ABC News March 5, 2020

California cruise ship guests advised to stay in rooms as coronavirus cases grow nationwide

WATCH: New coronavirus cases emerging in several states

An outbreak of novel coronavirus that emerged in China about two months ago has now infected more than 93,000 people globally and has claimed over 3,000 lives.

Today's biggest developments:

  • 12 Americans have been killed by virus
  • 12 suspected cases within U.S. Department of Defense
  • UNESCO: Over 290 million students out of school due to coronavirus
  • Switzerland, UK announce 1st coronavirus deaths
  • Cluster of cases in California linked to cruise ship
  • Editor's Picks

    Here's how Thursday's news developed. All times Eastern.

    8:07 p.m. Nurses offer insight into coronavirus care, their own safety

    Out of 6,500 registered nurses, only 29% said there is a plan in place to isolate a patient with a possible novel coronavirus infection, while 23% said they do not know, according to results from a National Nurses United survey.

    The report also says only 44% of nurses indicated their employer provided them with information about coronavirus and how to recognize and respond to potential cases.

    The results also show that a large percentage of nurses do not have access to N95 respirators on their units, with only 63% saying they do.

    One nurse opened up about her own experience treating a patient and the issue she faces now: being unable to get tested.

    The nurse from a Northern California Kaiser Facility, who was not named, said she is in quarantine after caring for a patient who tested positive.

    "I’m awaiting 'permission' from the federal government to allow for my testing, even after my physician and county health professional ordered it," she said in a statement.

    The nurse said she had volunteered to be on the care team for the patient, but did so assuming "if something happened to me, of course I too would be cared for."

    "I did this because I had all the recommended protective gear and training from my employer. ... But the National CDC would not initiate testing. They said they would not test me because if I were wearing the recommended protective equipment, then I wouldn’t have the coronavirus."

    She said the only way to care for the patients is if they are also properly cared for.

    "Nurses aren’t going to stand by and let this testing delay continue; we are going to stand together to make sure we can protect our patients -- by being protected ourselves," her statement read.

    7:39 p.m. 3 US states report 1st cases

    Colorado, Maryland and Nevada have all reported their first cases of novel coronavirus.

    The Colorado Department of Public Health announced that a man in his 30s, who was an out-of-state visitor to Summit County, was the state's first case. In Maryland, Gov. Larry Hogan said the state confirmed its first three cases. Hogan said the patients all contracted novel coronavirus while traveling overseas and are in good condition. Local health officials in Nevada confirmed only one case: a Clark County man in his 50s, who recently traveled to Washington state and is in airborne isolation.

    Other states, including California and New Jersey, reported new cases earlier Thursday.

    San Francisco reported its first two cases, with a man in his 90s in serious condition and a woman in her 40s in fair condition. New Jersey reported its second case.

    Texas announced its first two cases in Harris County, the state's most populous county -- both travel-related.

    In Boston, three people who attended a conference in the city last week have also tested positive, according to a statement from Biogen, which held the conference.

    The attendees are doing well and are under the care of their health care providers, the statement read.

    Michele Smith via AP
    In this photo provided by Michele Smith, a cruise ship worker cleans a railing on the Grand Princess Thursday, March 5, 2020, off the California coast.

    5:42 p.m. Grand Princess guests to remain inside their rooms as helicopters deliver test kits

    Passengers on the Grand Princess have been advised to stay inside their rooms for the remainder of the voyage, the cruise line announced.

    Princess Cruises said in a statement that the recommendation came from the U.S. Centers for Disease Control and Prevention.

    Staff members will deliver passengers' meals to their rooms, and all activities have been canceled, according to the statement. The gym, casino, bars, boutiques and other public places all have been closed.

    Earlier in the day, passengers could be seen standing on the ship's deck as California National Guard helicopters dropped off test kits.

    The ship is being held after officials identified a "small cluster" of novel coronavirus cases in Northern California from guests aboard the previous Grand Princess voyage from Feb. 11 to 21.

    There have not yet been any confirmed cases currently on board, the cruise line said.

    5:42 p.m. Families who lost loved ones at nursing home speak out

    The families of patients who died from novel coronavirus at a nursing home in Washington are grappling with many questions, and few answers, as to what exactly happened.

    Pat Herrick said she got a call at 3:30 a.m. that her mom, Elaine, had passed away.

    "She wasn't sick. She'd been really well. I was surprised," Herrick said. She made a point to note that she is grateful for the staff at the nursing home, but doesn't think they have enough help in handling the issue.

    "How are we going to these people out of here?" she said. Herrick also had trouble reaching her mom before she died, with staff telling her that they weren't able to get the phone to her.

    "Then I called at 8 o'clock and they weren't able to get the phone to her and then ..." she said before breaking down into tears.

    Another man, named Mike, said that his mom was a resident at Life Care and also died.

    "She passed away. No family members were present. I was asleep. I had no idea what was going on," he said, noting that his family has not yet received test results to confirm that she died from coronavirus but believes that's likely the cause.

    When he visited her about two weeks ago, Mike said nothing seemed amiss.

    "She was in there, and I didn't want to disturb her," he said. "I just peeked in the door. I saw her and she looked happy."

    5:07 p.m. HHS investigating nursing home in Washington after multiple deaths

    The U.S. Department of Health and Human Services is sending investigators to a nursing home in Kirkland, Washington, where nearly a dozen people have died from novel coronavirus.

    "CMS has jurisdiction over all the nursing homes and health care facilities," Centers for Medicare & Medicaid Services Adminstrator Seema Verma told ABC News. "The situation in Kirkland is very concerning, and that's why we have investigators on the ground to determine what happened."

    Verma said CMS initiated a "call to action" to all nursing facilities to double down on infection-control policies and procedures.

    4:15 p.m. Dow plunges again

    The roller coaster week for financial markets continued on Thursday, with the Dow Jones Industrial Average plummeting nearly 1,000 points.

    The Dow finished down 969 points, or 3.58%, while the S&P 500 and Nasdaq also tumbled by 3.39% and 3.1%, respectively.

    Among the hardest hit were airline stocks. An industry group issued a report Thursday, estimating the outbreak could cost the airline sector up to $113 billion, or more than three times worse than initial assessments.

    4:10 p.m. Army working on vaccine

    A U.S. Army lab in Maryland is working on developing a vaccine for novel coronavirus, senior Army medical officials told reporters.

    The efforts are "mutually supportive" to what the National Institutes of Health is doing, but not the same. The timetable is similar: 12 to 18 months.

    The lab at Walter Reed Army Institute of Research in Maryland began the effort when coronavirus was identified earlier this year.

    3:51 p.m. Pelosi signs $8.3B coronavirus bill

    Samuel Corum/Getty Images
    House Majority Leader Nancy Pelosi, D-Calif., signs the Coronavirus Emergency Response Package which passed the House with only three votes against it on Capitol Hill on March 5, 2020, in Washington, D.C.

    House Speaker Nancy Pelosi signed the $8.3 billion bill to help tackle novel coronavirus, touting the bill's strong bipartisan support.

    The bill was rushed to the Senate and will then makes its way to the White House.

    She said the bill "may be a first step" if other needs may arise, such as unemployment relief.

    3:34 p.m. Health officials update on testing, attempt to quash fears in US

    The U.S. Centers for Disease Control and Prevention intend to send 75,000 tests by the end of the week to some 70 public health laboratories, Health and Human Services Secretary Alex Azar said.

    Additionally, a private contractor that makes the same test used by the CDC is expected to send out around 400,000 tests by the end of the week, according to Azar.

    At the same press conference, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, tried to quell fears about novel coronavirus.

    "What is the risk of actually getting infected with the coronavirus? The risk in the United States as a whole is still low," Fauci said. "If you're a young otherwise healthy individual, the risk of your requiring any kind of medical intervention is low. And we know that from data from China, and from recent data from Korea, and recent data from Italy, and that is, about 80% or more of individuals who get infected will do well without needing any medical intervention."

    3:12 p.m. 11th person in Washington state dies, putting total US number at 12

    A woman in her 90s became the 11th person to die in Washington state, public health officials said.

    The woman, who was hospitalized at EvergreenHealth, died on Tuesday and was a King County resident, according to King County Public Health.

    Her death puts the total number of U.S. fatalities at 12, with only one outside of Washington in California.

    2:29 p.m. 5th case reported in Illinois

    A 20-year-old man is Illinois' fifth positive case of novel coronavirus, Gov. J. B. Pritzker said on Thursday.

    The patient is in isolation at Rush University Medical Center and in stable condition, according to Pritzker. He had recently traveled to Italy.

    2:08 p.m. Washington state cases reaches 70

    The positive cases of novel coronavirus in Washington state rose from 39 to 70 in the last 24 hours, according to the state's Department of Health.

    There were no new deaths reported. Ten of the 11 deaths in the U.S. were in Washington state.

    King County has the most positive cases and deaths in the state at 51 and nine, respectively. Snohomish County has reported 18 positive cases and 1 death.

    David Ryder/Reuters
    Medics load a person into an ambulance the Life Care Center of Kirkland, the long-term care facility linked to several confirmed coronavirus cases in the state, in Kirkland, Wash., March 4, 2020.

    1:52 p.m. Cases in South Korea appear to be in decline

    The World Health Organization said they are seeing encouraging signs out of South Korea, with the number of newly reported cases appearing to be in decline, according to WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

    South Korea has the highest national total of confirmed cases, behind China.

    However, Ghebreyesus said novel coronavirus remains a threat for every country "rich and poor."

    1:30 p.m. UK reports 1st death, 41 more dead in Italy

    The first death related to novel coronavirus has been reported in the United Kingdom.

    British Prime Minister Boris Johnson said that he extends his condolences to the family of the victim, however he cautioned that the situation is "pretty much as it has been" and still in the "contained phase."

    "Our scientists and advisers are making preparations for the 'delay' phase, so what they're looking at in the next few days is ... what kind of measures might be necessary to retard the spread of the disease," Johnson said. "As soon as they've decided that the moment is right ... we'll be absolutely clear with the public about what needs to be done. But for the moment things are as they have been and you know I'm going to say this, the best thing we can do is wash our hands."

    Meanwhile in Italy, there have been 41 new reported deaths in the last 24 hours, bringing the total fatalities to 148, according to the Civil Protection agency.

    The total number of cases in Italy hit 3,296, the Civil Protection reported.

    1:21 p.m. Number of cases more than doubles in the Netherlands

    The number of confirmed novel coronavirus cases in the Netherlands has reached 82, after 44 new patients tested positive and more than doubled the total, Harald Wychgel, spokesman for the National Institute for Public Health and Environment (RIVM), told ABC News.

    Two of the new patients are hospitalized and the others are in isolation in their homes.

    While the majority of the cases are either travel-related or in people who had contact with someone else infected, there are 13 cases that are presumed to be of an unknown origin, according to Wychgel.

    Of those cases, four are hospitalized with two patients in serious condition.

    12:55 p.m. 11 new positive cases in New York

    There are 11 new positive cases of novel coronavirus in Westchester County, New York, Gov. Andrew Cuomo announced.

    The newest cases bring the state's total count to 22, he said. Eight of the new cases are in Westchester County, two in New York City (which Mayor Bill de Blasio announced earlier in the day), and one on Long Island in Nassau County, according to Cuomo.

    The eight cases in Westchester County are linked to an attorney from there, who had been diagnosed earlier. Those patients are not hospitalized, but the patients in New York City and Long Island are hospitalized, Cuomo said.

    Officials did not give details on the identities of the new cases, but said "all of them are getting better."

    "The number will continue to go up. It must because we are continuing tests more and more," he noted.

    11:51 a.m. 12 suspected cases within US Department of Defense

    There are 12 suspected cases of the novel coronavirus within the U.S. Department of Defense, a senior defense official told lawmakers Thursday.

    Assistant Secretary of Defense for Health Affairs Thomas McCaffery could not say where the suspected cases were located, only that they included domestic and overseas cases.

    AFP via Getty Images
    This file photo taken on Dec. 26, 2011, shows the Pentagon building in Washington, D.C.

    Meanwhile, there are six U.S. military individuals who have tested positive for COVID-19. All six are in South Korea. Only one is an active-duty U.S. service member while the others are his wife and child, the widow of a U.S. veteran, the defendant of another American service member, and the spouse of a U.S. Department of Defense civilian employee, according to a press release from United States Forces Korea.

    11:36 a.m. Starbucks temporarily bans use of reusable cups due to coronavirus

    Starbucks announced it is suspending the use of reusable cups in its stores as part of precautionary steps in response to the coronavirus outbreak.

    "We will continue to honor the 10-cent discount for anyone who brings in a personal cup or asks for 'for here' ware," Rossann Williams, Starbucks' executive vice president and president of U.S. company-operated business and Canada, said in an open-letter Wednesday.

    Tingshu Wang/Reuters
    A staff member is seen at a Starbucks at the Beijing Daxing International Airport in Beijing, China, on Feb. 20, 2020.

    The Seattle-based coffee company said it has modified or postponed large meetings across offices in the United States and Canada, has increased increased cleaning and sanitizing for all company-operated stores to help prevent the spread of germs, and has restricted all business-related air travel, domestic and international through the end of the month.

    11:20 a.m. Kim Jong Un sends 'message of comfort' to South Korea as cases rise

    South Korea's Centers for Disease Control and Prevention confirmed 438 new cases of the novel coronavirus on Thursday morning, bringing the national total to 5,766.

    The vast majority of cases were reported in the city of Daegu, where a secretive religious sect has been linked to many of the infections.

    Jung Yeon-je/AFP via Getty Images
    South Korean soldiers wearing protective gear spray disinfectant on the street to help prevent the spread of the novel coronavirus, at Gangnam district in Seoul, South Korea, on March 5, 2020.

    South Korea's presidential office revealed Thursday that North Korean leader Kim Jong Un had sent a "message of comfort to the South Korean people who are battling against the outbreak of COVID-19." In the letter, Kim said he was "worried" about South Korean President Moon Jae-in's health and "also expressed his frustration that there isn't much that he can do to help at this moment," according to Moon's office.

    Additionally, Kim "expressed his candid thoughts and positions on the situation surrounding the Korean Peninsula," but Moon's office did not reveal those details.

    South Korea has the highest national total of confirmed cases, behind China.

    MORE: Coronavirus spurs Starbucks to temporarily suspend personal and 'for here' cups

    11:04 a.m. Coronavirus outbreak could cost passenger airlines $113 billion in lost revenue

    The global outbreak of the novel coronavirus could cost passenger airline businesses as much as $113 billion in overall lost revenue this year, the International Air Transport Association warned Thursday.

    Many airlines have canceled flights in light of the epidemic.

    Spencer Platt/Getty Images
    A plane sits on the tarmac at an airport in Columbia, South Carolina, on March 1, 2020. As concerns grow about the spread of the novel coronavirus, many travelers are altering their plans which has affected companies in the travel industry.

    "The turn of events as a result of COVID-19 is almost without precedent," Alexandre de Juniac, director-general and CEO of the International Air Transport Association, said in a statement. "In little over two months, the industry's prospects in much of the world have taken a dramatic turn for the worse. It is unclear how the virus will develop, but whether we see the impact contained to a few markets and a $63 billion revenue loss, or a broader impact leading to a $113 billion loss of revenue, this is a crisis."

    10:45 a.m. Tennessee confirms 1st case

    Tennessee has reported its first confirmed case of the novel coronavirus.

    The Tennessee Department of Health announced the news on social media Wednesday morning, without providing additional details. State officials are expected to hold a press conference later.

    8:30 a.m. Amazon tells Seattle-area employees to work from home

    Amazon is encouraging its employees in its Seattle and Bellevue offices to work from home through the end of the month, after nine people have died from the novel coronavirus in Washington state.

    "We are recommending that employees in Seattle/Bellevue who are able to work from home do so through the end of the month," an Amazon spokesperson told ABC News in a statement Wednesday night.

    Ted S. Warren/AP
    People walk out of an Amazon Go store in Seattle on March 4, 2020. An Amazon spokesperson said an employee who worked in a building on the company's campus in Seattle had tested positive for the novel coronavirus.

    The giant online retailer revealed earlier this week that one of its Seattle-based employees has contracted the virus.

    7:58 a.m. UNESCO: Over 290 million students out of school due to coronavirus

    School closures in over a dozen countries due to the coronavirus outbreak have disrupted the education of at least 290.5 million students worldwide, according to the United Nations Educational, Scientific and Cultural Organization.

    "We are working with countries to assure the continuity of learning for all, especially disadvantaged children and youth who tend to be the hardest hit by school closures," UNESCO Director-General Audrey Azoulay said in a statement Wednesday. "While temporary school closures as a result of health and other crises are not new unfortunately, the global scale and speed of the current educational disruption is unparalleled and, if prolonged, could threaten the right to education."

    Remo Casilli/Reuters
    An empty classroom of the I.T.C Di Vittorio - I.T.I. Lattanzio school is pictured after the government decree to close schools, cinemas, and urge people to work from home and not stand closer than one meter to each other, in Rome, Italy, March 5, 2020.

    Just two weeks ago, China was the only country mandating school closures. The novel coronavirus, known officially as COVID-19, emerged there in the city of Wuhan back in December.

    As of Wednesday, 22 nations on three different continents have announced or implemented school closures to prevent or contain the virus, including 13 countries that have shut schools nationwide.

    UNESCO said it will convene an emergency meeting of education ministers on Tuesday to share responses and strategies to maintain the continuity of learning and assure inclusion and equity.

    7:38 a.m. New York City has 2 more cases, mayor says

    In an interview Thursday on MSNBC's "Morning Joe," New York City Mayor Bill de Blasio confirmed two more positive tests for the novel coronavirus, bringing the city's total to four and 13 overall in New York state.

    "If there's good news here in our experience, we only have four people as of this morning who have tested positive," de Blasio said. "Of the tests completed 25 have come back negative so far. The batting average is good. On the four people, the ones who are previously tested, two of them are doing better."

    7:08 a.m. New Jersey announces 1st presumptive positive case

    New Jersey has announced its first presumptive positive case of the novel coronavirus.

    The individual is a man in his 30s who is currently at a hospital in Bergen County. He has been hospitalized since Tuesday, according to New Jersey Gov. Phil Murphy, who announced the case Wednesday night.

    Kena Betancur/Getty Images
    A researcher works in a lab that is developing testing for the novel coronavirus at Hackensack Meridian Health Center for Discovery and Innovation in Nutley, New Jersey, on Feb. 28, 2020. The facility develops novel therapies for some of the worlds most difficult diseases.

    The presumptive positive result came from a sample tested by the New Jersey Department of Health and is now being submitted to the U.S. Centers for Disease Control and Prevention for confirmatory testing.

    "My Administration is working aggressively to keep residents safe and contain the spread of COVID-19 in New Jersey," Murphy said in a statement Wednesday night. "We take this situation very seriously and have been preparing for this for weeks. I urge residents to remain calm and use resources from the New Jersey Department of Health and Centers for Disease Control to prepare and prevent the spread of infection. Safeguarding the public's health is one of my highest priorities and my Administration is prepared to respond swiftly to any additional positive cases of COVID-19 here in New Jersey."

    6:34 a.m. Texas confirms 1st coronavirus case

    A Texas man who recently traveled abroad has become the state's first confirmed case of the novel coronavirus.

    The man, a resident of Fort Bend County, Texas, who is in his 70s, fell ill after returning from his trip. State and local health officials confirmed his diagnosis Wednesday night.

    The man is currently isolated in a hospital and is in stable condition, according to Jacquelyn Johnson-Minter, director of Fort Bend County Health and Human Services.

    Callaghan O'Hare/Reuters
    People wearing masks are seen leaving the grocery store as voters cast their ballot in the Democratic primary election at a polling station in Houston, Texas, U.S., on March 3, 2020.

    The patient is a travel-related case, which officials said doesn't indicate spread within the state.

    Officials didn't express surprise over the confirmed case, saying it was only a matter of time before the virus came to Texas.

    "Having a COVID-19 case in Texas is a significant development in this outbreak, but it doesn't change the fact that the immediate risk to most Texans is low," Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, said in a statement Wednesday night. "This travel-related case reinforces the fact that we should all be taking basic hygiene steps that are extremely effective in limiting limit the spread of COVID-19 and all respiratory illnesses."

    6:20 a.m. Switzerland announces 1st coronavirus death

    A 74-year-old woman has become the first person to die from the novel coronavirus in Switzerland.

    Switzerland's Federal Office of Public Health recorded the death on Thursday. The patient was from Vaud, a mountainous district in the country's western region.

    Salvatore Di Nolfi/Keystone via AP
    Information regarding the novel coronavirus are displayed on a screen at the European headquarters of the United Nations in Geneva, Switzerland, on March 4, 2020.

    So far, 58 people have tested positive for COVID-19 in Switzerland.

    5:57 a.m. UAE urges residents not to travel due to coronavirus

    The United Arab Emirates advised its nearly 10 million citizens and residents to avoid travel amid a global outbreak of the novel coronavirus.

    MORE: Severe reduction of emissions from coronavirus not enough to mitigate climate change long-term, experts say

    Those who do choose to travel and leave the country will face health screenings at the airport upon their return and then must quarantine themselves at home for at least 14 days "to ensure that they are free of the disease," according to a statement from the Ministry of Health and Prevention.

    Christopher Pike/Reuters
    Travelers wear masks as they arrive at Dubai International Airport, after the United Arab Emirates' Ministry of Health and Community Prevention confirmed the country's first case of coronavirus, Jan. 29, 2020.

    Anyone found to be infected will be quarantined in isolation wards at health facilities, the ministry said.

    The United Arab Emirates has a massive foreign workforce, with almost 90% of the population not citizens.

    5:24 a.m. Facebook closes Seattle office after contractor tests positive

    Facebook announced it is closing its Seattle office until Monday after a contractor tested positive for the novel coronavirus.

    MORE: Facebook cracking down on ads that guarantee coronavirus cure

    "A contractor based in our Stadium East office has been diagnosed with the COVID-19," Facebook spokesperson Anthony Harrison told ABC News on Wednesday night. "We've notified our employees and are following the advice of public health officials to prioritize everyone's health and safety."

    Jason Redmond/Reuters
    The Seattle skyline is pictured from a Washington State Ferry following a statement from ferry officials asking riders to consider staying in their vehicles when driving on board and other steps to minimize coronavirus exposure in Seattle, Washington, U.S., March 4, 2020.

    The company is also encouraging all employees in Washington state's largest city to work from home for the rest of the month.

    4:04 a.m. Cluster of cases in California linked to cruise ship

    Public health officials are investigating a "small cluster" of coronavirus cases in Northern California connected to a cruise ship that sailed round-trip from San Francisco to Mexico last month.

    Princess Cruises, a cruise line headquartered in Santa Clarita, announced late Wednesday that it had been notified by the U.S. Centers for Disease Control and Prevention that the cases include guests who were on the previous Grand Princess voyage from Feb. 11 to 21.

    MORE: How to prepare for coronavirus in your community

    The Grand Princess is currently at sea, and the cruise line has canceled the ship's call to the Mexican port city of Ensenada so that it can sail back to San Francisco early.

    "While there are no confirmed cases of COVID-19 currently on board, the CDC has identified groups of guests and crew who will be tested before arrival into San Francisco," Princess Cruises said in a statement Wednesday night. "Public health officials have advised that no guests will be permitted to disembark until all results have been received. Out of an abundance of caution, all guests who have been identified for testing have been asked to remain in their staterooms. We will continue to proceed under the guidance of the U.S. CDC and local authorities."

    Scott Strazzante/San Francisco Chronicle via AP
    In this photo taken on Feb. 11, 2020, the Grand Princess cruise ship passes the Golden Gate Bridge as it arrives from Hawaii in San Francisco.

    The cruise line has also canceled the upcoming Grand Princess Hawaii cruise set to depart Saturday. All guests will receive a full refund as well as a "future cruise credit" equal to the cost of the fare paid for the canceled voyage, the cruise line said.

    MORE: At least 11 Americans dead from coronavirus; California declares state of emergency

    California Gov. Gavin Newsom declared a state of emergency Wednesday evening after announcing the state had 53 confirmed cases of the novel coronavirus, including one death. The deceased patient is a resident of Placer County who was on board the Grand Princess last month.

    Newsom said he delayed the cruise ship's arrival to give federal officials more time to prepare. The CDC will be flying testing kits to the cruise ship before being turned around in a matter of hours on shore.

    So far, 11 people in the United States have died from the newly identified virus, known officially as COVID-19, which emerged in China back in December and has since spread to dozens of other countries.

    ABC News' Joohee Cho, Dragana Jovanovic, Aaron Katersky, Luis Martinez, Elizabeth McLaughlin, Gabrielle Sarann, Christine Theodorou, Phoebe Natanson, Somayeh Malekian, Ibtissem Guenfoud, John Parkinson, Mariam Khan, Bonnie McLean and Amanda Maile contributed to this report.