, Italy has 10,149 cases of coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.

There are now simply too many patients for each one of them to receive adequate care.
Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow in these extraordinary circumstances. The document begins by likening the moral choices facing Italian doctors to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, its authors suggest, it is becoming necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”

The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”

Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, will be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In the case of total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”

In addition to age, doctors and nurses are also told to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.” This is in part because early studies of the virus seem to suggest that patients with serious preexisting health conditions are significantly more likely to die. But it is also because patients in a worse state of overall health could require a greater share of scarce resources to survive: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”

These guidelines apply even to patients who require intensive care for reasons other than the coronavirus because they too make demands on the same scarce medical resources. As the document clarifies, “These criteria apply to all patients in intensive care, not just those infected with CoVid-19.”

But if Italy is in an impossible position, the obligation facing the United States is very clear: To arrest the crisis before the impossible becomes necessary.

This means that our political leaders, the heads of business and private associations, and every one of us needs to work together to accomplish two things: Radically expand the capacity of the country’s intensive-care units. And start engaging in extreme forms of social distancing.  

                          

The Shortages May Be Worse Than the Disease

Over the centuries, societies have shown a long history of making the effects of epidemics worse and furthering their own destruction.

Cancel everything. Now.

Coronavirus: Extraordinary Decisions For  Doctors - The Atlantic:

COVID-19 and the Strategic National Stockpile

Federal public health officials warned Tuesday that the spread of coronavirus in the U.S. is "inevitable.

As the nation faces increased strains on its public health workforce from the COVID-19 outbreak, a new report examines the makeup of the U.S. public health workforce. This new primer describes the current public health workforce size, expectations for growth, employee demographics, job tenure, and the skill sets most in demand. This description is offered against the broader backdrop of the overall state and local government sector.

 The U.S. government has a secretive, $7 billion stash of emergency medical equipment — one that it drew on to respond to the terror attacks of 9/11, to prepare for a subsequent threat of anthrax attacks in 2001, and to help thousands of homes guard against Zika with insecticide.

The outbreak of the novel coronavirus, however, marks the first potential pandemic to reach U.S. soil since the H1N1 flu of 2009, teeing up one of the biggest challenges yet for the 21-year-old store, known as the Strategic National Stockpile.

Already, the outbreak has placed a significant strain on the stores of masks, medicine, and medical equipment. The stockpile has been called on to help with efforts to repatriate and quarantine Americans flown back from China and Japan, but has come under fire for a perceived shortage of masks — and for allowing millions of masks already in its stock to pass their expiration dates.

In past disasters, the SNS has provided resources. The timeline is shown below

Today, the Strategic National Stockpile works with governmental and non-governmental partners to upgrade the ability to respond to a national public health emergency, ensuring that federal, state, and local agencies are ready to receive, and stage and distribute products.

Since its beginning, the stockpile has responded to multiple large-scale emergencies including floods, hurricanes, and influenza pandemics. It has also supported various small-scale deployments for the treatment of individuals with life-threatening infectious diseases like anthrax, smallpox, and botulism.

Still, public health officials have criticized the stockpile for, in some cases, failing to act with sufficient urgency. After officials in Washington state requested 233,000 respirator masks, the stockpile initially offered to supply less than half the amount, the Washington Post reported. An SNS spokeswoman said the state eventually received the full requested shipment.

And the store has already proven valuable in other areas, Adams said. Beyond sending masks to hard-hit states, the stockpile helped with efforts to bring Americans in China and Japan back to the U.S., supplying protective equipment for medical workers who monitored the Americans’ health during their stays on military bases. That effort largely relied on materials stored in SNS warehouses but maintained by the National Disaster Medical System, a separate emergency medical-supply distribution network.

“We were quite involved with moving matériel to support the repatriation of State Department [employees] and other Americans from China, and then a follow-on mission of doing so from Japan,” Adams said.

Adams added that the stockpile has since “transitioned into providing support to what some would call ‘hot spot areas,’ states where they’re actively managing large numbers of patients with COVID-19,” the respiratory disease caused by the coronavirus, namely by shipping respirator masks to hard-hit regions like the Seattle metropolitan area.

Coming at a bad time there are ongoing changes for the NSP which hindered a quicker response

A spreadsheet detailing the spread of Covid-19 on a cruise ship