A Third Coronavirus Surge Has Taken Root in the U.S. – The New York Times
October 23, 2020
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In Ohio, more people are hospitalized with the coronavirus than at any other time during the pandemic. North Dakota, which is leading the nation in coronavirus cases per capita, reported more than 1,000 cases on Tuesday, the states worst daily total yet. And as of Monday, 16 states had added more cases in the prior week than in any other seven-day stretch.
After weeks of spread and warnings in certain areas, a third surge of coronavirus infections has now firmly taken hold across much of the United States.
The latest wave which is raging most acutely in the Midwest and the West, but is also spreading in various areas around the country threatens to be the worst of the pandemic yet.
Its arrival comes as cooler weather is forcing people indoors, setting up a grueling winter that will test the discipline of many Americans who have grown weary of wearing masks and turning down invitations to see family and friends. Over the last week, the country has averaged about 59,000 new cases a day, the most since the beginning of August. The daily total could soon surpass 75,687, a record previously set on July 16.
The high case count which has so far not translated to soaring deaths in part reflects increased testing. With about one million people tested on many days, the country is getting a far more accurate picture of how widely the virus has spread than it did in the spring.
But the latest developments also reflect a serious new level of the outbreak. Hospitalizations, the most accurate picture of how many people are seriously sick from the virus, are on the rise nationwide, worrying many public health officials. A rise in deaths tends to lag behind a spike in cases. And deaths are creeping up in places: Officials in Wisconsin reported 36 on Tuesday, a single-day record.
Deaths among hospitalized patients have also dropped, to 7.6 percent from 25.6 percent in the spring, according to one study. That may be because doctors have better treatments at hand, and the patients are younger and in better health on average than those in the first wave.
Still, Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota, recently offered an ominous warning: With infections rising and compliance eroding, he said, the next six to 12 weeks are going to be the darkest of the entire pandemic.
The pandemic has caused nearly 300,000 deaths in the United States through early October, the Centers for Disease Control and Prevention said in a report released Tuesday. The tally includes not only deaths directly caused by the coronavirus but also nearly 100,000 fatalities that are indirectly related but would not have occurred if not for the virus.
The study is an attempt to measure excess deaths fatalities from all causes that statistically exceed those normally occurring in a certain time period.
Many experts believe this measure tracks the pandemics impact more accurately than the case fatality rate. The figure includes deaths from Covid-19 that were misclassified or missed and deaths from emergencies like heart attacks that went untreated because people were afraid to go to the hospital.
Hidden in the new numbers from the C.D.C. is a statistic that may not mean as much as it appears: While the pandemic has taken the greatest toll on older citizens, the biggest percentage increase in excess deaths has occurred among young adults ages 25 to 44, among whom there was a 26.5 percent increase as compared with an increase of 14.4 percent in those over 85, a group with a large proportion of the nations excess deaths.
But in nonpandemic times, the death rate among people in that age group is very low, so a disaster such as Covid-19 can easily bump up their death statistics without adding up to large numbers of excess deaths.
Excess deaths among Black people and Hispanics of all age groups also rose compared with previous years, the C.D.C. reports. Hispanics experienced a 54 percent increase, while Black people saw a 33 percent rise.
By comparison, the increase for white Americans was 12 percent, according to the C.D.C.
Another report, published in the Proceedings of the National Academy of Sciences, found that in April nearly half of the nations excess deaths were in New York and New Jersey. A third were in people over age 85.
But excess deaths are only part of the story, noted the authors of that paper, led by Amy Finkelstein, a professor of economics at M.I.T. While deaths last spring were concentrated in New York and New Jersey, the economic ravages from the pandemic extended nationwide, even in states with almost no deaths.
Job losses in New York and New Jersey were just a small fraction 7 percent of job losses throughout the country. And while deaths were concentrated in older people, half of those who lost their jobs nationwide were ages 25 to 44.
Concentrating on case counts or death counts, they conclude, provides only a partial picture of the pandemics devastation.
Health crises concentrated in one part of the country and one age group may have substantial economic spillovers that are felt throughout the rest of the country and on other age groups, the authors wrote.
In what might be the final months of the Trump administration, Dr. Stephen M. Hahn, the head of the Food and Drug Administration, seems to be trying to save the agency from the fate of the Centers for Disease Control and Prevention, whose scientists have been stripped of much of their authority and independence in responding to the pandemic.
To many F.D.A. scientists, Dr. Hahn has been a disappointment. Under his leadership, the F.D.A. authorized hydroxychloroquine for hospitalized Covid-19 patients despite a lack of evidence, only to reverse the decision once the drug was tied to severe side effects.
In late August, Dr. Hahn made a significant error at a news conference with the president announcing the approval of plasma treatments for Covid-19, greatly exaggerating its benefits. He later publicly corrected the record.
That debacle seems to have been a turning point for Dr. Hahn and agency scientists.
On Sept. 10, F.D.A. directors wrote a joint statement, warning that political interference could destroy the agencys credibility. Dr. Hahn tweeted his support of the statement, and later that day noted that new vaccine guidelines were coming.
Experts in the Office of Vaccines Research and Review drafted new guidelines, to make its standards unmistakable to drugmakers and reassure jittery Americans that the agency would not cut corners when assessing a vaccines safety and effectiveness.
Within days of submitting the guidelines to the White House, F.D.A. scientists, fearing they would never be made public, decided to include them in the briefing materials for an outside group of vaccine experts scheduled to meet on Oct. 22. They slipped a version into the appendix of the committees briefing materials, with a new title.
Executives from Johnson & Johnson and Merck, each with vaccine candidates, called for the guidelines release. Dr. Albert Bourla, Pfizers top executive, wrote on Twitter that he had faith in the F.D.A.s ability to set standards.
The same morning, the materials were quietly posted online. The White House was given about an hours notice, according to a senior administration official. Later that day, the White House abruptly cleared the guidelines, which were then posted to the F.D.A. website.
Despite an uptick of coronavirus cases in New Jersey, Connecticut and Pennsylvania, New York officials said on Tuesday that travelers from those three neighboring states would not be required to quarantine, though each state meets the qualifications for the restriction.
The announcement came with no small amount of confusion: A senior adviser to the governor confirmed that Pennsylvania would be added to the quarantine list, and Mr. Cuomo later indicated in a news conference that New Jersey and Connecticut would not be required to quarantine, but he did not initially mention Pennsylvania.
But the governor later clarified in a statement that enforcement from Pennsylvania would also be too difficult to maintain, considering the vast number of people who cross the states northern border into New York and its eastern border into New Jersey.
That rationale was also articulated by Mr. Cuomo in reference to Connecticut and New Jersey, two neighbors to New York that have worked together for months to try to coordinate a response to the coronavirus crisis.
There is no practical way to quarantine New York from New Jersey and Connecticut, Mr. Cuomo, a third-term Democrat, said in a morning news conference. There are just too many interchanges, there are too many interconnections, there are too many people that live in one place and work in the other.
Adding to the confusion, Beth Garvey, special counsel to Mr. Cuomo, said during the morning news conference that New Jersey and Connecticut were both being added to the list on Tuesday, despite Mr. Cuomo earlier suggesting they would not be. In a brief aside after Ms. Garveys remarks, the governor said Pennsylvania, we have the same basic issue.
None of the states were on a quarantine list released on Tuesday afternoon by the governors office.
Still, Mr. Cuomo said that all nonessential travel among New York and the three states should be avoided and promised he would issue more guidance on that point on Wednesday.
New York did add two states to its list on Tuesday: Maryland and Arizona. All told, 40 states and territories are now on the travel advisory list, which Mr. Cuomo referred to as really a bizarre outcome considering that New York once faced one of the worst outbreaks in the country.
On Monday, more than 64,200 new cases and at least 517 new deaths were reported in the United States. Over the past week, there have been an average of 59,269 cases per day, an increase of 34 percent from the average two weeks earlier, and fears are growing in New York about a potential second wave. Two weeks ago, Mr. Cuomo closed nonessential businesses in parts of Queens and Brooklyn where positivity rates had spiked.
Since late June, New York, New Jersey and Connecticut have worked in concert to create a list of states from which travelers to the region are subject to a two-week quarantine.
Essential workers have been exempt from the quarantine since it began in June. Other workers who cross state lines have technically been subject to the advisory, but officials have also said that the quarantine is only required by those who spend at least 24 hours in a state on the list which would exclude most commuters.
The quarantine was intended to apply to any person arriving from an area with a positivity rate higher than 10 per 100,000 residents over a 7-day rolling average or an area with a 10 percent or higher positivity rate over a 7-day rolling average.
New Jersey has a population of about 8.88 million people, and so anything over an average of about 888 new cases puts the state above that threshold. According to a New York Times database, New Jersey has seen an average of 1,016 cases per day in the past week, an increase of 54 percent from the average two weeks earlier.
For Connecticut, the threshold is around 356, and its daily average in the past week was at 378 cases per day.
Though New York has seen a significant increase in cases in parts of New York City and its suburbs, its overall positivity rate has remained lower than its neighbors. On Tuesday, Mr. Cuomo said the daily rate was 1.32 percent statewide, and 2.91 percent in the so-called red zones, areas where he recently imposed severe restrictions as virus hot spots sprang up across the state. Hospitalizations in the state increased by eight, to 942.
In New York City, Mayor Bill de Blasio said Tuesday that the citywide seven-day average positivity rate was at 1.58 percent.
An earlier version of this item incorrectly described when more than 64,200 new cases and at least 517 new deaths were reported in the U.S. It was Monday, not Tuesday.
President Trump and other politicians have repeatedly warned that lockdowns and similar measures could cause at least as much distress as they prevent, in particular by increasing the risk of overdoses and suicides because of economic hardship. But the evidence for that claim is sparse; on Monday, a study posted on Medrxiv, a prepublication site, found that in Massachusetts, the suicide rate during the states lengthy stay-at-home advisory last spring remained steady, neither increasing nor decreasing.
The analysis is being submitted to a journal; it has not yet undergone peer review.
This narrative that longer stay-at-home policies drive suicides doesnt bear out, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Womens Hospital in Boston and the lead author of the study. At least in a state that had a very long stay-at-home advisory, which, for all intents and purposes, was a shutdown. It was a ghost town here.
Dr. Faust led a team of researchers from Harvard and Yale who compared suicide rates from March to May, when the state was largely shut down, with the rates during the same months in 2019, which were in line with previous years. The team adjusted for background trends (U.S. rates have been increasing steadily for many groups since at least 2008) and for the numbers of deaths still under investigation as possible suicides. The rate this spring was unchanged from previous years just under one suicide a month per 100,000 people.
Our data are reassuring that an increase in suicide deaths in Massachusetts during the stay-at-home advisory did not occur, the authors concluded. Moving forward, effective prevention efforts will require comprehensive attention to the full spectrum of mental health services.
At the Andbe Home, a private nursing home in northern Kansas, a single resident tested positive for the coronavirus on Oct. 7. Two weeks later, all 62 residents have become infected, along with at least 12 staff members, and 10 of the residents have died.
That is how hard, and how fast, the virus can hammer the vulnerable in the rural Great Plains and Mountain West, where the pandemic is now raging. States in the region that were little affected in the spring and summer and tended to see the virus as a distant threat now have some of the highest per capita infection rates in the country.
It is with great sadness and concern that I announce that we have a full Covid outbreak in our home, despite the precautions we have been taking since March, Megan Mapes, the administrator of the Andbe Home, wrote Friday on Facebook.
The home has barred all visitors, and residents are isolated in their rooms, Ms. Mapes wrote.
Covid-19 is known to be particularly lethal to adults in their 60s and older who have underlying health conditions, which has put nursing home populations at a higher risk of being infected and dying. In 15 states, the number of residents and workers at nursing homes who have died accounts for at least half of all deaths from Covid-19.
Coming in a small community, such an outbreak inevitably hits home for many people. My grandmother was one of the 10 deaths, Jamie McCreery posted on Facebook. Im shattered and angry, but not at this facility or the workers, who have known the residents and their families for many years.
With a population of just 5,400, Norton County, where the Andbe Home is located, is the hardest-hit county in Kansas right now, relative to its size. The county is grappling with two serious outbreaks in the nursing home and in the Norton Correctional Facility, a state prison where 18 prisoners and three officers have tested positive. Of the 340 cases the county has reported in all, more than 300 have come this month.
The virus spreads readily in congregate living facilities like prisons, group homes and college dorms, and nursing homes have suffered some of the worst outbreaks, because older people with health issues are among the most vulnerable to the disease.
More than 540,000 coronavirus infections and more than 84,000 deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database.
Deaths in the facilities represent about 38 percent of total coronavirus deaths in the country, a slight decline from late June, when nursing homes made up about 43 percent of U.S. deaths. However, the decline may be temporary, experts warn, amid a new surge of cases.
The American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living communities across the country, released a report on Tuesday warning that U.S. nursing homes could be facing another spike.
Danielle Ivory, Mitch Smith and Timothy Williams contributed reporting.
Lucy Tompkins and Jordan Allen
Argentina has become the fifth country in the world to surpass one million confirmed Covid-19 cases.
With a population of around 45 million, Argentina is by far the smallest country on the list, which also includes the United States, India, Brazil and Russia, according to worldwide tracking by The New York Times.
Almost 100,000 of Argentinas cases have been detected in the last seven days, reflecting how infections are soaring in the country, and experts worry that the true total could be far higher. Argentinas reported test positivity rate has hovered around 50 percent for weeks and has reached as high as 75 percent, but the reliability of that data has been questioned recently, with reports that many negative test results were not recorded.
Argentina reported 12,982 new cases and 451 deaths on Monday. In total, 26,716 people have died of the coronavirus in the country, a fatality rate of 2.7 percent, according to the Health Ministry.
Argentina received praise early in the pandemic for imposing a strict quarantine in mid-March. It closed its borders and managed to keep the coronavirus largely under control while other South American countries, including neighboring Brazil, suffered gigantic outbreaks.
Though certain restrictions have since been relaxed, much of Argentina remains under some type of lockdown order.
Once concentrated in the Buenos Aires metropolitan area, the virus has since spread to much of the country, including remote areas with scarce medical resources, even though domestic flights and long-distance buses and trains have largely been grounded.
Argentinas early success in controlling the virus, which was accompanied by a sharp increase in approval ratings for President Alberto Fernndez, led to what some critics call an undue focus on the lockdown as the main strategy to combat the crisis.
What they failed to do in parallel was containment and mitigation of the pandemic, said Adolfo Rubinstein, an epidemiologist who was health minister under the previous president, Mauricio Macri, who was defeated by Mr. Fernndez last year. They needed to go out and detect community cases early, and mitigate the expansion of the pandemic.
U.S. ROUNDUP
With the number of coronavirus infections reaching record levels in New Mexico, Gov. Michelle Lujan Grisham announced new restrictions on Tuesday in the hopes of tamping down the viruss spread.
The governor indicated that the new policies were driven in part by the states health systems being overwhelmed with inpatient coronavirus cases, which has led to 81 percent of all adult hospital beds and 71 percent of intensive care unit beds being filled.
Those policies go into effect Friday, and apply to restaurants and bars, retail stores and other businesses that typically involve close contact between patrons and employees. Any that report four or more positive coronavirus cases over a two-week period will have to close their doors for 14 days. All retail establishments across New Mexico, including grocery stores, will have to close at 10 p.m. each night, and the state will also close state museums and historical sites to visitors.
This last week has been scary, Ms. Lujan Grisham said. Its been unsettling and upsetting to see everybodys hard work and sacrifice undone in only a few short weeks. That is the awful, relentless nature of this virus.
Over the past week, there have been an average of 563 cases per day, an increase of 139 percent from the average two weeks earlier, according to a New York Times database.
New Mexicos positivity rate is 6.5 percent and climbing fast, an indicator of the viruss rapid spread.
According to state contact tracers, restaurants and bars remain a top source of possible exposure to the coronavirus. Those that offer indoor dining will now have to be certified by the state to do so, including consenting to health checks for employees, as well as keeping a record of patrons to assist with contact tracing if needed. Certification will be required after Oct. 30, and indoor dining capacity will be limited to 25 percent of an establishments usual maximum.
In other U.S. news:
In Washington State, colleges and universities will now have to provide quarantine facilities for students if they are exposed to Covid-19 On Tuesday, Gov. Jay Inslee issued more restrictions for higher education campuses as the University of Washington struggles to contain an outbreak among its fraternities and sororities. There have been outbreaks in Whitman County, home of Washington State University, as well.
Officials in North Dakota reported 1,029 new cases on Tuesday, a single-day record and the first time the state has reported more than 1,000 cases in a single day.
A private school in California was ordered to pay $15,000 for ignoring a judges order to stop in-person teaching, in what The Associated Press reported could be the first ruling of its kind in California against a school for violating virus-related health orders. The judgment ended a nearly three-month legal battle between the health authorities and Immanuel Schools, a private Christian school in Californias Central Valley.
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Across the world, the countries that are waging the most successful fights against coronavirus are adopting regional and local measures to protect their populations. And thats why last week, we launched the three local Covid alert levels for England with interventions based on the prevalence of the virus in local areas. Since then weve been undertaking discussions with local leaders in those parts of the country, which are currently bearing the brunt of the second wave of this epidemic. I dont want anybody to think that your actions, our actions, are in vain or the efforts in vain because our collective action across the country has brought the R number well below its natural rate of about 3. As a result, the virus is not spreading as quickly as it did in February and March. Informed by the data that weve just seen, I can announce that Greater Manchester will move to the Very High Alert level. That means that pubs and bars must close unless theyre serving substantial meals. Households cant mix indoors or in most outdoor settings. In some public outdoor spaces, groups must be limited to the Rule of Six. And we strongly advise against travel into and out of the area.
Prime Minister Boris Johnson of Britain announced on Tuesday that Greater Manchester, the countrys second-largest urban area, would be put under the highest level of virus restrictions, shutting many pubs and bars and forbidding indoor socializing by people from different households.
The announcement came despite opposition from the areas mayor, Andy Burnham, who had pushed for greater financial aid for affected residents, and amid a spike in cases around Europe that has reinvigorated the debate over how to balance economic and health concerns.
I know these restrictions are tough on businesses and on individuals, Mr. Johnson said. Not to act would put Manchesters N.H.S. and the lives of many of Manchesters residents at risk.
Mr. Johnson pointed to the areas growing outbreak it has reported more cases over the last seven days than any other place in England, according to a New York Times database. He added that he hoped that local officials would work with the central government to carry out the restrictions, which take effect Friday.
The government will provide some 22 million pounds in aid, which Mr. Burnham argued was woefully insufficient. Talks over relief funds collapsed shortly before the announcement was made, though Mr. Johnson indicated they could be restarted.
At no point today were we offered enough to protect the poorest people in our communities through the punishing reality of the winter to come, Mr. Burnham said.
In London on Tuesday, Heathrow Airport, the countrys largest, began offering rapid tests for 80 ($104) to Hong Kong-bound passengers to meet its entry requirements, in an effort to encourage travel. The service will initially be offered for four weeks, and passengers must book it ahead of time. The tests will be done by private-sector nurses, with results expected within an hour.
Ireland on Monday became the first European country to reimpose a national lockdown, in a dramatic U-turn for the government, which two weeks ago fell short of imposing the highest level of restrictions despite advice from public health experts. The six-week period will begin on Wednesday.
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A Third Coronavirus Surge Has Taken Root in the U.S. - The New York Times
