In the midst of national shortages of testing swabs and protective gear, some medical suppliers and health policy experts are looking ahead to another extraordinary demand on manufacturing: Delivering a vaccine that could potentially end the pandemic.
Making a vaccine is not easy. More than two dozen companies have announced programs to develop a vaccine against the coronavirus, but it may still take a year or more before one passes federal safety and efficacy tests in humans and becomes available to the public.
Here in the United States, more than 300 million people may need to be inoculated. That means at least as many vials and syringes or double that amount, if two shots are required. To meet that demand, companies will have to ramp up manufacturing; products that doctors give little thought to now could easily become obstacles to vaccine delivery in the future.
Were thinking about the vaccine, but what if the vials it is stored in, or rubber stoppers in the vial or the plungers in the syringes become the constraint? said Prashant Yadav, who studies health care supply chains at the Center for Global Development in Washington, D.C.
Timing the orders of medical products like syringes and all the raw materials required to make them will be essential. Medical device manufacturers could increase inventory or find alternative supply chains for products that are running low, but everything will need to be systematically planned. Adding the capacity to make millions more syringes could take a manufacturer as long as 18 months to complete such a large order, for example.
The Covid-19 pandemic is creating industrywide challenges, including expected delays in inventory replenishment for certain products, said Lucy Bradlow, a spokeswoman for Cardinal Health, a manufacturer that makes vials and syringes as well as other medical supplies.
Several manufacturers worry that the Trump administration may be waiting too long before ordering for an ample supply of medical equipment needed to deliver a vaccine. One manufacturer said they had recently received an order for syringes, but were concerned that the Biomedical Advanced Research and Development Authority, a branch of the Health and Human Services Department built to help with pandemic preparedness, was still soliciting too few supplies for nationwide vaccine delivery.
Elleen Kane, a spokeswoman for the H.H.S., said the department has been working daily with our manufacturers to secure those supplies and assist them with any anticipated obstacles in their supply chains.
In March, the H.H.S. set up a public-private partnership to find drug packaging solutions that were based in the United States. It could be adapted for future therapeutic or vaccine delivery for the Strategic National Stockpile, a federal cache of supplies and medicines held in case of emergencies.
The White House is also developing a plan, called Operation Warp Speed, to accelerate vaccine production and try to get manufacturing capacity set up in advance of a vaccine approval. But some experts say that it is unclear whether the plan will apply to vaccine delivery devices like syringes and details are still scarce about which federal agency would be responsible.
Earlier in April, New Hampshires senators, Jeanne Shaheen and Maggie Hassan, sent a letter addressed to Vice President Mike Pence, urging him to ensure that the federal government obtains the materials to meet the demand for a vaccine when it becomes available.
Of course, a lot will depend on the type of vaccine and when it is approved. A variety of RNA- and DNA-based vaccines are currently undergoing clinical trials, as well as more traditional types, which are made by placing instructions for coronavirus spike proteins inside a different dead or harmless virus.
RNA or DNA vaccines might have different storage and refrigeration requirements because the technology has never been used for an approved vaccine before. The final vaccine might be packaged in ready-to-use glass syringes, which are commonly used in flu campaigns in Europe, or in a single-dose or multi-dose vials that would be administered with disposable plastic syringes, which are standard for many vaccines in the United States.
The amount of vaccine manufactured by a company could also affect the number of delivery systems needed, said Michael Gusmano, a health policy expert at the Hastings Center and Rutgers School of Public Health. It is unlikely that a pharmaceutical company will be able to match demand immediately nationally or internationally.
The good news is we have time, Dr. Gusmano said. Medical device manufacturers could slowly scale up vials and syringes as a vaccine becomes more widely available.
Early estimates of the coronaviruss infectiousness suggest that at least 70 percent of the population will need to be immunized to reach what experts call herd immunity, when enough people are immune to a disease that they can also indirectly protect others who are not immune.
Thats a remarkably high number, and I dont think were anywhere close to that just with people who have been exposed to the virus and developed antibodies, Dr. Gusmano said. So youre talking about a fairly massive vaccination campaign.
Preliminary surveys in California and New York suggest that anywhere between 4 to 21 percent of people have developed antibodies to the coronavirus. But the accuracy of many antibody tests have been called into question. And it is still unclear whether having some of these antibodies provides effective and long-lasting immunity against the coronavirus. Plus, most vaccination campaigns aim to immunize a high proportion of the population around 90 percent to successfully prevent transmission of disease.
To produce the number of vials and syringes needed for a coronavirus vaccine, medical suppliers will need to increase manufacturing shifts and overtime for their employees, as well as collaborate with U.S. and foreign trade authorities to expedite shipments and shorten lead times.
A handful of manufacturers are based in the U.S., but many still have to import the glass tubing for vials, polypropylene for syringes and rubber or silicone for small parts like the stoppers and plungers in these devices. Becton Dickinson & Company, one of the worlds largest manufacturers of needles and syringes, said it made nearly all components of its needles and syringes in-house in the United States. Other companies may source from their factories and partners located largely in China and India, where lockdowns and export bans have already decreased production and exports.
Although syringe manufacturing is mostly automated, with parts like the barrel and plunger made from a mold and put together on an assembly line, Dr. Yadav said manufacturers in India had told him fewer employees were able to work than needed for full capacity.
At least 69 countries have also banned or restricted the export of medical devices, medicines and protective equipment, according to the Global Trade Alert project at the University of St. Gallen in Switzerland, because of their own needs during the pandemic. Manufacturers of medical syringes may have to find new supply channels, including partnerships with glass and plastic manufacturers that operate outside of the health care industry.
Some lawmakers are concerned that without more federal coordination, individual companies will not have the capacity to match vaccine delivery to the overwhelming demand.
The Trump administration needs to prepare our domestic supply chain now for the delivery of an eventual vaccine that will need to be delivered to the entire country, Senator Shaheen said. Its vital that federal agencies exercise better foresight so that we dont see supply shortages like we continue to experience for testing and protective equipment.
You would think that, based on the past, that the U.S. would be a galvanizing, lead element in pushing for transparency and early planning on the vaccine front, said Stephen Morrison, who runs a global health program at the Center for Strategic and International Studies. I dont think thats true in this administration.
A European ambassador said he and his colleagues remain hopeful that the United States will take the lead on ensuring fair global vaccine access. But we are a bit skeptical at the moment, he said, because we dont see the forthcoming attitude that weve seen in the past.
One disputed report in particular is driving much of the angst: that the Trump administration tried to acquire exclusive rights to the coronavirus vaccine business of CureVac, a German-based company. Trump aides and CureVac officials adamantly denied the mid-March report, but German officials confirmed and condemned it.
The U.S. is planning an intense push to create a vaccine and have enough doses available to cover most Americans by the end of this year, the president confirmed this week. The project is called Operation Warp Speed, according to Bloomberg News and other media reports, which described it as an effort to compress the usual process for developing a vaccine into a shorter timeline.
Asked about the project Thursday, Trump said he was in charge of it and that he was not overpromising. Whatever the maximum is, whatever you can humanly do, were going to have, the president said.
Health officials and analysts caution that its too early to go into full-fledged panic about a looming global vaccine fistfight.
An acceptable vaccine could be at least a year to 18 months away; companies across the world, especially in the United States, Europe and China, are in the hunt to find a vaccine, and some trials are already underway. Some diplomats carefully pointed out that by the time vaccines are ready for sale and distribution, Trump may no longer be president, and his America First ideas may be shunted aside.
You have the election in six months time -- you never know, an Asian diplomat told POLITICO.
But further blurring the picture is the fact that the global health infrastructure isnt entirely under the thumb of any one government. Its a complex amalgam of government bodies, private companies, NGOs, foundations and multilateral partnerships that at times do overlapping work.
Theres no binding treaty or other mechanism that governs how a vaccine will be produced and distributed worldwide. And while the World Health Organization has for decades offered a forum for coordination, discussion and standard-setting, its authority is still limited, including when it comes to private companies with profit motives.
Trump has also dealt a blow to the WHO by recently pausing Americas substantial funding for it. He alleges that the U.N. body effectively helped China cover up the extent of the crisis when the virus first emerged in the Chinese city of Wuhan last year. The WHOs supporters say Trump is trying to deflect attention from his own downplaying of the crisis early on.
But the growing U.S. hostility to the WHO is hardly the only obstacle to international coordination on a vaccine rollout: China likewise did not express support last month for a new global partnership to coordinate research and development for vaccines, tests and coronavirus cures. The absence of the two pharma powerhouses from the April 24 gathering, led in part by the WHO, disappointed European leaders, who are pushing for a cooperative approach. French President Emmanuel Macron said he hoped they could reconcile this initiative with China and the U.S.
Officials involved in the April 24 gathering as well as Mondays planned EU-led conference stress that there is an American presence in such events even if the U.S. government itself doesnt formally take part. A number of foundations, companies and others playing a role are U.S.-based.
European Commission President Ursula von der Leyen. | Thierry Monasse/Getty Images
There is a strong American footprint in the whole construction, European Commission President Ursula von der Leyen said about Mondays gathering in an interview with France 24. We have a lot of American scientists and philanthropists that are working with us in this global framework weve created. The government of the United States is informed. And I hope they consider to participate.
Asked about the Trump administrations participation and plans for future international coordination on vaccines, a spokesperson for the U.S. State Department offered a vague comment that attacked the WHO.
Americas world-leading scientists are working hard on a Covid-19 vaccine, the spokesperson said. We welcome serious efforts to assist in that endeavor and look forward to learning more about the World Health Organizations proposal. We remain deeply concerned about the WHOs effectiveness, given that its gross failures helped fuel the current pandemic.
Spokespersons for the White House and the Department of Health and Human Services did not offer comment.
The United States has historically been a leader in global vaccine initiatives, often footing much of the bill. Its interest dates back decades and covers successful efforts to eradicate or dramatically constrain diseases such as smallpox, polio and measles. The focus has often been on vaccinating children so that they never fall ill and over time contribute to whats known as herd immunity in their broader communities.
But infectious disease crises that have arisen in more recent years have exposed weaknesses in a system that relies so much on goodwill and benevolence, rather than any particular set of international rules.
For example, the rise in 2009 of an H1N1 novel influenza led wealthier nations to put in large advanced orders for a vaccine and buy most of what was eventually manufactured, angering developing countries who lacked similar funds. The WHO and others managed to secure pledges of donations for the poorer countries, but even those were limited, according to research posted by the National Center for Biotechnology Information.
The Covid-19 crisis is in many ways more severe, with infections in more than 180 countries. Aside from the vaccine issue, it has exposed the frailty of global cooperation in other ways. Efforts to work together at the G-7, G-20 and United Nations level have had limited impact amid finger-pointing between Washington and Beijing.
Its not just the U.S. that has put the needs of its own citizens first. Dozens of countries, including the U.S. and some in Europe, have imposed travel restrictions as well as limits on the exports of masks and other critical medical equipment.
Global health leaders are trying to avoid a repeat of such nationalist tactics when it comes to vaccines and other types of medicines that could combat Covid-19. They warn in particular that leaving the virus to fester in one country could, simply due to migration patterns, mean it will re-emerge elsewhere. And they say that a globally coordinated approach to distributing a vaccine -- prioritizing at-risk populations, for instance -- would yield better results.
Melinda Gates told POLITICO in an interview that medical workers should be at the head of the line for vaccinations because of their regular exposure to the virus. She also praised European leaders for being out in front in coordinating on vaccines and therapeutics.
Its the European leaders, quite honestly, who understand that we need global cooperation, she said.
National security officials and public health experts also are increasingly concerned about the prospect of China developing a vaccine first, and how Americas unwillingness to take charge of global vaccine coordination might help both Chinas economy and its propaganda efforts.
China does have a head start in the global effort to come up with a vaccine, said one national security official who spoke on condition of anonymity to discuss U.S. government concerns. But they also have a pattern of theft and trying to steal everyone elses research. So you would think theyd be very benevolent [with the vaccine] so as not to be seen as a pariah.
A spike in hacking attempts on U.S. hospitals and labs, which intelligence and national security officials have attributed primarily to China, is a sign of how high the stakes are for the Chinese government especially as it attempts to repair its reputation amid accusations that it covered up the origins and severity of the novel coronavirus late last year.
They know that whoever finds a workable vaccine right now basically rules the world, said another national security official.
The propaganda coup alone is a strong incentive, experts said. But the economic and diplomatic implications of being the first to develop a vaccine, especially if the U.S. continues to retreat, would be enormous for the Chinese Communist Party.
Being able to vaccinate its own population first, for example, would serve as a strong economic rudder for China and allow it to fully open its economy to global companies, said Dr. Ross McKinney, Jr., the chief scientific officer at the Association of American Medical Colleges.
It would also yield diplomatic leverage, said Matt Kroenig, a former Pentagon and CIA official who now serves as deputy director at the Atlantic Councils Scowcroft Center.
Often, Chinese offers of aid come with strings attached, said Kroenig, whose new book examines American power competition with China. So they could use it as a way to try to increase their influence and further push out the U.S.
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But the question remains of whether the world would even trust a vaccine produced by China, Kroenig noted, given the recent episodes of China delivering faulty medical equipment to Europe.
One of the great advantages the U.S. has in this competition is that we have these 30 formal treaty allies with leading scientific research communities, Kroenig said. So we could and should be doing a much better job of galvanizing allies and bringing them together on the vaccine issue.
Having perceived a void in U.S. leadership in this area, the Atlantic Council convened an allied town hall on Tuesday to discuss how the U.S. and its allies could better cooperate on vaccine development but the fact that a think tank, rather than the Trump administration, organized the event only drove the point home for some attendees that the U.S. is not positioning itself as a leader in this space.
Meanwhile, as their governments have been sparring, American and Chinese scientists have actually been cooperating on Covid-19 research. Researchers in the U.S. and China have co-authored about 407 papers on coronavirus this year, according to data compiled by Axios, and Pennsylvania-based Inovio Pharmaceuticals announced in January that it was collaborating with Beijing Advaccine Biotechnology Co. on a Covid-19 vaccine.
Such collaboration can be positive as long as the information flows both ways, said McKinney, of the AAMC. But weve been finding that the information does not always flow both ways. So there is some asymmetry going on with regard to the research efforts that I think is the worry.
Other joint U.S.-China research efforts have spawned mistrust: The Trump administration recently cut off grant funding to an American NGO that had been working with Chinese scientists at a lab in Wuhan, China, that some in the Trump administration suspect was responsible for unleashing the virus on the world.
Some officials and diplomats argue that instead of waiting for Washington and Beijing to cooperate on a vaccine, its better to work with those who are willing to cooperate now, while leaving the door open for the U.S. and China to join later.
We can be in the camp of those who say without the U.S. and without China its useless, and we give up and we wait for the vaccine to maybe come one day, or we take action and find our third way, a French official said.
Jillian Deutsch, Rym Momtaz and Sarah Wheaton contributed to this report.
A COVID-19 antibody testing center is seen at Steve's 9th Street Market in Brooklyn on April 25. Here's a quick guide to sorting out the pluses and minuses to each type of test. Michael Nagle/Xinhua News Agency/Getty Images hide caption
A COVID-19 antibody testing center is seen at Steve's 9th Street Market in Brooklyn on April 25. Here's a quick guide to sorting out the pluses and minuses to each type of test.
Testing for the coronavirus has been very much in the news. The first and most urgent focus is on increasing access to tests to diagnose people with current infections. But now other tests are appearing as well. Antibody tests, which can identify people with signs of past infection, are starting to be available. And a third type of test is on the way.
Here's a quick guide to sorting out the pluses and minuses to each type of test.
What it does: Doctors use this test to diagnose people who are currently sick with COVID-19. This is the one we've been hearing so much about.
How it works: This test uses a sample of mucus typically taken from a person's nose or throat. The test may also work on saliva that's under investigation. It looks for the genetic material of the coronavirus. The test uses a technology called PCR (polymerase chain reaction), which greatly amplifies the viral genetic material if it is present. That material is detectable when a person is actively infected.
How accurate is it: Generally speaking, these are the most reliable tests. However, a few days may pass before the virus starts replicating in the throat and nose, so the test won't identify someone who has recently been infected. And swabs can sometimes fail to pick up signs of active infection.
How quick is it: These samples are generally sent to centralized labs for analysis, so it can take several days to get results back. Wait times were longer earlier in the pandemic because of a testing backlog. There are also two rapid PCR tests, which can be run on specialized equipment already widely distributed throughout the U.S. The speediest one, by Abbott Laboratories, can provide a result in 13 minutes, but one study suggests this test can miss more than 10% of cases.
What it does: Antibody tests identify people who have previously been infected with the coronavirus. They do not show whether a person is currently infected. This is primarily a good way to track the spread of the coronavirus through a population.
How it works: This is a blood test. It looks for antibodies to the coronavirus. Your body produces antibodies in response to an infectious agent such as a virus. These antibodies generally arise after four days to more than a week after infection, so they are not used to diagnose current disease.
How accurate is it: There are more than 120 antibody tests on the market. The Food and Drug Administration has allowed them to be marketed without FDA authorization, and quality is a great concern. A few tests have voluntarily submitted to extra FDA approval. Other tests are being validated by individual medical labs or university researchers.
In general, these tests aren't reliable enough for individuals to act based on the results. And researchers say, even if you were certain you had antibodies to the coronavirus, it's still unknown if that protects you from getting sick again. Still, these tests can provide good information about rates of infection in a community, where errors in an individual result have less impact.
How quick is it: These tests generally produce results in a few minutes, based on a drop of blood taken from the finger. Some research labs use a more sophisticated antibody test, called an Elisa (Enzyme-linked immunoassay) that are more accurate but are not as widely available.
What it does: This test identifies people who are currently infected with the coronavirus. It may be used as a quick test to detect active infections. Initially it will not be used to diagnose disease, but it may be used to screen people to identify those who need a more definitive test.
How it works: Antigen tests can identify virus in nose and throat secretions. It does this by looking for proteins on the surface of the virus (as opposed to the diagnostic test, which looks for genetic material that is carried inside the virus). This is the same technology used in your doctor's office for rapid strep testing.
How accurate is it: These tests are not yet on the market, so there is currently no information about their accuracy. Researchers do not expect it to be as accurate as the PCR diagnostic test, but it is possible they could be used to screen patients for infection. Dr. Jordan Laser, a lab director at Northwell Health, notes antigen testing is used for rapid strep tests, which are reliable, and rapid flu tests, which are not.
How quick is it: These tests should provide results in just a few minutes. As a result, they could be used to screen people in hospitals, certain workplaces, or in other instances where it's important to find out quickly whether someone is currently at risk of spreading the disease. But unless these tests are proven to be highly accurate, physicians would still need to follow up a positive result with a PCR test to make a medical diagnosis.
You can contact NPR science correspondent Richard Harris at rharris@npr.org.
Why are the origins of the pandemic so controversial?
How Covid-19 began has become increasingly contentious, with the US and other allies suggesting China has not been transparent about the origins of the outbreak.
Donald Trump, the US president, has given credence to the idea that intelligence exists suggesting the virus may have escaped from a lab in Wuhan, although the US intelligence community has pointedly declined to back this up. The scientific community says there is no current evidence for this claim.
This follows reports that the White House had been pressuring US intelligence community on the claim, recalling the Bush administrations pressure to stove pipe the intelligence before the war in Iraq.
A specific issue is that the official origin story doesnt add up in terms of the initial epidemiology of the outbreak, not least the incidence of early cases with no apparent connection to the Wuhan seafood market, where Beijing says the outbreak began. If these people were not infected at the market, or via contacts who were infected at the market, critics ask, how do you explain these cases?
Two laboratories in Wuhan studying bat coronaviruses have come under the spotlight. The Wuhan Institute of Virology (WIV) is a biosecurity level 4 facility the highest for biocontainment and the level 2 Wuhan Centre for Disease Control, which is located not far from the fish market, had collected bat coronavirus specimens.
Several theories have been promoted. The first, and wildest, is that scientists at WIV were engaged in experiments with bat coronavirus, involving so-called gene splicing, and the virus then escaped and infected humans. A second version is that sloppy biosecurity among lab staff and in procedures, perhaps in the collection or disposal of animal specimens, released a wild virus.
The scientific consensus rejecting the virus being engineered is almost unanimous. In a letter to Nature in March, a team in California led by microbiology professor Kristian Andersen said the genetic data irrefutably shows that [Covid-19] is not derived from any previously used virus backbone in other words spliced sections of another known virus.
Far more likely, they suggested, was that the virus emerged naturally and became stronger through natural selection. We propose two scenarios that can plausibly explain the origin of Sars-CoV-2: natural selection in an animal host before zoonotic [animal to human] transfer; and natural selection in humans following zoonotic transfer.
Peter Ben Embarek, an expert at the World Health Organization in animal to human transmission of diseases, and other specialists also explained to the Guardian that if there had been any manipulation of the virus you would expect to see evidence in both the gene sequences and also distortion in the data of the family tree of mutations a so-called reticulation effect.
In a statement to the Guardian, James Le Duc, the head of the Galveston National Laboratory in the US, the biggest active biocontainment facility on a US academic campus, also poured cold water on the suggestion.
There is convincing evidence that the new virus was not the result of intentional genetic engineering and that it almost certainly originated from nature, given its high similarity to other known bat-associated coronaviruses, he said.
The accidental release of a wild sample has been the focus of most attention, although the evidence offered is at best highly circumstantial.
The Washington Post has reported concerns in 2018 over security and management weakness from US embassy officials who visited the WIV several times, although the paper also conceded there was no conclusive proof the lab was the source of the outbreak.
Le Duc, however, paints a different picture of the WIV. I have visited and toured the new BSL4 laboratory in Wuhan, prior to it starting operations in 2017- It is of comparable quality and safety measures as any currently in operation in the US or Europe.
He also described encounters with Shi Zhengli, the Chinese virologist at the WIV who has led research into bat coronaviruses, and discovered the link between bats and the Sars virus that caused disease worldwide in 2003, describing her as fully engaged, very open and transparent about her work, and eager to collaborate.
Maureen Miller, an epidemiologist who worked with Shi as part of a US-funded viral research programme, echoed Le Ducs assessment. She said she believed the lab escape theory was an absolute conspiracy theory and referred to Shi as brilliant.
While the experts who spoke to the Guardian made clear that understanding of the origins of the virus remained provisional, they added that the current state of knowledge of the initial spread also created problems for the lab escape theory.
When Peter Forster, a geneticist at Cambridge, compared sequences of the virus genome collected early in the Chines outbreak and later globally he identified three dominant strains.
Early in the outbreak, two strains appear to have been in circulation at roughly at the same time strain A and strain B with a C variant later developing from strain B.
But in a surprise finding, the version with the closest genetic similarity to bat coronavirus was not the one most prevalent early on in the central Chinese city of Wuhan but instead associated with a scattering of early cases in the southern Guangdong province.
Between 24 December 2019 and 17 January 2020, Forster explains, just three out of 23 cases in Wuhan were type A, while the rest were type B. In patients in Guangdong province, however, five out of nine were found to have type A of the virus.
The very small numbers notwithstanding, said Forster, the early genome frequencies until 17 January do not favour Wuhan as an origin over other parts of China, for example five of nine Guangdong/Shenzhen patients who had A types.
In other words, it still remains far from certain that Wuhan was even necessarily where the virus first emerged.
The pandemic has exacerbated existing geopolitical struggles, prompting a disinformation war that has drawn in the US, China, Russia and others.
Journalists and scientists have been targeted by people with an apparent interest in pushing circumstantial evidence related to the viruss origins, perhaps as part of this campaign and to distract from the fact that few governments have had a fault-free response.
The current state of knowledge about coronavirus and its origin suggest the most likely explanation remains the most prosaic. Like other coronaviruses before, it simply spread to humans via a natural event, the starting point for many in the scientific community including the World Health Organization.
Further testing in China in the months ahead may eventually establish the source of the outbreak. But for now it is too early.
But some scientists and legal experts say the moves reflect a dangerous disregard for science in the middle of a deadly pandemic, and could be used to further weaken protections down the road.
The main type of pollution in question -- PM 2.5 -- are microscopic particles that float in the air we breathe and measure barely a fraction of the diameter of a human hair.
The current PM 2.5 standard requires air particle levels to be limited to 12 micrograms per cubic meter.
Still, the EPA decided to leave the regulations untouched.
"Based on review of the scientific literature and recommendation from our independent science advisors, we are proposing to retain existing PM standards which will ensure the continued protection of both public health and the environment," EPA Administrator Andrew Wheeler said in an April 14 statement justifying the move.
Only one new COVID-19 infection Hawaii was verified by the Department of Health on Friday.
The new case is on Oahu.
As the number of new cases has dwindled in recent weeks, public officials have begun to relax restrictions on some businesses, but the states stay-at-home order stays in effect through May 31.
Six new recoveries were reported Friday as well. Of the 619 people in Hawaii documented by DOH with COVID-19 infections to date, 532 of them have recovered.
A mandatory 14-day quarantine rule has not kept a few hundred tourists from coming to the islands in recent days.
Cory Lum/Civil Beat
The states COVID-19 death toll remains at 16, including 11 people on Oahu and five on Maui.
Those who do not require hospitalization but have been exposed or have fallen ill with the coronavirus must stay home and self-isolate for 14 days.
To qualify as recovered and become classified by the health department as released from isolation, federal guidelines dictate at least seven days have passed since the patients symptoms began and three days have passed since their fever resolved.
Oahus cumulative infection count reached 400 on Friday. Oahu reported four more recoveries, marking 368 people released from isolation to date.
Two more people were hospitalized on Maui as of Friday, and DOH continues to monitor the health of 72 people who are hospitalized across the state, including 16 on Maui, 53 on Oahu, and one patient each on the Big Island and Kauai.
Among the other nine Hawaii residents diagnosed out of state, one is hospitalized.
A cluster of 58 infections that began at Maui Memorial Medical Center involve 38 staff and 20 patients who are being monitored by DOH, officials said.
More than 300 people have been tested in relation to the Maui investigation.
Mauis documented COVID-19 patient count stands at 116 as of Friday, and no new recoveries were reported. Eighty-four people on Maui have recovered to date.
Two more recoveries were reported in Hawaii County, with state health officials reporting a total of 60 recoveries on the Big Island among the 73 infections cases confirmed by the department to date.
Only one active case of COVID-19 remains on Kauai and the patient is hospitalized. The island has reported no new infections for more than two weeks 20 of the 21 people diagnosed to date have qualified to be released from isolation.
More than 30,296 people have been tested for the virus to date.
Antibody testing is now underway in Hawaii. Clinical Labs Hawaii began its antibody testing on Thursday, and Hawaii Pacific Health hospital officials announced shortly after that they would offer antibody testing to their employees this week.
A mandatory 14-day quarantine is still imposed on any travelers arriving in the islands. Non-compliance is punishable by a $5,000 fine or jail for both visitors and residents.
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Congress has opened a probe into Carnival Corporation, the operator of the Princess Cruises line of cruise ships, over its handling of COVID-19 outbreaks, according to a report from Bloomberg. Officials are now requesting Carnival turn over documents and communications about its coronavirus response and its plans for future improvement.
The investigation, led by the US House Committee on Transportation and Infrastructure, is specifically looking into how much Carnival executives were aware of the severity of the coronavirus outbreaks on its cruise ships and the lack of action it took during active cruises after being informed of the risks. More than 1,500 confirmed COVID-19 cases can be traced back to the company's cruise ships, and dozens of Carnival customers and crew members have since died from the virus.
The probe cites a damning Bloomberg feature story from writers Austin Carr and Chris Palmeri from last month that delves intricately into how Florida-based Carnival handled news of the COVID-19 outbreaks aboard nine of its ships. The story itself, which everyone should go read, is astonishing, featuring illuminating interviews with crew members and passengers and a lengthy sit-down with Carnival CEO Arnold Donald. It paints the picture of a company that, even in early March as the threat of the novel coronavirus become abundantly clear worldwide, did not take action fast enough to order its passengers into self-isolation and dock its cruise ships. Instead, many ships decided to let customers remain in extremely close contact with one another in swimming pools and in dining areas featuring buffets.
We would hope that the reality of the COVID-19 pandemic will place a renewed emphasis on public health and passenger safety, but frankly that has not been seen up to this point, wrote House member Peter DeFazio (D-OR) in the letter sent to Carnival announcing the investigation. It seems as though Carnival Corporation and its portfolio of nine cruise lines, which represents 109 cruise ships, is still trying to sell this cruise line fantasy and ignoring the public health threat.
Bloomberg reports that many of the customers who received refunds from Carnival were given the option to receive the credit for a future cruise, and Carnival in some cases sweetened the deal by giving out free vouchers as well. While the company suspended its cruises starting in March, some passengers and crew remain stuck on ships around the world. Our goal is the same as the committees goal, Carnival said in a statement to Bloomberg, to protect the health, safety and well-being of our guests and crew, along with compliance and environmental protection.
In addition to the House probe, Australian police last month launched a criminal investigation into how Carnival handled the docking of one of its Princess ships, the Ruby Princess, in Sydney on March 19th. The investigation is looking into whether Carnival officials misled Australian authorities about the COVID-19 outbreak aboard the ship, as Carnival customers at the time made up nearly one-third of all Australian deaths from the virus.
GARDEN CITY, Kan. (KWCH) The Finney County Health Department confirmed the second and third deathsof Finney County residents related to Coronavirus (COVID-19).
The health department says these cases include a man in his 40s with no known underlying medical conditions and a woman in her 70s who did have underlying medical conditions.
"(The) Finney County Health Department is continuing their disease investigation and notifying anyone who may have had contact with the individuals," the county says."We send our deepest condolences to both families in this difficult time as they navigate this loss."
As of Friday afternoon (May 1) Finney County has confirmed a total of 404 positive cases, and that 994 individuals have been tested
Six people with confirmed positive cases in Finney County are currently hospitalized, the health department says.
In an instance in which there are five or more confirmed positive cases traced back to a particular location or business as a source of exposure, the Finney County Health Department says it will notify the public in a news release.
The Finney County Health Department says it has recently increased testing for COVID-19.
"At the inception of our drive-through testing site, we had the capacity to test 50 people a day. Since then, we have now increased our capacity to test 140-160 people a day, and are continually looking for opportunities to increase capacity for testing," Finney County says.
The county says, "If you are experiencing a fever, cough, shortness of breath, or loss of taste or smell, or suspect you may have been exposed to COVID-19, please call the Finney County Hotline at 620-272-3600 from 8 a.m. to 5 p.m. Monday through Saturday.:
Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces Schools and College Facilities Statewide Will Remain Closed for the Rest of the Academic Year | Governor Andrew M. Cuomo Skip to main content
Directs Schools and Colleges to Create Re-Opening Plans that Re-Imagine Facilities to Be Approved by the State
State is Partnering with Kate Spade New York Foundation and Crisis Text Line to Provide 24/7 Emotional Support Service for Frontline Workers; Workers Can Text NYFRONTLINE to 741-741
Department of Financial Services to Require New York State-Regulated Health Insurers to Waive Out-of-Pocket Costs for Mental Health Services for Frontline Essential Workers
Announces New Targeted Efforts to Further Reduce Number of New Hospitalizations per Day
Five New Drive-Through Testing Facilities Now Open in Monroe, Erie, Broome, Niagara and Oneida Counties
Confirms 3,942 Additional Coronavirus Cases in New York State - Bringing Statewide Total to 308,314; New Cases in 48 Counties
Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced all K-12 schools and college facilities statewide will remain closed for the rest of the academic year and will continue to provide distance learning during that time. The schools will also be required to continue meal programs and child care services for essential workers. The state will make a decision about summer school programming by the end of May.
Governor Cuomo is also directing all schools and colleges to create re-opening plans that re-imagine school facilities in light of the COVID-19 pandemic. These plans should consider how schools can monitor the spread of COVID-19; how to reinforce student safety; when and how to resume extracurricular activities; protocols for special student populations; steps to ensure student mental health; alternative academic calendars; among other considerations. All plans will be reviewed and approved by the state.
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The Governor also announced the state is partnering with the Kate Spade New York Foundation and Crisis Text Line to provide a 24/7 emotional support service for frontline health care workers. Those workers can text NYFRONTLINE to 741-741 to access these emotional support services.
The Governor also announced that the State Department of Financial Services will require New York State-regulated health insurers to waive cost-sharing, including deductibles, copayments and coinsurance, for in-network mental health services for New York's frontline essential workers during COVID-19. DFS will also issue an emergency regulation to prohibit insurers from imposing cost-sharing for telehealth and in-person mental health services rendered by in-network providers on an outpatient basis to frontline essential workers eligible to be tested at one of the State's drive through or walk in COVID-19 testing sites.
All schools and colleges will continue to provide distance learning, meal delivery and child care servicesfor the remainder of the school year.
The Governor also announced new targeted efforts to further reduce the number of new hospitalizations per day, which has remained steady at approximately 1,000 over the last several day. This new effort will gather additional information and data from hospitals about the individuals who are being hospitalized for COVID-19, including if they are essential workers, where they work, how they commute, where they live and other demographics. This specific information and data from the hospitals will be used to come up with a new strategy more tailored to the reduction of new daily hospitalizations.
The Governor also announced five new drive-through testing facilities have opened and are now accepting patients in Monroe, Erie, Broome, Niagara and Oneida Counties. Residents who would like to be tested at these facilities must make an appointment by calling 888-364-3065 or online atcovid19screening.health.ny.gov. Information about the location of these new facilities is located below:
"It's critical that we protect our students from this virus, and given the current circumstances we are in we do not think it is possible to put the necessary precautions in place that would allow us to re-open schools this academic year,"Governor Cuomo said."All schools and colleges will continue to provide distance learning, meal delivery and child care services for the remainder of the school year. And in the meantime, we want schools to start developing a plan to re-open with new protocols that incorporate everything that we are now doing in society and everything that we have learned from this pandemic. This has been a hardship on everyone, but our educators across the state have done a phenomenal job stepping up to make the best of this situation."
Finally, the Governor confirmed 3,942 additional cases of novel coronavirus, bringing the statewide total to 308,314 confirmed cases in New York State. Of the 308,314 total individuals who tested positive for the virus, the geographic breakdown is as follows:
County
Total Positive
New Positive
Albany
1,204
39
Allegany
35
0
Broome
299
15
Cattaraugus
49
2
Cayuga
51
3
Chautauqua
35
2
Chemung
123
1
Chenango
99
1
Clinton
61
2
Columbia
202
32
Cortland
28
0
Delaware
61
0
Dutchess
3,002
48
Erie
3,481
162
Essex
28
0
Franklin
15
0
Fulton
75
4
Genesee
154
1
Greene
139
8
Hamilton
3
0
Herkimer
60
2
Jefferson
61
0
Ill. (KWQC) - Officials with the Illinois Department of Public Health announced Friday 3,137 additional cases of COVID-19.
They also announced 105 additional deaths.
- Adams County: 1 female 60s- Clinton County: 1 female 80s- Cook County: 1 female 30s, 1 male 30s, 2 females 40s, 1 male 40s, 2 females 50s, 1 male 50s, 5 females 60s, 13 males 60s, 5 females 70s, 10 males 70s, 9 females 80s, 12 males 80s, 5 females 90s, 2 males 90s- DuPage County: 1 male 40s, 1 female 70s, 1 male 70s, 2 females 80s, 3 males 80s, 2 females 90s, 1 male 90s- Jackson County: 1 female 80s, 1 male 80s- Kane County: 1 female 70s, 1 male 70s, 1 female 80s, 1 male 80s- Lake County: 1 male 60s, 1 female 70s, 1 female 90s, 1 male 90s- Madison County: 1 female 70s- McHenry County: 1 female 80s, 1 male 100+- Sangamon County: 1 female 80s- St. Clair County: 1 male 60s- Whiteside County: 1 female 90s- Will County: 1 male teens, 1 female 60s, 2 males 60s, 1 male 70s, 2 females 90s
Currently, the Illinois Department of Public Health is reporting a total of 56,055 cases, including 2,457 deaths, in 97 counties in Illinois.
The age of cases ranges from younger than one to older than 100 years.
Within the past 24 hours, laboratories have processed 14,821 specimens for a total of 284,688.
