https://edition.cnn.com/2020/04/11/opinions/new-york-hit-hard-coronavirus-sepkowitz/index.

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Why New York has been hit so hard by coronavirus

Opinion by Kent Sepkowitz
Updated 0016 GMT (0816 HKT) April 12, 2020

Editor’s Notes: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial
Sloan Kettering Cancer Center in New York City. The views expressed in this commentary are his own. View  more
opinion at CNN.

(CNN) New York state reached a tragic milestone this week: It now has more Covid-19 patients than any
country in the world, aside from the United States. The state's total of 181,026 cases, as of April 11, is
higher than Spain's (161,852 cases) and Italy's (152,271), countries with populations many times larger
than New York. New York state reached a tragic milestone this week: It now has more Covid-19 patients
than any country in the world, aside from the United States. The state's total of 181,026 cases, as of April
11, is higher than Spain's (161,852 cases) and Italy's (152,271), countries with populations many times
larger than New York.

The disease is killing New Yorkers disproportionately. Of the 20,389 deaths in the United States, 8,627,
or 42%, have occurred in New York. Its mortality rate is 4.7%, compared with 3.4% in the rest of the
country, according to CNN's figures based on data from the Johns Hopkins University Center for Systems
Science and Engineering. New York City and its suburban counties — Nassau, Suffolk, Westchester and
Rockland — are responsible for 93% of the statewide case count. Furthermore, in New York City, the
Covid-19 death rate is about 6% higher than most countries.

Why does New York seem to be having a different epidemic from most other parts of the country? Is the
reason simply population size and density? New York is by far the nation's most populous city, with more
than 8 million people, twice as many as Los Angeles. But New York also has eight or nine times more
cases than any other city — so what gives? No other city or county has a fraction of the cases of New
York City.

A caution on numbers: Counting cases and mortality rates is difficult because most counting is done by
county or borough or parish rather than city, and city of residence may differ from city of diagnosis or
death. Even so, New York City is off the charts.

How about population density? Covid-19 spreads most easily when people are packed together — in
churches or cruise ships, in outdoor events like concerts or Mardi Gras, or perhaps in small apartments
with multiple roommates or large families. New York's population density, about 27,000 people per
square mile, is easily the highest in the country, though it's nowhere near the top for cities across the
globe. Many cities — in Asia, for example — have a density of nearly 40,000 people per square mile.
The density explanation may explain some of the difference, but not all of it. New York's densest
borough is Manhattan, while relatively sprawling Queens sits at fourth out of five. But Queens has more
than twice the cases and twice the rate of cases as Manhattan.

Maybe it's because so much testing is being done in New York. If you test more, you find more, and if
you find more, you test even more. It is likely that more tests, and more tests per population, are
performed in New York than elsewhere in the United States, and that the New York rate stacks up
favorably to countries with aggressive testing programs, such as Iceland and South Korea and Germany,
but comparative information is sketchy. The split between tests performed by public versus private labs
has made accurate tracking just about impossible, despite the heroic efforts of such groups
as as Covidtracking.com, Worldometers, and Our World in Data.

Furthermore, the current advice — stay home if you are sick but stable and don't be tested — introduces
additional uncertainty. This pales in comparison to the clear evidence of deaths at home likely due to
Covid-19 but never diagnosed. So yes, New York City probably is testing at a brisker pace than elsewhere
and yes, this may contribute to the high case numbers, but we will never have an accurate picture.

The high number of cases and rates likely do derive in some modest amount to each explanation above —
plus the fact that the epidemic has been in New York City a week or two longer than many other places.
A more mature epidemic is always a larger epidemic.

More concerning is the elevated mortality rate in New York City. As has been well documented, some of
this is due to the tragic overwhelming of the city's hospitals. We will never know just how many people
died due to the country's inept preparation for the pandemic, but the impact surely was, and still is,
substantial. Still, a mortality rate of about 6% is quite high, even though most countries, particularly in
western Europe, have seen mortality rates rise as the pandemic drags on. As patients who have hung on
for weeks have begun to die, and the rate of new cases has slowed, this tilts the proportion of fatal cases.

New York City also has had a very male outbreak; substantially more men have been diagnosed,
hospitalized and have died, in keeping with data seen in other countries.

Sadly, the likeliest explanation for the high death rate, though, is the chronically inadequate health care
given to minorities and the poor throughout New York City, as in the rest of the country. New York City
and New York state have only now released the race distribution of cases and deaths, as well as by zip
code, a surrogate for poverty rates. It is clear that severe disease has not been distributed equally by race
and ethnicity.

Black and Hispanic New Yorkers represent 51% of the city's population, yet account for 62% of Covid-
19 deaths. They have twice the rate of death compared with whites, when adjusted for age. This likely is
due to both a higher proportion of black and Hispanic New Yorkers being diagnosed with severe disease
and a higher rate of death among those who are known to be infected. This disparity likely is the result of
several factors. Co-morbid conditions, such as hypertension and diabetes, are strongly associated with
death from Covid-19 and are more common in black and Hispanic communities. But what causes high
rates of poorly controlled hypertension and diabetes? Lack of appropriate health care. People who cannot
easily find good health care for reasons of money, time, location, or trust may be more likely to stay at
home undiagnosed and spread the virus — as well as experience potentially fatal delays in diagnosis and
treatment.

The explanation is the same for New York City as for Italy, New Orleans and probably Iran: the virus
exploits weaknesses in health and health care, be it advanced age or co-morbidity or access to care.
Hopefully, the Covid-19 pandemic will force us to reckon honestly with the many shortfalls that have
been exposed and build a fair, forward-thinking approach that allows doctors and nurses to care for
people in need. Failure to do this will only further darken the memory of those who have died and the
hearts of those who remain.
Publisher releases bilingual picture book
Update: April, 11/2020 - 09:56
|

The cover of the English - Vietnamese picture book The Sea Saw. Photo courtesy of
the publishing house. 
HÀ NỘI - A new bilingual picture book that was recently released should appeal to both Vietnamese and
expat children.

The book entitled The Sea Saw is published by Việt Nam Women's Publishing House. 

The English version by Tom Percival was published last year. It is about a long journey of a teddy bear
travelling back from a beach with the help of the sea to gather with its owner Sofia, who accidentally lost it
during her trip to the coast.
 
"The book is suitable for children but it also touches mature readers' heart," said Lê Thu Ngọc, the book's
editor. "The bilingual book will inspire children to learn both English and Vietnamese."
 
The writer tells a journey through decades from a little girl to an old woman in the 32-page books with
beautiful illustrations.
 
The teddy bear belongs to little Sofia, the main character. Those two images are always intertwined in the
story although they must be separated in terms of distance and time.
 
The translator was a 14-year-old, Nguyễn Lê Minh Phụng. She won the Best Translator award for the Junior
Ambassador for Literature in Việt Nam in a contest held by the publishing house, the Irish Embassy and
English language teaching centre Amslink. 
 
"It is an extremely lovely story," said Phụng. "The plot is not complicated or so unique but somehow still
touches the reader's heart as it is like a gentle melody about a trip back for a reunion.
 
"The lesson from the story is educational especially to children and they will find their life more meaningful
after reading this. The book itself is a work of art the reader can feel the illustrator's dedication through each
page of vivid or gloomy figures.
 
"I am a little proud of myself and feel a sense of accomplishment."
 
Phụng is a 9th-grade student at Archimedes High School in Hà Nội. She likes to learn languages and read
books so jumped at the chance to be the translator of the book The Sea Saw. – VNS

https://vietnamnews.vn/life-style/684965/publisher-releases-bilingual-picture-book.html