Over the past month, Hong Kong has averaged one new confirmed coronavirus case a day.
Taiwan has reported only one case in the past three weeks. The situation is similar in Vietnam. Although the number of coronavirus cases continues to grow globally, there are places that have managed to successfully control COVID-19.
New Zealand's triumph
Perhaps the greatest success story is New Zealand, which has stopped local transmission and has a plan to completely eliminate the virus from its territory.
"The lesson is that it can be done," says Siouxsie Wiles, an associate professor of microbiology in New Zealand. "Obviously, the longer you leave it, and the more cases there are, the harder it becomes. But that doesn't mean that we shouldn't try."
Wiles heads up the Bioluminescent Superbugs Lab at the University of Auckland. Much of her work focuses on antibiotic resistance and infectious diseases. When the coronavirus hit, she got involved in communication efforts in New Zealand to help explain the virus, including by using a popular cartoon.
But it wasn't just scientists who led the charge. Wiles and many other New Zealanders give much of the credit for their country's success to the swift and decisive leadership of Prime Minister Jacinda Ardern in March.
Jacinda Ardern, the prime minister of New Zealand, briefs the media on COVID-19. She issued a call for New Zealanders to protect one another from the health threat. Mark Mitchell/Pool/AFP via Getty Images hide caption
Jacinda Ardern, the prime minister of New Zealand, briefs the media on COVID-19. She issued a call for New Zealanders to protect one another from the health threat.
"Our prime minister made the decision that she did not want what was happening in Italy to happen in New Zealand," Wiles says. In mid-March, as cases were exploding in Italy and Spain, Ardern ordered anyone entering New Zealand into quarantine. At that point, the country had confirmed just six cases. A few days later, on March 19, Ardern shut down travel to the country, essentially banning all foreigners from entering the island nation of 4.8 million.
She took to the national airwaves to explain a four-stage lockdown system that New Zealand would use to confront the health crisis. "I'm speaking to all New Zealanders today to give you as much certainty and clarity as we can as we fight COVID-19," she said in a nationally televised address on March 21.
Ardern called the threat "unprecedented," but she was calm and reassuring. "Here's how we'll know what to do and when," she said as she laid out plans to shut down schools, most businesses and domestic travel.
Wiles at the University of Auckland says that the prime minister did something quite interesting, "which was that unlike many other countries, she never put us on a war footing."
So Ardern's speeches weren't about attacking an invisible enemy as many world leaders would say.
Instead she called on New Zealanders to confront this crisis by protecting their fellow citizens.
"She talked over and over about us being a team of 5 million and that we all do our part to break these chains of transmission and to eliminate the virus," Wiles says. "I think that has been one of the really crucial things everybody knowing how they had to behave and that they were behaving for the good of everybody."
Wiles heard the prime minister's calls for everyone to come together so many times that she refers to it as Ardern doing her "united thing."
New Zealand is now reopening most businesses and is even talking about complete elimination of the coronavirus from its territory.
As of late May, New Zealand had had roughly 1,500 cases and fewer than two dozen deaths from COVID-19.
Outstanding in Asia
Several nations in Asia have had far larger outbreaks but have managed to bring the disease under control.
For example, South Korea has reported more than 11,000 cases. In late February and early March, South Korea was reporting about 750 new cases a day. Now the country is down to an average just a few dozen per day.
Gi-Wook Shin, the head of Walter H. Shorenstein Asia-Pacific Research Center at Stanford University, says the most successful countries all did some things similar to New Zealand.
"There are some common threads," Shin says. One is very swift and effective action by the state against the outbreak.
Hong Kong, Taiwan, Vietnam and South Korea all either banned incoming visitors early in the outbreak or placed them in two-week quarantines. South Korea quickly developed its own testing system.
Many countries in the Asia-Pacific region have experience with the central government being involved in business development, particularly technology development. So they know how to harness their manufacturing and research hubs to attack particular problems. Shin says the faith in government in these countries and the experience of having the state lead economic development in the past helped these countries respond faster to the pandemic.
"In those countries in Asia, absolutely, they believe that the state, the central government, is responsible for intervening and then solving this problem," Shin says.
Another clear trait of the successful responses against COVID-19 is that they've all been "apolitical." The efforts haven't been framed as coming from one political party or another but rather as efforts for the good of everyone.
The successful Asian countries had national plans, and the leaders articulated them to their people.
"If you look at like Korea, Taiwan, Vietnam or maybe even Hong Kong," Shin says. "The message from the central government was very clear, very straightforward, very coherent and, I think, very effective."
Angela Merkel's TV strategy
Countries in other parts of the world have also managed, for various reasons, to tame COVID-19.
Many nations in the Caribbean have corralled the virus after it arrived on their shores. In addition, Costa Rica, Iceland and Rwanda have also reduced spread to extremely low levels. Mauritius has only reported two cases since April.
In Europe, Germany is still dealing with hundreds of cases a day, but it brought transmission down faster and with far fewer deaths than most other countries in Europe. On March 18, German Chancellor Angela Merkel did something that she had never done before while in office. She took to the airwaves and gave a televised national address. The topic: explaining her plan for how to tackle the coronavirus outbreak. "It is serious," Merkel said of the virus. "Take it seriously."
Jana Puglierin, a senior policy fellow at the European Council on Foreign Relations in Berlin, says Merkel going on TV to give a speech in a crisis was very unusual for her.
"She has never done that in any of the previous crises, not in the migration crisis, not during the eurozone crisis. So this was really a first for her," Puglierin says.
As a public speaker, Merkel has a reputation as being cold.
"But in this speech, she really managed to connect with the people," Puglierin says. Merkel brought Germans on board to fight the outbreak. She told them that the only way to overcome this crisis was for every German to accept it as their own responsibility to reduce the spread of the virus. "She convinced them that this was necessary," Puglierin says.
Merkel added that since the end of World War II and national reunification, there has been no other challenge that depends as strongly on Germans working together.
"She was very human, very approachable, very transparent and very clear in her message," Puglierin says. And it also helped that Merkel is a scientist, with a doctorate in quantum chemistry. She understood the science behind the outbreak. "And she has this tremendous gift of explaining everything that is related to that virus in a very clear and understandable way for ordinary citizens."
Germany is still dealing with coronavirus transmission but has brought its daily case numbers down significantly. Parts of the country are starting to reopen. Things aren't perfect. Some of the reopening is fairly chaotic. Students are going back to school at different times.
"My kids, for example," Puglierin says. "One goes to school once before the summer break starts. The other goes every third day, and the neighbor kid goes every day. So that adds to a lot of frustration."
But there's a feeling that things are moving in the right direction. Case numbers in Germany are going down. Millions of students are returning to school. That's the kind of progress that so many people around the world desperately want to see.
The number of Wisconsiniteshospitalized due to COVID-19 hasbeen on the rise in recent weeks.
More than 400 patients statewide werehospitalizedwith coronavirus as of Wednesday morning, according to the Wisconsin Hospital Association and state health officials. Fewer than 300 were hospitalized in early May.
The latestnumber 413 currently hospitalized coronavirus patients was down slightly from 422 on Tuesday.
But an additional 335 people are hospitalized while awaiting coronavirus test results, surpassing the previous high of 295, in early April.
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Mostof theCOVID-19 patients in the state are in southeastern Wisconsin, which on Wednesday reported 290 people arehospitalized with coronavirus.
Ben Weston, director of medical services in the Milwaukee CountyOffice of Emergency Management, noted anupward trend in COVID-19 hospitalizations in Milwaukee County over the past two weeks, from 146 on May 14 to 205 on Tuesday,
The figure dropped to 180 on Wednesday, but it's a concerning trend overall, he said.
"If tomorrow we see we're right back up to 200 and we keep creeping up, then I think we got to step back and say, what's going on?"he said.
The increasing hospitalizations come as Wisconsin on Wednesday reported its largest single-day increases in coronavirus deaths, cases and tests. After the state countincreased by just 10 between Sunday and Tuesday, 22 deaths were reported Wednesday, bringing the total to 539. The previous single-day high was 19.
Newly confirmed cases totaled 599 in Wisconsin, breaking the state's record of 528 set a week earlier.
Thetroubling record-setting coronavirus numbers were reported two weeks after the Wisconsin Supreme Court struck down Gov. Tony Evers' stay-at home order.
State health officials on Wednesday said they couldn't say whether the new COVID-19 cases are linked to the court's decision to overturn the order.
"I think we would not feel confident saying that on the two-week anniversary, we are attributing increases to the lifting of Safer at Home, but we certainly will continue to track the data," Andrea Palm, secretary of the state Department of Health Services, told reporters.
She urged people to maintain physical distancing to "keep the curve flat, to help continue to protect the people of this state, particularly those that are most vulnerable."
"We obviously are concerned about outbreaks and hot spots around the state. We are concerned about the increase the slight increase in hospitalizations that we're seeing in some parts of the state," Palm said.
While state health officials were hesitant to link the newcases to any one specific cause or event, they noted how the highly contagious virus is spread.
"All 599 cases that were diagnosed today resulted from a person being in close contact with another person who had the infection," saidRyan Westergaard, the chief medical officer at the Department of Health Services. "And that's the only thing we can say with certainty."
Researchers said it is especially difficult to linkcases to one single event now that Wisconsin is nearly fully reopened, and thephased approach outlined under Gov. Tony Evers' Safer at Home order meant to allow health officials to track how, where and why cases were rising is out the window.
Now, its going to be much harder to understand if we do see a surge in cases, what was the thing that really contributed the most to that happening, said Amanda Simanek, an associate professor of epidemiology in the University of Wisconsin-Milwaukees Zilber School of Public Health.
Oguzhan Alagoz, a professor at the University of Wisconsin-Madison and an infectious disease modeling expert, said the increases Wisconsin is seeing are likely driven by many factors, like increased testing availability.
Palm also noted that thestate reported 10,330 new test results Wednesday, the first time it had surpassed 10,000 tests reported in a day.
Of those tests, 5.8% were positive down from 8% on May 20.
People are alsointeracting and moving about more and have been since before the state order was lifted, according to daily cellphone mobility data that showed people were apparently developing quarantine fatigue.
Westonsaid even he gets the sense sometimes that the pandemic is coming to an end and things are returning to normal.
"And then we snap back to reality and unfortunately COVID hasn't gone anywhere,"he said. "It's still here. It's just as much, if not probably more, here than it was back when we had stay-at-home orders. All that's changed is the orders and the law that surrounds it."
And as people increasingly venture out of their homes, there's no reason to think that there won't be increased spread of the virus, increased hospitalizations and, to some degree, increased deaths, he said.
Simanek andAlagoz agreed, noting that how cautious people remain in their interactions will play a major role in how large an increase Wisconsin could see. While the state may not see one major spike, localized clusters of cases are a big concern.
It wont necessarily be one thing, Simanek said. You could have outbreaks that are tied to a certain group gathering or outbreaks that are tied to a certain physical location, like we have seenhappen across the U.S.
Alagoz said early mobility data shows people are taking precautions despite moving more.
With current levels of movement, if people didnt wear masks, if people were behaving as they were pre-March 10, believe me, we would have seen a double, triple, exponential increase in the number of cases, Alagoz said.
Without the order, Alagoz and other experts say, those precautions wearingmasks, maintainingsocial distance, and limitinginteractions to small, consistent groups will determine how large the increase in cases will be.
Contact Mary Spicuzzaat (414) 224-2324 ormary.spicuzza@jrn.com. Followheron Twitter at @MSpicuzzaMJS.
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Scientists have learned a great deal about how the novel coronavirus spreads. But one of the mysteries they're still trying to untangle is where the virus, known as SARS-CoV-2, came from in the first place. Scientific evidence points overwhelmingly to wildlife and to bats as the most likely origin point.
Bats are critically important for pollinating flowers and dispersing seeds. They catch bugs, the same ones that bite us and eat some of our crops. But bats also harbor some of the toughest known zoonotic diseases those caused by germs that spread between animals and people.
The rabies virus, the Marburg virus, the Hendra and Nipah viruses all find a natural reservoir in bats, meaning those viruses can live in bats without harming them. The Ebola outbreak in West Africa was traced to a bat colony. The SARS virus originates in bats, along with other coronaviruses. And now, SARS-CoV-2 is linked to bats too. The virus has a 96% genetic similarity to coronavirus samples previously found in bats.
Globally, zoonotic diseases have been on the rise for decades. The CDC estimates that six out of ten infectious diseases in people come from animals. Increased human interactions with animals through land development that destroys habitat, agricultural practices and livestock and wildlife trade have created a perfect storm for emerging diseases to appear throughout the world, pathogens both previously known and completely novel.
There is not enough genetic evidence to know how precisely this particular coronavirus transmitted from animals (likely bats) to humans, and whether an intermediate animal was involved in the chain of transmission. Further genetic testing and evidence is needed to fully know where this coronavirus came from. The work of virus hunting of tracking an outbreak to its origin point can take years. The 2003 outbreak of SARS, for instance, took a decade of detective work, sampling the feces, urine, or blood of thousands of horseshoe bats across China until a match was found.
BRUSSELS For decades, even when the 2008 financial crisis threatened to blow the bloc apart, the European Unions wealthier nations resisted the notion of collective debt. But the coronavirus has so fundamentally damaged the blocs economy that it is now forcing European leaders to consider the sort of unified and sweeping response once thought unworkable.
The European Commission, the blocs executive branch, on Wednesday proposed that it raise 750 billion euros, or $826 billion, on behalf of all members to finance their recovery from the economic collapse brought on by the virus, the worst crisis in the history of the European Union.
The plan, which still requires approval from the 27 national leaders and their parliaments, would be the first time that the bloc raised large amounts of common debt in capital markets, taking the E.U. one step closer to a shared budget, potentially paid for through common taxes.
For those reasons, the proposal had all the hallmarks of a historic moment for the E.U., vesting greater authority in Brussels in ways that more closely than ever resembled a central government.
This is about all of us and it is way bigger than any one of us, Ursula von der Leyen, the commission president, told European Parliament members in a speech in Brussels. This is Europes moment.
At another moment one without a calamitous recession looming the proposal would probably have been dead on arrival and antagonized the populists and nationalists who oppose the gathering power of Brussels. But the urgent need for a powerful response to the virus has muted much of the appeal of that message, at least for now.
There is little question that Europes recovery will be difficult and cost trillions, with some of its economies set to shrink by as much as 10 percent this year. The friction between China and the United States also poses a major challenge for a bloc that trades heavily with both.
Until now, the European Central Bank had been propping up the economy by sweeping up bonds by member states at low cost to ensure money keeps flowing in to finance stimulus efforts. But the economic crisis is so large that anything less than a bold response from European Union leaders risked inviting another kind of crisis one of legitimacy.
With Britain gone, the calamity brought on by the virus forced Germany and France, the blocs two strongest countries that often find themselves at loggerheads, to step up in a rare display of joint leadership, paving the way for the commissions proposal.
Even so, the plan is bound to be watered down in the weeks and months ahead. The proposal requires unanimous backing by member states, and a handful of the richer and less affected ones, such as the Netherlands and Denmark, consider joint borrowing and grant distribution to be unfair.
We need to take everyones interests into account and there are very different interest groups: the southern countries, who fundamentally always want more; the East Europeans, who have an interest in preventing everything from flowing south; and, of course, those who have to pay for it all, the net payers, Sebastian Kurz, the Austrian chancellor, who opposes parts of the commissions proposal, told Politico on Wednesday.
But the countries hardest hit by the virus, namely Italy and Spain, are also too big and too central to the European Unions ambitions to let fail. For now the plan not only suggested large-scale joint borrowing, but also that most of the money raised be distributed in the form of grants, or free cash.
The 750 billion raised would be split in two pots, the commission said. One would include 500 billion to be distributed as grants to all countries based on their recovery needs, with Italy getting the biggest slice and Spain the second biggest. This means the money would be free, with no repayment demanded and no strings attached, and would not count toward national debt levels.
Another pot of 250 billion would be made available in the form of loans to countries that apply for them, coming with more scrutiny and conditions, and would be added to a countrys debt load.
At the heart of the commissions plan is the idea of using some of its own budget to issue bonds, a move its made only a handful of times for smaller amounts in the past. The institution, which has a Triple-A rating, the best possible, from ratings agencies, said it could levy its own taxes to repay those bonds, which will have a maximum 30-year maturity.
The European Commission itself will be greatly empowered if its proposal goes through, not only because it will be able to issue bonds in the markets, but also because any powers to raise taxes directly will give it more of the semblance of a federal government, which it currently lacks, as it depends almost entirely on member state contributions for its budget.
If members dont grant the commission powers to raise its own taxes directly to repay the bonds, officials said they would need to pay bigger contributions into its budget, or see some of the programs it funds shrink or die to free up funds instead.
Some see this move as a great step forward in deepening the economic binds that tie European Union members and bringing them closer to a United States of Europe. But experts warned that, while important, this is not a leap into mutualized debt, like in the United States.
We dont become a federal Europe, however the proposal is a big deal in terms of the architecture of the European Union, said Maria Demertzis of the Brussels-based think tank Bruegel. If Europe is considering to issue common debt and to raise taxes to back this debt up, then were talking about a big deal.
But real debt mutualization would see Germany guaranteeing Italys debt, for example, said Mujtaba Rahman, who heads the Europe practice at Eurasia Group, a political risk consultancy.
Von der Leyens announcement today is a very important step, but only one on what will prove a long and windy road toward genuine debt mutualization in the European Union, Mr. Rahman said.
Berlin would demand a veto over Italian budgetary choices as the quid pro quo, and the European Union is nowhere near mature enough politically for such a system just yet, he added.
The proposal pushed forward Wednesday sidesteps some of those stickier issues by making the European Commission the guarantor of any debt, rather than individual nations, something resisted in Germany and elsewhere and legally unacceptable under the current setup of the bloc.
But both Chancellor Angela Merkel of Germany and President Emmanuel Macron of France recognized that allowing some E.U. countries to recover faster and stronger would only deepen inequalities in the bloc, hampering the way it trades and operates internally.
Ms. von der Leyen, too, stressed that its crucial for the recovery to be even across the bloc.
Most of the onus on financing the recovery is still falling on national governments, and will continue to, even if the commission proposal is endorsed. Germany and other wealthy countries have their own ample funds to draw from to quickly prop up their economies and dont need European Union funding.
Germany has deployed more than a trillion euros to support its economy, even cutting checks to out-of-work freelancers and bailing out and renationalizing a share of its national flag carrier, Lufthansa.
But other nations, in particular those with fewer resources or still hobbling from the last crisis, need European Union funding more as they face depleted coffers and expensive borrowing in markets.
The European Commission also made 540 billion available earlier in the crisis for members to finance unemployment benefits, small businesses and the rebuilding of their health care systems.
A new president, on the job for less than a year and confronted with the worst recession in the European Unions history, Ms. von der Leyen has been under considerable pressure to propose an ambitious plan to support the blocs recovery.
The rare Franco-German proposal, floated last week, gave Ms. von der Leyen the top backing she needed, but a Dutch diplomat swiftly noted Wednesday that her plan would still meet resistance in the continents wealthy north, paving the road for fraught negotiations among leaders starting next month.
Charles Michel, the president of the European Council who presides over the 27 leaders meetings, said there should be a session on June 19 to tackle the proposal, urging the heads of government to support Ms. von der Leyens pitch and quickly deploy this money where its needed.
That sense of urgency may not be shared by all and the potential for a lengthy and messy approval process is a key problem with the Commissions proposals, experts said.
Its single biggest weakness is the fact that real money will only begin to flow where its needed most next year, raising a question about the economic picture in the second half of this year, Mr. Rahman said.
Just 40% of self-identified GOPers in newly released Gallup data said that the coronavirus' mortality rate was higher than that of seasonal flu, which kills roughly 1 out of every 1,000 people who get it. That number is largely unchanged from a mid-March Gallup survey that showed 42% of Republicans believing that coronavirus is deadlier than the flu.
Those numbers stand in stark contrast to the 9 in 10 Democrats who told Gallup that coronavirus is killing more Americans than the flu and the two-thirds of independents who said the same.
It's also in stark contrast to the known facts regarding coronavirus' mortality rate.
"The crude case fatality rates, covering people who have a Covid-19 diagnosis, have been about 6 percent globally as well as in the United States. But when all the serological data is compiled and analyzed, the fatality rate among people who have been infected could be less than 1 percent."
So, why do so many Republicans simply not buy it?
"Beyond partisan affiliation and political ideology, news diet is a powerful predictor of how Americans view the lethality of the coronavirus. For example, the likelihood that a hypothetical politically moderate independent with a conservative news diet would incorrectly answer this question increased four percentage points between mid-March to mid-April, compared with decreases of seven points for the same individual with a mixed news diet and 19 points with a liberal news diet."
What the Gallup numbers affirm is that facts are under assault in this country. And in a situation like this global pandemic has created, ignorance of facts (or ignoring them) can get people killed.
From the early days of the coronavirus pandemic in the U.S. to the 100,000th death, every U.S. state and territory, except American Samoa, has lost a resident to the coronavirus pandemic.
Watch the day-by-day rise in reported deaths in this animated map.
While several vaccine developers have issued statements looking into the future -- setting possible timetables for study completion and vaccine manufacturing -- the ethicists and doctors say one group in particular stands out as being the most aggressive in painting the rosiest picture: the University of Oxford in England.
Oxford has recently walked back some of its optimism, but for months, it set a tone that its vaccine was the most promising, without any solid evidence that this was based in fact.
First, in a field fraught with potential failure, two Oxford researchers stated that they're "80% confident" that the vaccine will work, and that they might be able to complete large-scale clinical trials in just six weeks, a fraction of what some other vaccine companies estimate they can do.
Second, some experts have accused Oxford scientists of spinning results of their vaccine research in monkeys to make the vaccine look more powerful than it is, which Oxford denies.
Third, one leader in the Oxford team has gone so far as to denigrate other teams trying to get a Covid vaccine on the market, calling their technology "weird" and labeling it as merely "noise." Such name-calling is highly unusual and aggressive among scientists.
Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, said he "sat straight up" when he heard one of the Oxford scientists talk about how well their vaccine is progressing.
"Some of us in the scientific community here in the US have been a little surprised at the sprightly competitiveness of some of the comments from our colleagues at Oxford. We don't usually see that in public pronouncements," said Schaffner, a longtime adviser to the US Centers for Disease Control and Prevention. "We've been grumpy with our national political leaders about providing inaccurate information, and we should hold scientific leaders to those same standards."
Dr. Paul Offit, a University of Pennsylvania pediatrician who developed a vaccine for rotavirus, agrees.
"At this point, the Oxford researchers have no idea whether they have something or not," Offit said. "You just get so tired of this 'science by press release.' "
But one of the leaders of the Oxford research team says he and his colleagues are just being straightforward.
"We're going to be first to finish," said Dr. Adrian Hill, one of the lead Oxford researchers. "How can you criticize us for giving our honest opinion?"
On April 16, CNN's Erin Burnett pressed Hill on his predictions.
"Do you have any concern that you're being overly optimistic, that that just seems, for lack of a better word, too good to be true?" Burnett asked.
"We don't think so," Hill answered.
Weeks later, Hill would have to backtrack on his own optimism, warning against "over-promising" and ratcheting down his expectations of success.
Most vaccine efforts will fail
Five Chinese companies have vaccines in human trials. Oxford is the only one in Europe. Worldwide, there are 114 more candidates in pre-clinical trial stages.
Vaccine development is a risky business. Sometimes even ones that get to large-scale clinical trials fail.
Even so, scientists from various experimental vaccine teams have made public statements about their interim results.
On May 18, Massachusetts-based Moderna put out a press release declaring that results in eight human study subjects showed that its vaccine "was generally safe and well tolerated."
Moderna CEO Stphane Bancel referred to the results as "positive interim Phase 1 data" and that "the Moderna team continues to focus on moving as fast as safely possible to start our pivotal Phase 3 study in July."
Moderna's stock soared, and the company was criticized for announcing results on just eight study subjects when the data hadn't even been peer-reviewed or published in a scientific journal.
The Oxford scientists have voiced less caution, frequently appearing in the media and making public proclamations that theirs will likely be successful and first.
On April 11, lead researcher Sarah Gilbert told The Times of London that she was "80% confident" that the Oxford vaccine will work.
Her own colleague questioned that statement a few weeks later.
But Hill, the director of the Jenner Institute at Oxford, which specializes in vaccine development, dismissed Bell's comments.
"It's like asking me about a renal drug, asking John about a vaccine. It's not what he does. It's what Sarah does every day and has done for 25 years," Hill said.
Bell did not respond to CNN's multiple requests for comments.
On May 19, Hill told CNN he stood by Gilbert's estimate.
"We did not exaggerate anything. We're not backtracking at all from the 80%," he said.
The wisdom of Spider-Man
Inovio and Moderna have said they expect their large-scale clinical trials, known as Phase 3 trials, to last around six months. Pfizer hasn't given a timetable for its Phase 3 trial.
On May 19, Hill told CNN that his group is planning to start its Phase 3 trial sometime before July 1, and that they could finish by the end of the July, which means the trial would be between a month and six weeks long, although he thought August or September was more likely.
"I've not seen anyone wrap up a Phase 3 trial in a month to six weeks," said Dr. Saad Omer, a Yale University infectious disease expert who's done clinical trials on polio, pertussis and influenza vaccines. "We need to benchmark this against realistic expectations."
Hill said he thought it was important to benchmark his trial progress because "it has huge public policy implications" for officials who are trying to make rules about when to open up communities.
But Omer said that's exactly why it's important to be realistic about how long the vaccine development process will take.
"I buy that this is a pandemic and we may need to show progress and show steps, and I'm OK with making forecasts if decision makers want that, but do it with a level of uncertainty, because that's what's warranted," said Omer, director of the Yale Institute for Global Health.
He said the issue isn't Oxford's specific vaccine technology -- he said they were "scientifically solid" -- but rather that unexpected events can happen during a vaccine trial.
One big stumbling block for any vaccine trial is that Covid-19 infection rates in many areas of the world are flattening out or declining. The point of Phase 3 is to vaccinate people and then see if they naturally become infected, and with lower rates of circulating virus, the study subjects are less likely to be exposed to the virus in the first place.
"Just because things have gone right does not mean the next steps will go exactly on time, and won't go sideways, even if eventually we'll get there," Omer said.
That's why he encourages humility in making any projections about reaching the finish line.
"As Spider-Man says, with great power comes great responsibility, and being responsible is not projecting things with more precision than the field and the history of vaccine development suggests," he added.
Oxford scientist insults other vaccine teams
Hill, the Oxford scientist, has several arguments about why he thinks his vaccine is more promising than the others currently in human clinical trials.
First, he cites his team's many years of research on the technology used in their Covid vaccine.
The Oxford vaccine uses what's called an adenovirus vector. Adenoviruses cause the common cold, but in this case, the adenoviruses are weakened and modified to deliver genetic material that codes for a protein from the novel coronavirus. The body then produces that protein and, ideally, develops an immune response to it.
Despite all this research, none of the Oxford vaccines has made it on the market, Hill said.
Still, Hill told CNN in the May 19 interview that his vaccine, plus one in China that also uses an adenovirus vector, are "the front runners" among the vaccines in clinical trials.
Hill then proceeded to disparage other teams' vaccines -- a highly unusual and aggressive move.
The four US vaccine candidates use a different technology -- or vaccine "platform" -- than Oxford.
Two of them, Moderna and Pfizer, use RNA vaccines, which inject a piece of genetic material from the novel coronavirus into human cells to stimulate immunity.
Hill described RNA vaccines as merely "noise from the new boys."
A Harvard University blog describes it differently.
Hill was particularly disparaging of Moderna, which he said has "weird and wonderful technology." When asked what he meant by "wonderful," Hill said, "I was being sarcastic."
"They've got an unproven technology," he said.
CNN asked Moderna for its response, as well as Pfizer.
"Our only competitors in this race are the virus and the clock. We are rooting for multiple vaccines to succeed because we believe no manufacturer can make enough doses for the planet," according to the Moderna statement.
"Our industry peers, the other pharmaceutical and biotechnology companies as well as health authorities, have come together like never before. We're acutely aware that we are all on the same side, and COVID-19 and other diseases are the enemy," Pfizer spokeswoman Amy Rose wrote in an email to CNN.
Hill also took a jab at Inovio, a US vaccine maker in clinical trials, saying "they can't scale up to get into phase three," clinical trials.
Inovio's technology uses a brief electrical pulse to deliver plasmids, or small pieces of genetic information, into human cells. Inovio says those cells then produce the vaccine, which leads to an immune response.
Jeff Richardson, a spokesman for the company said that "our competition is the virus, not other companies. There needs to be three or four winners to vaccinate the world. Most likely, there will be a number of vaccines that make it, and that's a good thing."
As for the four Chinese companies in clinical trials with a potential Covid vaccine, Hill said "they have a problem."
For a vaccine clinical trial to be successful, there needs to be sufficiently high levels of the virus circulating in the community. If there isn't enough virus around, it will be impossible to tell if the vaccine protected the study subjects, or if they were just never exposed to the virus.
"There's no Covid left in China. They can't finish," Hill said.
There is still a bit of Covid left in China, with a few dozen cases left, according to the latest briefings by the nation's National Health Commission. While this is likely not enough for a full-scale clinical trial, the researchers could conduct trials in other countries where the vaccine is still circulating more widely.
Oxford not in 'slam dunk' territory
The Oxford scientists have sometimes tempered their positive statements with more cautious ones.
"Nobody can be absolutely sure it's possible. That's why we have to do trials. We have to find out. I think the prospects are very good, but it's clearly not completely certain," Gilbert answered.
But the US and British media have focused more on the positive statements, often writing glowing reports about the vaccine's progress.
A few weeks ago, a headline in a US newspaper story proclaimed that the "Oxford group leaps ahead" even though it's not clear there's a single front runner among the vaccines.
"Should be careful when talking about #COVID19 vaccine progress. As a vaccine researcher, I am cautiously optimistic; but we must be mindful of projecting too much confidence. We are not in slam dunk territory," he wrote.
Oxford's monkeys, in particular, have received attention.
BioRxiv.org is a pre-print server, meaning the articles have not been reviewed by other scientists and have not been published in the medical literature.
After the monkeys were vaccinated and then exposed to the virus, they were euthanized and examined for lung damage. According to the Oxford study, none of the vaccinated animals had signs of pneumonia or other lung problems, but two out of three unvaccinated monkeys did develop some degree of viral pneumonia.
"We were very excited by seeing that in the first try," he added.
But William Haseltine, a virologist and former professor at Harvard Medical School, said Hill was being "misleading."
"In this interview Hill is like a magician who distracts the audience with one shiny object to detract you from the fact that his accomplice is picking your pocket," Haseltine told CNN in an email.
Also, he said the monkeys had just as much viral RNA in their nasal secretions compared to the unvaccinated monkeys, an indication to him that the vaccine didn't work and the monkeys could possibly spread the virus to others.
Thirdly, Haseltine pointed to neutralizing antibodies. A vaccine should elicit high levels of antibodies capable of disabling the virus and preventing it from infecting human cells. Haseltine said the level of these antibodies in the monkeys who received the Oxford vaccine was "extremely low."
Haseltine told CNN that the monkey study on the Oxford vaccine was an "outright failure."
The Oxford scientists quickly wrote a statement rebutting Haseltine's article. They had been given the novel coronavirus directly into their noses -- called an intranasal challenge -- and so the presence of virus in the nasal swabs "may reflect use of a very high intranasal challenge dose greater than that transmitted in natural infections," according to the statement.
They also wrote that there were neutralizing antibodies present in all the monkeys who were vaccinated, but not in the unvaccinated monkeys.
"The comment by Haseltine appears to misunderstand the impressive efficacy of the [Oxford] vaccine in the non-human primate model," according to the statement.
Offit, the co-inventor of the rotavirus vaccine, said he thinks it's not a deal breaker that the vaccinated monkeys got infected. People sometimes still get the flu when they get a flu vaccine, but they often get only mild symptoms. Children still can get rotavirus after getting his vaccine, but again, typically a milder version that's less life-threatening.
He said the fact that the monkeys did not develop pneumonia after receiving the Oxford vaccine is "encouraging," but he was not convinced that the Oxford vaccine would ultimately work, since vaccines that show signs of success in animals sometimes fail in humans.
"As vaccine researchers like to say, mice lie and monkeys exaggerate," Offit said.
Offit and others say they sometimes cringe when they hear Oxford scientists talk about their vaccine.
Bioethicist Alta Charo said sometimes scientists can become "overly optimistic" about their work, especially as they race to put an end to the pandemic.
"It is very easy to get caught up in the potential of a new medical product when early development and testing seem to show promise. It is very easy to believe in your own work," said Charo, a professor at the University of Wisconsin Law School.
Art Caplan, a bioethicist at NYU Langone Health and CNN medical analyst, said it's especially important to be circumspect about vaccines, since so many people have lost trust in vaccines and are hesitant to vaccinate their children, or downright refuse to do so.
"The world is watching, and if you're puffing something up that's uncertain, that's really troubling," he said.
On Saturday, after months of rosy predictions, Hill deflated his predictions of success considerably and softened his competitive tone.
In that interview, Hill warned against "over-promising" and said that developing a vaccine is "not a race against the other guys. It's a race against the virus disappearing, and against time."
Offit said this was much more realistic.
"This tells you he's starting to back away from his original statements, as he's noticed the impracticality of his original statements," he said.
Offit has some advice for Covid vaccine developers: Be quiet.
"Now researchers can't wait to step out to the microphone -- and there are so many microphones out there -- to say, 'I've got it! This looks really good!' " Offit said.
When he and his team were developing the RotaTeq vaccine, he said they didn't speak to the media until they received final approval from the US Food and Drug Administration in 2006.
Today that vaccine saves hundreds of lives a day worldwide, Offit said, mostly children under the age of 2.
"When we discovered our rotavirus vaccine was safe in mice, we didn't say anything. When we finished our Phase one clinical trials, we didn't say anything. We just moved forward," he said.
People pray inside St. Michael's Church on Tuesday in Brooklyn. Stephanie Keith/Getty Images hide caption
People pray inside St. Michael's Church on Tuesday in Brooklyn.
On this broadcast of The National Conversation, we'll reflect on experiences from Asian American listeners who have faced racism and discrimination during the pandemic. We'll also answer your questions about religious practices, health insurance and the future of work.
The staggering American death toll from the coronavirus, now approaching 100,000, has touched every part of the country, but the losses have been especially acute along its coasts, in its major cities, across the industrial Midwest, and in New York City.
The devastation, in other words, has been disproportionately felt in blue America, which helps explain why people on opposing sides of a partisan divide that has intensified in the past two decades are thinking about the virus differently. It is not just that Democrats and Republicans disagree on how to reopen businesses, schools and the country as a whole. Beyond perception, beyond ideology, there are starkly different realities for red and blue America right now.
Democrats are far more likely to live in counties where the virus has ravaged the community, while Republicans are more likely to live in counties that have been relatively unscathed by the illness, though they are paying an economic price. Counties won by President Trump in 2016 have reported just 27 percent of the virus infections and 21 percent of the deaths even though 45 percent of Americans live in these communities, a New York Times analysis has found.
The very real difference in death rates has helped fuel deep disagreement over the dangers of the pandemic and how the country should proceed. Right-wing media, which moved swiftly from downplaying the severity of the crisis to calling it a Democratic plot to bring down the president, has exacerbated the rift. And even as the nations top medical experts note the danger of easing restrictions, communities across the country are doing so, creating a patchwork of regulations, often along ideological lines.
Why has the virus slammed some parts of the country so much harder than others? Part of the answer is population density. Nearly a third of Americans live in one of the 100 most densely populated counties in the United States urban communities and adjacent suburbs and it is there the virus has taken its greatest toll, with an infection rate three times as high as the rest of the nation and a death rate four times as high.
In a country deeply segregated along racial, religious and economic lines, density also aligns with political divisions: Urban America tilts heavily blue. In the 2016 presidential election, Mr. Trumps vote share increased as population density fell in almost every state.
But the divide in infections has been exacerbated by the path the virus has taken through the nation, which is not always connected to density. In some parts of red America, cities have been virtually unscathed and the sparsely populated outlying areas have been hardest hit. Researchers have also found links between the viruss effects and age, race and the weather, and have noted that some of the densest cities globally have not been hit as hard.
If seeing is believing, the infection has simply come to some areas of the country on a far different scale than others. As of Friday, Alabama had experienced 11 deaths per 100,000 residents and New Jersey had lost 122 per 100,000. Both states have had a huge spike in unemployment claims.
Texas, solidly Republican territory and the second most populous state in the nation, had one of the countrys hottest economies before the outbreak. The states biggest cities have so far escaped the worst of the damage. More than 200 metro areas in the United States have higher infection rates than both Dallas and Houston, which may explain why Texas residents are particularly frustrated by the shutdown.
The cure is worse than the disease, no doubt, said Mark Henry, a Republican who oversees the Galveston County government in southeast Texas. There are businesses that were shut down that are never going to open again.
Over all, the infection rate is 1.7 times as high in the most urban areas of the country compared with nearby suburbs, and 2.3 times as high in the suburbs as in exurban and rural areas.
Amid the pandemic, there are densely populated red counties near major cities with high infection rates Suffolk County in New York, Jefferson Parish in Louisiana, and Monmouth County in New Jersey, for example.
But those are true outliers.
A recent spate of outbreaks in meat plants, prisons and nursing homes has created hot spots in 245 counties that supported Mr. Trump, double the number at the beginning of the month. Some of those outbreaks are hitting subsets of the population that historically have not voted for Republicans. In Iowa, for example, Latinos make up 6 percent of the population but nearly a third of those infected. The population is 4 percent black, but 12 percent of those infected are black.
Over all, African-Americans and Latinos have had higher infection and death rates from the virus, and are far more likely to identify as Democrats than as Republicans.
Several companies have studied social distancing metrics based on anonymized cellphone location data, including the mobility research firms Unacast and Descartes Labs. While the companies do not break down findings by political party, the underlying data they collect shows less social distancing in counties that supported Mr. Trump than in those that supported Hillary Clinton.
Rural and exurban county residents, who tend to favor Republicans, do have to travel more for essential services and are less likely to have jobs that allow for working from home. Yet even in more densely populated suburban areas, there was less evidence of social distancing in counties that voted for Mr. Trump.
Matthew Gentzkow, a Stanford University economist who is leading a group of researchers tracking partisanship in the virus response, said his team initially thought that a health crisis would minimize differences assuming that people who disagree over taxes or guns would agree about a pandemic. But instead they found that Republicans were more skeptical about the effectiveness of social distancing than Democrats and have been traveling more outside their homes.
We initially saw partisanship and thought maybe by the time we looked at the data it would be gone, Dr. Gentzkow said. But it turns out that no, this is pretty serious and what we see is that the gap got bigger and bigger. These are real belief differences that should have us really concerned.
Public opinion polls do show widespread support for stay-at-home orders, but also indicate that Republicans are less likely to see the virus as a significant threat to their health. Some skepticism around the impact of the pandemic can be traced to a distrust of the government that has grown among conservatives in the last decade, according to Arlie Hochschild, a sociologist at the University of California, Berkeley, and the author of a 2016 book about the American right called Strangers in Their Own Land.
In the absence of trust, you just believe your eyes and the information that you see in your Facebook feed, she said.
The experience of residents in Texas underscores how much direct evidence of the viruss toll has shaped how people view the measures taken to mitigate it.
At the onset of the crisis, Gov. Greg Abbott, a Republican, tried to appeal to both sides of the political spectrum, allowing local governments to make their own decisions until Texas became one of the last states to issue stay-at-home orders and one of the first to roll them back last month.
In Hardin County in southeast Texas, where the population is about 57,000, there have been just 125 cases and five deaths. Kent Batman, 60, the county Republican chairman, who has spent his life in the region, said he had heard of only two fatalities, both of which he dismissed as anomalies.
To Mr. Batman, like many other Republicans in East Texas, the health crisis has felt far away, like a big city plague. Were not New Orleans, were just not like that, he said.
Interviews with dozens of Republicans in southeast Texas and other parts of the country over the past month found a pervasive its-not-coming-for-my-neighborhood attitude, with many seeing themselves as a world apart from the regions that have been overwhelmed by the virus. They are enthusiastic backers of rolling back restrictions not just as a way to spur the economy, but also based on the belief that individuals should make their own decisions about risk. They dismiss factual reports from the news media as exaggerated and trying to incite panic, because the reports dont align with their own experience.
Toward the end of March, Judy Nichols, 60, began monitoring charts daily to see how many people near her had the virus. She lives in Jefferson County, not far from Beaumont, and serves as the chair of the county Republican Party. After two weeks, she stopped keeping tabs on the numbers as her worry subsided.
Over the past several weeks, Ms. Nichols said, she has felt like the winner of a product lottery. She owns several Papa Johns pizza franchises, and business has increased nearly 80 percent pizza in a time of anxiety seeming to be one thing many people can agree on. But nearly everyone she knows is struggling to pay the bills.
On the other side of the partisan divide in Texas, Lina Hidalgo, a Democrat and the top elected official in Harris County, which includes Houston, put in place stay-at-home orders before the governor did in March. Last week, she extended her stay home, work safe guidelines until June 10.
She is concerned about the economic impact. She just doesnt see a safe alternative. When you have a political system, there are going to be attacks, she said. But lets debate the politics when this is over.
Jim Meadows, a 60-year-old refrigeration parts repairman in Nederland, Texas, who describes himself as an extreme conservative, doesnt think the economic question can be set aside. He is upset by the unemployment and financial devastation, which is clearer to him than what he called this invisible plague.
Through his work he has, however, begun taking orders for plexiglass partitions that many businesses around him want to use. He said he was pandering to the uninformed.
Rashell Collins Bridle, a 42-year-old mother of five who also lives in Nederland and makes her living selling items on eBay, said a minister she knew had died after contracting the virus. Even so, she said she and her friends were more focused on freedom than on health.
I guess other people expect us to set our futures on fire to keep their fear warm, she said. I think thats incredibly selfish if youre that fearful, then just stay home.
For Professor Hochschild, who studies division, sentiments like this in a crisis reinforce what she has seen across the country.
There is an underlying stoicism that was there before the pandemic that is really getting tapped, she said. Theres a notion of snowflake liberals who cant take it, who are too dainty and fragile and not hearty like us.
On the first weekend that Texas lifted the stay-at-home orders, Ms. Bridle took her family to a state park on the Gulf of Mexico. She said American flags were flying from many cars and trucks on the road as if it were the Fourth of July.
She said that if schools open with hefty restrictions on recess or how far desks must be spaced together, she will instead place her daughter in a Christian home school co-op.
And if there is another stay-at-home order this year?
We probably wont stand for that again, she said. I myself wont comply. I will never comply with anything else like this ever.
The coronavirus still has a long way to go. Thats the message from a crop of new studies across the world that are trying to quantify how many people have been infected.
Official case counts often substantially underestimate the number of coronavirus infections. But even in results from a new set of studies that test the population more broadly to estimate everyone who has been infected, the percentage of people who have been infected so far is still in the single digits. The numbers are a fraction of the threshold known as herd immunity, at which the virus can no longer spread widely. The precise herd immunity threshold for the novel coronavirus is not yet clear; but several experts said they believed it would be higher than 60 percent.
Even in some of the hardest-hit cities in the world, the studies suggest, the vast majority of people still remain vulnerable to the virus.
Some countries notably Sweden, and briefly Britain have experimented with limited lockdowns in an effort to build up immunity in their populations. But even in these places, recent studies indicate that no more than 7 to 17 percent of people have been infected so far. In New York City, which has had the largest coronavirus outbreak in the United States, around 20 percent of the citys residents have been infected by the virus as of early May, according to a survey of people in grocery stores and community centers released by the governors office.
Similar surveys are underway in China, where the coronavirus first emerged, but results have not yet been reported. A study from a single hospital in the city of Wuhan found that about 10 percent of people seeking to go back to work had been infected with the virus.
Viewed together, the studies show herd immunity protection is unlikely to be reached any time soon, said Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health.
The herd immunity threshold for this new disease is still uncertain, but many epidemiologists believe it will be reached when between 60 percent and 80 percent of the population has been infected and develops resistance. A lower level of immunity in the population can slow the spread of a disease somewhat, but the herd immunity number represents the point where infections are substantially less likely to turn into large outbreaks.
We dont have a good way to safely build it up, to be honest, not in the short term, Dr. Mina said. Unless were going to let the virus run rampant again but I think society has decided that is not an approach available to us.
The new studies look for antibodies in peoples blood, proteins produced by the immune system that indicate a past infection. An advantage of this test is that it can capture people who may have been asymptomatic and didnt know they were sick. A disadvantage is that the tests are sometimes wrong and several studies, including a notable one in California, have been criticized for not accounting for the possibility of inaccurate results or for not representing the whole population.
Studies that use these tests to examine a cross section of a population, often called serology surveys, are being undertaken around the country and the world.
While these studies are far from perfect, said Carl Bergstrom, a professor of biology at the University of Washington, in aggregate they give a better sense of how far the coronavirus has truly spread and its potential for spreading further.
The herd immunity threshold may differ from place to place, depending on factors like density and social interaction, he said. But, on average, experts say it will require at least 60 percent immunity in the population. If the disease spreads more easily than is currently believed, the number could be higher. If there is a lot of variation in peoples likelihood of becoming infected when they are exposed, that could push the number down.
All estimates of herd immunity assume that a past infection will protect people from becoming sick a second time. There is suggestive evidence that people do achieve immunity to the coronavirus, but it is not yet certain whether that is true in all cases; how robust the immunity may be; or how long it will last.
Dr. Mina of Harvard said to think about immunity in the population as a firebreak, slowing the spread of the disease.
If you are infected with the virus and walk into a room where everyone is susceptible to it, he said, you might infect two or three other people on average.
On the other hand, if you go in and three out of four people are already immune, then on average you will infect one person or fewer in that room, he said. That person in turn would be able to infect fewer new people, too. And that makes it much less likely that a large outbreak can bloom.
Even with herd immunity, some people will still get sick. Your own risk, if exposed, is the same, said Gypsyamber DSouza, a professor of epidemiology at Johns Hopkins University. You just become much less likely to be exposed.
Diseases like measles and chickenpox, once very common among children, are now extremely rare in the United States because vaccines have helped build enough herd immunity to contain outbreaks.
We dont have a vaccine for the coronavirus, so getting to herd immunity without a new and more effective treatment could mean many more infections and many more deaths.
If you assume that herd protection could be achieved when 60 percent of the population becomes resistant to the virus, that means New York City is only one-third of the way there. And, so far, nearly 250 of every 100,000 city residents has died. New York City still has millions of residents vulnerable to catching and spreading this disease, and tens of thousands more who are at risk of dying.
Would someone advise that people go through something like what New York went through? said Natalie Dean, an assistant professor of biostatistics at the University of Florida. Theres a lot of people who talk about this managed infection of young people, but it just feels like hubris to think you can manage this virus. Its very hard to manage.
In other cities, serology surveys are showing even smaller shares of people with antibodies. The quality of these studies is somewhat varied, either because the samples werent random or because the tests were not accurate enough. But the range of studies shows that most places would have to see 10 or more times as many illnesses and possibly, deaths to reach the point where an outbreak would not be able to take off.
The serology studies can also help scientists determine how deadly the virus really is. Currently, estimates for whats called the infection fatality rate are rough. To calculate them precisely, its important to know how many people in a place died from the virus versus how many were infected. Official case rates, which rely on testing, undercount the true extent of infections in the population. Serology helps us see the true footprint of the outbreak.
In New York City, where 20 percent of people were infected with the virus by May 2, according to antibody testing, and where more than 18,000 had died by then, the infection fatality rate appears to be around 1 percent.
For comparison, the infection fatality rate for influenza is estimated at 0.1 percent to 0.2 percent. But the way the government estimates flu cases every year is less precise than using serology tests and tends to undercount the number of infections, skewing the fatality number higher.
But even if the fatality rates were identical, Covid-19 would be a much more dangerous disease than influenza. It has to do with the number of people who are at risk of getting sick and dying as the disease spreads.
With the flu, only about half the population is at risk of getting sick in a given flu season. Many people have some immunity already, either because they have been sick with a similar strain of flu, or because they got a flu shot that was a good match for the version of the virus they encountered that year.
That number isnt high enough to fully reach herd immunity and the flu still circulates every year. But there are benefits to partial immunity in the population: Only a fraction of adults are at risk of catching the flu in a normal year, and they can spread it less quickly, too. That means that the number of people at risk of dying is also much lower.
Covid-19, unlike influenza, is a brand-new disease. Before this year, no one in the world had any immunity to it at all. And that means that, even if infection fatality rates were similar, it has the potential to kill many more people. One percent of a large number is bigger than 1 percent of a smaller number.
There arent 328 million Americans who are susceptible to the flu every fall at the beginning of the flu season, said Andrew Noymer, an associate professor of public health at the University of California, Irvine. But there are 328 million Americans who were susceptible to this when this started.
