Category: Corona Virus

Queues of cars have been forming outside testing sites run by states, counties, health care systems and pharmacies in numerous cities in recent days, including in the Chicago suburb of Arlington Heights.

"I think it's a combination of holidays coming up, but also just the uptick in the (infection) numbers out there," the hospital's Dr. George Kondylis told WBZ.

"I tried five different places before I got in this line, and none of them had any open spots or appointments," Pun told WBTS.

In the town of Saugus north of Boston, cars snaked around a testing site at a mall Tuesday night, and some people waited more than two hours, WBZ reported.

"I could not believe it when it was zig-zagging five times just to get through," Travis Morrow told WBZ about that line.

Wait times went up to 90 minutes even for those with appointments, he said.

Dr. Ashish Jha, dean of the Brown University School of Public Health, said the pre-holiday scramble for tests is laying bare the nation's limited testing capacity and lack of a national testing strategy.

"I think we should just acknowledge: We don't have enough tests, our infrastructure is not working very well. And then get to fixing it, as opposed to denying it or downplaying it." Jha said. "From the beginning of this pandemic the entire administration has not taken testing seriously enough and we are paying the price of that."

Labs warn of slower testing and supply challenges

The average number of new daily cases across a week rose above 165,000 Thursday -- the highest ever recorded, and nearly five times the average seen in mid-September, when it was at a post-summer-surge low, Johns Hopkins University data show.

Clinical labs already are "facing delays or cancellations on orders for critical supplies, such as pipette tips," Khani said. Increases in wait times for test results would result, she said.

The ACLA represents lab companies such as LabCorp and Quest Diagnostics.

Quest's statement included an "appeal to personal responsibility," calling on Americans to follow the CDC's guidance on wearing masks and social distancing.

"We are committed to doing everything in our power" to meet demand, but "we can't do it alone," the company said. By following CDC guidelines, "each of us can help to reduce the spread of Covid-19, improve testing and patient care, and potentially save lives."

In a briefing with reporters this week, Adm. Dr. Brett Giroir, the White House coronavirus testing czar, said labs were generally in good shape, and that the administration was "aggressively helping states in any way that we that we can."

On Friday, he released a statement saying the government is closely monitoring turnaround times at ACLA labs, which he said were averaging just under two days.

"No one, and especially me and my team, is downplaying any aspect of the pandemic response, and anyone making that erroneous assertion is uninformed," Giroir said. "The most significant issue driving the pandemic at the moment is lack of adherence to mitigation basics: mask wearing, washing hands and maintaining distance."

Some city-run sites ask Thanksgiving travelers to stay away

For those who buck recommendations not to travel or gather with other households for Thanksgiving, health officials have offered different shades of advice on whether and how these travelers should get tested.

The city's sites are testing nearly 6,000 people daily, and results on average take 24 to 48 hours, the center said.

"If people need tests for any other reason -- like travel or visiting -- they need to go to their private provider," the email reads.

The city's health director, Dr. Grant Colfax, went further this week, discouraging any Thanksgiving visits and pre-travel testing, regardless of where that testing comes from.

"Please do not use testing to determine whether you can travel or not," Colfax said. "A negative test cannot be an excuse to put yourself or others at risk."

The tone is different in nearby Contra Costa County. Though health officials there want people to avoid Thanksgiving gatherings, they say they suspect people will ignore those warnings.

"Unfortunately, a lot of these tests people are doing for holiday planning may come at the expense of people that need a test because they have symptoms or known exposure," Wallace, the testing coordinator, told KIRO.

Read more:

Lines to get tested for coronavirus are growing long ahead of Thanksgiving and amid rising cases - CNN

U.K. scientists are moving ahead with plans to infect volunteers with the virus that causes COVID-19. Such experiments have been done with other pathogens, including flu viruses (pictured here).

By Warren CornwallNov. 20, 2020 , 12:00 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

In the early days of the COVID-19 pandemic, tens of thousands of young volunteers offered to risk their health by letting scientists intentionally infect them with the pandemic coronavirus, hoping to speed the hunt for a vaccine or treatment. Several research groups announced plans to run these so-called human challenge trials, even as some scientists questioned whether they could be conducted ethically.

Now, with the recent news that conventional human trials have produced at least two very promising vaccines, scientists are debating whether planned challenge trials are still needed. In the United States, one nascent effort appears to be on hold. In the United Kingdom, however, researchers say they are moving ahead. There are still many strong arguments for pursuing human challenge trials, says Christopher Chiu, an immunologist at Imperial College in London and lead researcher for the proposed U.K. trial.

In traditional human trials, researchers give volunteers either a vaccine or a placebo, then wait months or longer for enough cases to emerge to gather statistically rigorous results. Challenge trials can move faster by first vaccinating volunteers and then intentionally exposing them to SARS-CoV-2 in a controlled setting. Researchers would then closely monitor the volunteers for days or weeks.

But challenge trials are also rife with ethical concerns. For example, because no reliable treatments for severe COVID-19 have emerged, people who volunteer to test a vaccine could be putting their lives on the line if they get sick.

Medical authorities around the world have adopted a cautious approach.Even 1year after the outbreak began, no such trial is underway. Meanwhile, 11 vaccines have entered the final phase of conventional human testing, with promising results already emerging:Pfizer and BioNTech announcedon 18 November that their vaccine is 95% effective, and Modernaannounced similar preliminaryresults 2 days earlier.

Proponents say challenge experiments could still advance science and save lives. They could be used to compare the effectiveness of different vaccines, for instance, and help quickly screen the most promising second-generation candidates from the dozens now in the works. Challenge studies could also help answer unknowns, such as what immunological markers indicate someone is protected from the virus, and whether vaccines block infection entirely or simply prevent people from getting sick. Thats important, because if a vaccinated person can still transmit the virus, people who arent vaccinated would be at risk.

Its hard to use large-scale field trials to figure out whether a vaccinated person still sheds the virus, says Marc Lipsitch, a Harvard University epidemiologist who hasadvocated for COVID-19 challenge trials. Its almost prohibitively expensive because in a 30,000-person trial you have to test 30,000 peoplea week for a long period of time, he says.

The initiative Chiu heads, the Human Challenge Consortium, is the closest to starting. Backed by 33 million from the U.K. government, Chiu is preparing to submit the test plan to government regulators in late November. If approved, scientists could infect the first young adult volunteers in January 2021. The preliminary studies, involving up to 100 volunteers ages 18 to 30, would determine the lowest viral dose needed to cause an infection. Once researchers have a standard dose, they could move forward with head-to-head comparisons of different vaccine candidates. Although the experiment wont replace large-scale traditional efficacy trials, it could highlight which vaccines warrant further investment, Chiu says.

Chiu is comfortable with intentionally infecting people with SARS-CoV-2 because there is growing evidence that young adults have a low risk of serious illness. He consulted with researchers at Kings College London who help managean app tracking COVID-19 symptomsfor more than 4 million people. Among 650 young adults with confirmed cases, nine in 10 had no symptoms after 3 weeks, whereas the symptoms of a few outliers resolved after a few months, Chiu says.

In the United States, however, the recent vaccine results have put a damper on enthusiasm for human challenge trials. A month ago, virologist Matthew Memoli put the final touches on plans for a challenge trial at the National Institute of Allergy and Infectious Diseases (NIAID), where he heads the Clinical Studies Unit at the Laboratory of Infectious Diseases. Now, he says, That program is in limbo.

After the first news of the vaccine success, Memoli heard NIAID Director Anthony Fauci and the head of the National Institutes of Health, Francis Collins, make remarks at an online meeting with the Bill & Melinda Gates Foundation that suggested the challenge experiment might not be necessary. Collins confirmed the exchange through a spokesperson.

Thats welcome news to some, who fear that challenge trials present risks of serious complications and warn that the long-term impacts of SARS-CoV-2 infections are uncertain. Wilbur Chen, an infectious disease expert at the University of Maryland, Baltimore, who has conducted challenge experiments to study intestinal diseases including cholera, says such trials are far riskier for COVID-19. Antibiotics could effectively treat his volunteers if they got sick, Chen says, but I dont think theres a good rescue therapy right now for COVID-19. He co-wrotea recent articlein theProceedings of the National Academy of Sciencesarguing that challenge experiments would be unethical at this point.

Others, however, say the apparent success of some vaccines could strengthen the case for using challenge trials to test other vaccines. Once viable vaccines are available, its harder to justify continuing to use a placebo in traditional trials involving thousands of people, says Rutgers University, New Brunswick, bioethicist Nir Eyal, who earlier joined Lipsitch in supporting the use of challenge trials. Are you going to hope that tens of thousands of people will altruistically be willing to forgo access to a proven vaccine? Are you going to block their access to the vaccine? he asks. Challenge trials offer a way to speed testing of other vaccines, which the world may end up needing.

Seema Shah, a bioethicist at Northwestern University whohas written about challenge trials, thinks such trials could still be useful, but there is less urgency now. And she would like to see more ways to ensure participants safety, such as finding biological markers for people at greater risk of getting sick. I think I would feel more comfortable waiting a bit to see how those things developed and whether the risk could be minimized further, she says.

Lipsitch agrees that the immediate need is not great for human challenge trials. But, he adds, researchers need to keep preparing in case we have reason to start doing them.

Continue reading here:

Should researchers shelve plans to deliberately infect people with the coronavirus? - Science Magazine

Press Briefing by Vice President Pence and Members of the Coronavirus Task Force | November 19, 2020  Whitehouse.gov

See original here:

Press Briefing by Vice President Pence and Members of the Coronavirus Task Force | November 19, 2020 - Whitehouse.gov

Xinhua/Serge Haouzi via Getty Images

By Jennifer Couzin-Frankel, Gretchen Vogel, Lila GutermanNov. 20, 2020 , 4:20 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

Since March, Science has reported on the researchand lack thereofguiding the hard decisions schools have faced in the coronavirus pandemic. After stories in the spring and summer, an article this week examines schools in countries with high viral transmission. The reporters and editor steering this coverage dont leave it behind when the workday ends: All three have school-age children. In this conversation, they reflect on the intersection of the personal and the professional.

Lila Guterman: Gretchen and Jennifer, Im happy to have the chance to chat with you after editing your stories on this topic! All of our kids are close in age, ranging from eightto 13. But weve experienced three very different school environments: Im in Washington, D.C., where public schools including my kids have been closed since March; Gretchen is in Berlin, where the public school her children attend opened this fall with full classes after a limited reopening in April; and Jennifer is in Philadelphia, with two children in private schools that reopened in September.

So, what has it been like living what you write?

Gretchen Vogel:I was motivated to do these stories because I wanted answers. In Germany, families are required to send school-aged kids to in-person school, so I didnt have a choice about whether to send my children back. But I wanted to know what the risks were (or are), and how I could help minimize them, both for my family and for the school.

Jennifer Couzin-Frankel:Like Gretchen, I had personal reasons to dive into thisand we both have the advantage, as science reporters, to be able to connect with people who know a lot more than we do. But I didnt expect the range of emotions that covering this has entailed, and the disorientation and stress of so many intersections between my reporting and the experience of navigating school with my children. Its been weird to toggle, sometimes in the same hour, between chatting with an infectious disease doctor about how kids might spread this virus to agonizing over how best to support my children and protect our family.

And Gretchen, just like we embarked on this because we wanted answers, now I feel like I should have them! But Im reminded that our reporting has uncovered how tough answers are to come by.

G.V.:I know the feeling. Way back in April I thought, Hey, Sweden has its schools open, and they have great epidemiologists there. I bet they have some answers already! But when I started making calls, I was shocked to learn thatalmost no one was keeping trackof what was happening in Swedish schools. As time wore on, I kept expecting solid data to appear. Schools are open all across Europe! I was so sure that by now, wed be able to say how often a kid or teacher infects someone else at school. But, to my dismay, other countries havent done much better than Sweden did collecting information on school outbreaks. The data are still really thin. And as our school has discussed how much to keep windows open, whether air purifiers are a worthwhile investment, and whether everyone should wear masks all day, Id been hoping to find clarity in the data. That, too, has been hard to come by.

Lila, I know your experience has been different, with schools closed in Washington. How have the stories weve been working on dovetailed with your life?

L.G.: Initially, when our public charter school announced midway through the summer that they would do distance learning for at least the first 2 months, I was relieved not to have to make a decision about whether to send kids to the classroom.

J.C.F.: I admit that in the late summer, I sometimes wished the decision of whether or not to send my kids into school buildings had been made for me. I tend to be pretty data-driven, and I was struggling with a big unanswered question: How much does COVID-19 spread in schools, especially in schools that have lots of protections in place?We ultimately decided to send our 8-year-old in person and keep our middle-schooler remote for the fall term; for various reasons, these felt like the best choices at the time. That said, we are in a hugely privileged position: Our childrens schools have many resources at their disposal, and they were able to open with lots of mitigation, including strict masking requirements. But we still worried about the risk of viral spread in schools.

G.V.: Jennifer, as you know, I had my own worries back in August. After schools opened part time in the spring and few outbreaks emerged, German school authorities announced a return to normal schedules for the fall. Some places required older kids to wear a mask all day, but most decided that was too hard on students, and so only required masks in hallways and other common areas. Once children are at their desks, they can take their masks off. I was sure this would immediately result in outbreaks all over.

To my surprise and relief, it didnt. Students and teachers at our school have tested positive, but so far, it seems, no one has passed the virus on at school.

J.C.F.: As weve traveled this path professionally and personally, accumulating more and more information, I feel like our perspectives have shifted.

L.G.: Definitely. I started out worried that reopening U.S. schools was a terrible idea, that the virus was sure to spread among children and to teachers and families. But with each week that passed without major outbreaks at schools, I became more comfortable with the idea of sending children into school buildingsparticularly younger children. Through much of the fall, the D.C. area has had very low transmission of the virus, and its been frustrating to watch other areas with more transmission open schools while our area stayed closed. It has really emphasized to me the variation across states and regions here in the U.S. (Unfortunately, as has been true in many places, community transmission in this area has increased in the past week or two.)

Closed schools also make me worry about exacerbating inequities. Kids facing a range of tough circumstances, from homelessness to family job losses, may be especially at risk without in-person school. Because of the overlap of those groups with Black and Latino populations, closed schools disproportionately impact those populations. And its very complicated because those are the same groups that have been hardest hit by the coronavirus. Perhaps because of that, in many parts of the U.S., they are opting out of in-person school more than white families. Our school isnt open, but a survey of families about their comfort with returning to the classroom showed that same divide by race. How do we address these damaging disparities? I dont know.

J.C.F.: I know how lucky I am to have the option of in-person school for my kids. At the same time, Ive been reminded that even when a school tries to be safe, it cant guarantee a space free of COVID-19. A few weeks ago, my daughter developed a sore throat and headache. Alarm bells went off and we immediately scheduled a COVID test. Thankfully, the next day we learned that she was negative. The early symptoms turned out to be a bad cold. My first reaction was immense relief; my second was to wonder, How did she catch a cold when shes masked and generally distanced at school? Ive since heard of kids across several schools, all of them doing a great job with COVID risk mitigation, whove contracted colds and other mild infections. Its a reminder that masks and small cohorts and extra time outdoors and all the rest dont eliminate the spread of pathogens among kids.

G.V.: Oh yes, some sort of cold (likely a rhinovirus) raced through our elementary school soon after it opened. Almost everyone got it. It wasnt COVID-19all tests were negative. But it definitely made clear that the hygiene measures the school had in place didnt block all viruses. Then we got a warning from the school about lice in the ninth grade. How are they passing lice to each other when theyre supposed to stay 1.5 meters apart?

One thing Ive found surprising is the general expectation that if school is open, then life is back to normal. If the kids are sitting in the same classroom all day, without masks, theyre sharing germs anyway, as the reasoning seems to go, so it must be OK for the parents to get together as well. Schools here even held in-person back-to-school nights with parents and staff in August and September. People were supposed to wear masks and keep their distance, but I still thought, Is this a good idea? I did attend, and none of the meetings turned into superspreader events. I guess we got lucky.

J.C.F.: I carry an image in my mind of notches on a stick, with each notch representing an activity that can be risky. Every family has its own stick, and were all doing something: going to the grocery store, enrolling a kid in soccer, getting necessary dental work. Once my 8-year-old started in-person school, we cut out as much as we could, though we still hosted occasional outdoor masked playdates for our older child learning remotely. Like parents everywhere, we are trying to do the best we can to support our kids and protect our family. Its a tough balance.

Having a child in schoolanother notch on our stickreally pushed us to pare down elsewhere. I feel an obligation to reduce risk for not just our family, but also our community. If I can reduce my notches, that helps everyone else.

G.V.: In Germany, theres an active debate about whether schools should go back to hybrid mode, with classes split in half and taking turns with in-person and distance learning. And more regions are requiring at least older children to keep their masks on in class. Closing restaurants and bars and gyms seems to have had an effectnew cases have flattened a bitbut we will have to see what happens in the coming weeks. Im kind of surprisedmaybe I shouldnt be?that my feelings on the topic are still very mixed.Should schools close? I wish I knew!

J.C.F.: Yes! Like you, even after living this, reporting on it, practically marinating in this topic for months, I still dont know. The rising caseload in the Philadelphia region shows no sign of flattening. More schools are going back to remote learning at least for a couple of weeks. The citys public school system recently delayed a late November plan for partial reopening. That said, from a big-picture perspective, I feel more comfortable than I did 2 months ago about sending my children to school. Maybe, as Lila suggested earlier, that comes from simply watching schools near and far welcome students every day without disaster striking. It also comes from the research weve been learning about. But cases are so high here right now, as is the positivity rate. Its hard not to feel uneasy. Its a roller coaster for sure.

More here:

Worlds collide when three Science reportersand parentscover coronavirus and schools - Science Magazine

Maryland's new coronavirus restrictions that went into effect Friday come at a time when the state has been shattering records for new case loads.

With coronavirus cases showing what Gov. Larry Hogan called a staggering, spiking surge this week, restrictions the state had loosened earlier this fall tightened once more starting 5 p.m. Friday.

Heres what the governor has ordered:

For Maryland businesses impacted by the tightened COVID-19 restrictions, news that a rise in cases required new rules was understandable, but at the same time, tough for many to hear.

Every week, it seems like its something different. Its definitely been difficult, said Jamie Ellis-Ade, general manager at Brewers Alley in Frederick.

She said the restrictions limiting the hours for dine-in service will mean a loss in business. If you come in for dinner at 9, you have one hour to eat your meal and get out, so thats really difficult, Ellis-Ade said.

To make up for the expected decline in revenue, Ellis-Ade said they will push takeout service, which will continue at 10 p.m.

More Coronavirus News

Looking for more information? D.C., Maryland and Virginia are each releasing more data every day. Visit their official sites here: Virginia|Maryland|D.C.

At Dancing Bear Toys and Gifts, also in Frederick, the restriction that impacts them is the decrease to 50% capacity for businesses. Store manager Sarah Hyatt said they dont have to do much to prepare for the change. It hasnt been too difficult, Hyatt said.

She added that, at the height of the pandemic, they took most of their business online. Also, since reopening in the summer, they havent been more than half full with customers.

Though she has been surprised by the number of people showing up to the store, she said, compared to this time last year, business is actually up. I think a lot of people are getting an early start to their holiday shopping, Hyatt said.

The new restrictions come at a time when Maryland has been shattering records for new case loads and as people get ready for Thanksgiving.

Maryland on Thursday recorded 2,910 new cases nearly 600 more cases than the previous one-day high, which was only set five days before.

In four of the last six days, the state reported over 2,000 new cases. More than 1,000 new cases have been reported every day for more than two weeks now.

The states hospitalization, positivity rates and case per 100,000 people have also been climbing, with the states smaller, less populated counties, in western Maryland and on the Eastern Shore, hit the hardest.

In fact, hospitals are starting to reach capacity again, with about 85% of the states hospital beds already filled. As of Thursday morning, there were 1,192 people hospitalized.

Maryland has had 174,733 confirmed cases of COVID-19. For perspective, 16 of Marylands 24 jurisdictions have smaller populations than that.

Hogan said about half the people contacted by Marylands contact tracing teams refuse to offer any help, but the contact tracing data the state does have shows a large uptick in new cases among Marylanders who have recently been exposed in bars and restaurants.

He also said compliance with health measures, such as the wearing of face masks and social distancing, drops dramatically as the day gets later.

Weve lost more Marylanders to COVID-19 than we lose to car accidents, gun violence and the flu combined, the governor said on Tuesday, the day he mandated the new restrictions.

Overall, Marylands positivity rate has risen from under 4.4% earlier this month to almost 7.2% now, and public health experts warn the coming weeks are expected to be even more grim.

Like WTOP on Facebook and follow @WTOP on Twitter to engage in conversation about this article and others.

Get breaking news and daily headlines delivered to your email inbox by signing up here.

2020 WTOP. All Rights Reserved. This website is not intended for users located within the European Economic Area.

Originally posted here:

Maryland businesses brace for impact of reimposed COVID-19 restrictions - WTOP

The "cold chain" is just one of the challenges in distributing vaccines worldwide.

There are plenty of others: decisions about priority populations and databases to keep track of who's received what vaccine, where and when. Additionally, different vaccines may have more or less efficacy with different population groups; and governments will need PR campaigns to persuade people that vaccines are safe.

But the logistics of transporting and storing vaccines -- getting them from the factory gate to the patient's arm -- are critical. And as most vaccines are likely to require two doses, the whole chain needs must be repeated within weeks.

The Pfizer-BioNTech vaccine needs to be kept at around -70 degrees Celsius (-94 degrees Fahrenheit) while it's transported. That's 50 degrees Celsius colder than any other vaccine currently used.

Moderna says its vaccine can be kept in freezers typically available in pharmacies, and in a refrigerator for 30 days. But there are likely to be fewer doses of the Moderna vaccine than of the Pfizer's available over the next year.

Phase 3 trials have shown both vaccines to be around 95% effective but the results haven't yet been reviewed by regulators.

On Wednesday, the CEO of BioNTech, the German biotech company partnering with Pfizer, acknowledged the issue of temperature control.

"We are working on formulation which could allow us to ship the vaccine even maybe at room temperature," Ugur Sahin told CNN. "We believe that in the second half of 2021 we will have come up with a formulation which is comparable to any other type of vaccine."

But in the meantime US Health and Human Services Secretary Alex Azar believes the Moderna candidate is "more flexible" for settings like a local pharmacist. Pfizer's, he said Monday, would be better suited to "big institutional vaccination, say a whole hospital setting, several nursing homes at once."

Pfizer plans to ship up to 1.3 billion doses next year, requiring a lot of dry ice (carbon dioxide in solid form at around -78 degrees Celsius), and a lot of isothermic boxes. The boxes will hold up to 975 vials (4,875 doses) and can be refilled with dry ice for up to 15 days of storage.

Pfizer is testing the supply chain in four US states. Its CEO, Albert Bourla, said Wednesday he has "zero concerns" about the cold chain requirements.

But shipping such a vaccine can pose big challenges. Dr. Jarbas Barbosa, assistant director of the Pan American Health Organization, told CNN that "the rural and the urban areas in any country in the world are not ready to manage this vaccine today."

"So, who is prepared in the world? No one."

One issue is the availability of dry ice.

Sam Rushing, president of Florida-based Advanced Cryogenics, told CNN there are already regional shortages in the US.

US officials are confident enough dry ice will be available. Paul Ostrowski, director of supply, production and distribution for Operation Warp Speed, told CNN last week that courier UPS had pledged to "provide dry ice reshipments throughout all of America upon demand."

But Rushing cautions that dry ice is not very user-friendly and can be hazardous if stored improperly, especially in a confined space. The Federal Aviation Administration classifies it as hazardous cargo.

Peter Gerber, CEO of Lufthansa Cargo, told CNN that the need for dry ice "clearly reduces also the transport capacity because if you have to load more ice you can't load so much vaccine. And of course the procedures have to be very special in order to ensure that it always has this degree of coldness."

US courier DHL is adapting distribution plans according to each vaccine's specifications. David Goldberg, CEO of Global Forwarding US for the company, says "there's a restriction on the amount of dry ice used on an aircraft -- typically 500-1,000 kilos depending on a number of factors."

Once they arrive, Pfizer vials can be stored at between 2 and 8 degrees Celsius for up to five days before deteriorating. Pfizer says it has developed a "just-in-time system which will ship the frozen vials direct to the point of vaccination." It will also monitor the temperature of every box being shipped.

Julie Swann, an expert in supply chains at North Carolina State University, says that large hospital systems, which often have ultra-cool freezers, may have a role as distribution hubs. But not all US states have them; Hawaii said last week none of its hospitals had such freezers.

Breaking down shipments of a frozen vaccine for rural areas or small groups of essential workers -- without compromising their temperature -- will be another headache, Swann said.

When a vaccine needs to be used within a few days, providers will need to ensure they are ready. "You can't just wait to see who shows up," Swann told CNN. "And we don't really have good data yet defining where and who the priority populations are."

Prashant Yadav, a supply chain expert and senior fellow at the Center for Global Development, said: "It's a question of how soon can we start thinking about multiple packaging formats."

Beyond the US

If getting a frozen vaccine to tens of millions of people is a challenge in the US, it's a far greater problem for poorer countries.

Transport links are slower and medical facilities less equipped in the developing world. CO2 production is scarce, and the cost and hazards of shipping huge amounts of dry ice are also a hurdle, Yadav says.

David Gitlin, the CEO of refrigeration specialists Carrier, told CNN last week: "When you look at places like Africa and India, they just don't have the cold chain infrastructure. The United States spends 300 times more per capita on cold chain than India."

Peru is one of many countries that have ordered the Pfizer vaccine. In the capital, Lima, where large volumes can be administered quickly, it should be effective, says Dr Germn Mlaga, one of a team working on Peru's vaccine options. But while there are probably 30 ultra-cold freezers in Lima "for the other 20 million Peruvians including in the Andes and the rainforest there are none."

"For the rest of the country we could use vaccines like the Chinese one that requires from 2 to 8 degrees which is more manageable," Mlaga said.

"It's about cost-effectiveness, which is not just about the vaccine but the whole process of vaccinating," said Yadav. But if Pfizer's candidate proves to be the most effective, demand for ultra-cold freezers would be overwhelming.

Barbosa says the Pan American Health Organization is urging member states not to spend huge sums on preparing for one vaccine but join a multilateral facility called COVAX -- essentially a clearing house for buying vaccines run by the World Health Organization.

Beyond the cold chain, there are other logistical hurdles.

A massive airlift will be required to get vaccines where they need to go. Pfizer, which has production lines in Europe and the US, says it expects an average of 20 daily cargo flights worldwide.

DHL expects that 15 million cooling boxes will need to be delivered on 15,000 flights over the next two years. David Golberg told CNN the company has established a high quality cold-chain network and is adding flights between China, Europe and the US.

Many countries can call on existing programs as models. Peru's national vaccination program reaches about 75% of its population, Mlaga said.

India's polio vaccination program is ubiquitous -- covering more than 90% of children by this year, according to Gagandeep Kang of the Wellcome Trust Research Laboratory at the Christian Medical College in Vellore.

"For polio programs, we have used boats and mules and enterprising health staff," said Kang. But such programs are designed for less than a tenth of the population, and Covid-19 vaccines will need to focus on different groups, she said.

India will need "a series of waves each addressing a different group as vaccine become available," she told CNN.

"We will need to see performance characteristics of other vaccines, and their delivery requirements before making a call on what to go with," said Kang, who is also a member of the World Health Organization's Global Advisory Committee on Vaccine Safety.

In such a dynamic situation, record-keeping becomes critical. Dr. Anna Blakney, who is working on a vaccine being developed by Imperial College London, said there is no centralized infrastructure in the US for monitoring who is getting what and when, which she describes as a "really critical issue."

Yadav says that even when the vaccine reaches its destination there will need to be some flexibility to allow people to get their second dose in a different location if desired. And that demands reliable databases.

Barbosa said that beyond the supply chain, governments "must have a good communications strategy to overcome public skepticism and conspiracy theories about vaccines."

Blakney agrees. "This process [of vaccine development] has been so fast that it's not surprising people are skeptical as they read about safety and possible side-effects," she said. Blakney is part of an international effort launched by research scientists to reassure people via social media about the safety and efficacy of COVID-19 vaccines.

Finding enough dry ice is just one in a sequence of challenges to get the world vaccinated against Covid-19.

CNN's Claudia Rebaza and Fred Pleitgen contributed to this report.

Follow this link:

The world's now scrambling for dry ice. It's just one headache in getting coronavirus vaccines where they need to go - CNN

Coronavirus infection numbers hit an all-time record Friday, with nearly 24,000 new daily cases recorded -- and so did the number of patients in the country's intensive care units. Official data from the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) show that the number of Covid-19 patients in German intensive care units (ICU) has climbed from 267 on September 21 to 3,615 as of November 20 -- a more than 13-fold increase in the space of just two months.Europe's largest economy has gotten through the pandemic fairly well for now compared to its neighboring countries. This in in part due to its high intensive care capacity with 33.9 beds per 100,000 inhabitants; in contrast, Italy has just 8.6. But with Covid cases across the region skyrocketing, even Germany's healthcare system is under strain and hospitals in some areas are increasingly coming close to their limits.

Germany's leadership on Friday warned the system could collapse in weeks if the current trajectory continues. "The number of severe cases in intensive patients is still rising. The number of deaths is something that is not really being talked about and it remains very high," said Steffen Seibert, spokesman for Chancellor Angela Merkel.

"We have not yet managed to bring the numbers back to a low level. We have basically only managed to get past the first step so far, that is, to stop the strong, steep, exponential increase of infections and we are now stable, but our numbers are still very, very high."

'Patients deteriorate very quickly'

Michael Oppert, head of intensive care at the Ernst von Bergmann hospital in Potsdam, just outside Berlin, is equally concerned about the dramatic rise in recent weeks -- and expects things to get worse.

"We are not at the tip of the wave now, at least as far as I see," he told a visiting CNN team this week. "And we do have a capacity for a few more patients, but if this carries on at the speed that we are experiencing right now I would imagine that even our hospital, with over 1,000 beds, will come to a point where we have to send patients home or to other hospitals to get treated."

Bettina Schade, chief nurse on the Covid ward in the same hospital, described how the ward has changed over the last few weeks. "The numbers of patients have been increasing. We are getting a lot more patients with varying degrees of illness. Both for the normal Covid ward, but many also come to the emergency unit and very quickly have to be put into ICU," she said. "We are currently experiencing having to put a lot of patients from the normal Covid ward into ICU very quickly because patients deteriorate very quickly."

This applies even to many younger patients with severe symptoms, said Tillman Schumacher, a senior infectious disease physician. "We have patients of 30 or 40 years here who are on a ventilator and I am not sure if they'll survive."

Only two of the 16 ICU beds were vacant and the hospital staff was already canceling non-urgent operations to free up capacity -- as well as making plans to convert more of its general intensive care facilities into Covid units.

Dr. Uwe Janssens, head of the DIVI, explained what measures would be taken if the current spike continues. "The regular program of hospitals has to be shut down, a partial closing down of the regular operations and admissions of patients which you can delay for several weeks without any strain, they can be delayed. There are people who don't need an emergency surgery or an emergency catheter or something like that. They can be delayed. And doing this you get the capacity and get the nurses and the physicians to help the ICU physicians and ICU nurses on their wards.''

After taking into account non-Covid patients, 22,066 intensive care beds in the country were occupied as of November 20, while 6,107 remained vacant. Germany has a reserve of about 12,000 ICU beds, including field hospital beds at Berlin's convention center.

Despite the large capacity, health minister Jens Spahn earlier this month warned that ICUs could be overwhelmed if daily infection rates continued to rise at the current level. "We are now increasingly seeing a rising burden and the threat of being overwhelmed in intensive care, in hospitals and at GPs," he said in an interview with Germany's state broadcaster ARD.

Germany offers help to other European countries

And that could be bad news for all of Europe. Until now, Germany has been taking in Covid patients from neighboring countries whose health care systems are overwhelmed.

The German Foreign Office confirmed to CNN that during the first wave of the pandemic, between March 21 and April 12, 232 patients were transferred to Germany for treatment -- 44 of them from Italy, 58 from the Netherlands and 130 from France. In the fall too, the federal states of North-Rhine Westphalia and Saarland offered spaces to 36 patients -- three of them from the Netherlands, 25 from Belgium and eight from France, a Foreign Office spokesperson said.

''These patients have a need for intensive medical care,'' said Anja Wengenroth, a spokeswoman at University Hospital Muenster in Muenster, North Rhine-Westphalia. Her hospital established a system in the spring whereby Benelux countries -- Belgium, the Netherlands and Luxembourg -- could put in a request for ICU beds, a scheme which is ongoing. The North Rhine-Westphalia Ministry of Labor, Health and Social Affairs confirmed to CNN that currently ''46 hospitals have currently agreed to accept foreign Covid-19 patients. There are currently 76 beds on offer.''

Anne Funk, head of the division of cross-border cooperation in Germany's smallest federal state of Saarland, which borders France, told CNN that during the first wave of the pandemic, its hospitals took in 32 French patients. At the end of October, Saarland offered France eight beds; three patients have been transferred to date.

"We would like to help wherever we can," Funk said. "We do not want to differentiate between nationalities. At the moment we still have capacities. We are coordinating with medical and local authorities in France on an individual needs basis. We are here to help.''

For now they can continue to do that, but with Germany's ICUs filling up quickly, it's not clear for how much longer.

Anti-pandemic protests

Germany has recently seen a string of demonstrations against the country's anti-pandemic measures, with many protesters denying the severity of the virus.

The country is in a nationwide partial lockdown which requires restaurant and bars to remain closed, people to avoid travel, keep their contacts to an absolute minimum and limit public meetings to members of two different households. Schools and shops have remained open. German federal and state leaders will meet next week to decide on introducing further measures.

On Wednesday, thousands of people gathered near the parliament in Berlin while lawmakers inside debated plans for greater legal powers to enforce restrictions. Police used water cannon and tear gas to disperse protesters, many of whom were not wearing face masks.

This is considered a slap in the face by frontline medical staff working hard to keep people alive, like Schade. "I also hear some people I know say things like: it's like a flu or can be compared to a regular flu," the chief nurse said. "We just cannot understand people saying that! Of course we all have the fear that maybe at some point we won't make it anymore and could have a situation like they had in Italy where patients are outside in cars and get treated with oxygen because there's no more capacity."

Germany is still far away from such scenarios but, while there are still thousands of ICU beds available in the country, Oppert had a message of warning about the second wave of the pandemic and its dynamic.

"It is different, it is harder," he said. "We do tend to see more patients now. Not only here in the Berlin/Potsdam region, in which we have a heavy burden of intensive care patients, but nationwide the numbers are climbing and they're still climbing, they are not coming down at the moment."

View post:

European countries believed that Germany would always have spare ICU beds for them. Now they're almost full - CNN

Good morning.

In California, weve spent the past several days learning new details about the ways in which some of our leaders have flouted the very same guidelines theyve promoted to help keep everyone safe.

That French Laundry dinner Gov. Gavin Newsom apologized for attending? Photos obtained by Fox 11 show it was not as outdoors as you might have thought. As CalMatters reported, two high-powered doctors association executives were also among the guests.

Oh, and reporters are still trying to figure out which of your elected representatives decided to go to Hawaii for a lavish policy summit, just days after California announced advisories against traveling out of state, because many of them wont own up to being there.

Nevertheless, we are now exactly one week away from Thanksgiving a holiday that experts have warned is almost custom tailored to facilitate the spread of the coronavirus.

Both the state and local governments have been announcing new restrictions or reinstating previous ones aimed at getting the surge under control.

Heres what you need to know about restrictions now:

More than 94 percent of the states population lives in the 41 counties currently under the states purple tier of restrictions. What does that mean?

It means that many businesses that may have been operating indoors, such as restaurants, movie theaters and museums, must either move everything outdoors or close down.

Hair salons and barber shops can be open indoors with modifications. Shopping malls, stores and swap meets can be open at 25 percent capacity.

Indoor gatherings of any kind are banned and outdoor gatherings can only include people from up to three households.

[See a grid showing whats open and whats closed under each tier on the California Department of Public Healths website.| Look up where your county falls here.]

All that said, individual counties may impose more stringent restrictions than the state mandates.

For instance, officials in Los Angeles County which has struggled for months with stubbornly high case loads have said that the virus is spreading to dangerous and unsustainable levels.

So, effective Friday, the county is requiring that restaurants operate at half capacity, even outdoors. Also, personal care businesses cant accept walk-ins, and they must provide only services that dont require customers to take their masks off.

As far as outdoor gatherings, which the state guidelines cap at simply three households, Los Angeles County is capping at 15 people.

And if things continue to get worse, officials say they will reimpose a stay-at-home order similar to the one the county implemented in March, which would require people to stay home except to go to essential businesses. (The threshold would be a five-day average of more than 4,000 new cases per day, or if there are more than 1,750 hospitalizations per day.)

San Francisco officials have also paused reopening plans without a state mandate.

[Track coronavirus case numbers and hospitalizations by California county.]

So is there a curfew?

Although earlier this week, Mr. Newsom said he and other state officials were looking at research into whether some kind of statewide curfew could be effective, there is no such curfew right now.

In Los Angeles, however, the county is requiring all restaurants, bar, wineries and nonessential stores to close from 10 p.m. to 6 a.m.

Last week, New York officials announced a similar step, requiring bars and restaurants to close at 10 p.m.

When do we have to wear masks?

The state updated its mask mandate recently to make it slightly more expansive. But for the most part, if youve been following it already you wont have to do anything different.

There are a few exceptions, but, basically, if youre inside somewhere thats not your home, and youre not eating or drinking (which probably wont be the case, given that indoor dining should be closed in most of the state), you should be wearing a mask.

If youre outside, but youre somewhere you may come within six feet of people, you should be wearing a mask. And if youre in a car with someone who doesnt live in your household, you should be wearing a mask.

(This article is part of the California Today newsletter. Sign up to get it delivered to your inbox.)

Read more:

A horrifying milestone: A quarter of a million people have died in the United States from Covid-19. [The New York Times]

Heres what happened at the French Laundry dinner. [The New York Times]

Orange County is set to provide 11,000 free at-home Covid testing kits to residents, first to communities that have been disproportionately impacted by the virus, and then to more residents as the tests become available. [The Orange County Register]

In her annual State of the District address, San Diego Unified School Districts superintendent released a proposed education plan calling for significant federal coronavirus aid for schools. [The San Diego Union-Tribune]

San Francisco has rejected the Warriors ambitious plan to bring more than 9,000 fans to games in the upcoming N.B.A. season at least for now. [The San Francisco Chronicle]

Newport Beach has canceled its famed annual Christmas boat parade to discourage people from gathering, although it was already set to be streamed online. [The Daily Pilot]

Share how youre celebrating Thanksgiving

This year, your Thanksgiving will be different. But if youre adapting your traditions, wed love for you to share what that means.

Are you sending pies in the mail? Watching your cousins deep fry a turkey over FaceTime? And why are these traditions meaningful to you?

Please tell us here.

In an interview, Representative Kevin McCarthy, the House minority leader, credited President Trump with bringing turnout that helped get Republicans elected. [The New York Times]

See more California election results, including in House races. [The New York Times]

The University of California, Berkeley, stripped the names of professors who were outspoken about their racist views from two buildings, LeConte Hall and Barrows Hall, following years of advocacy. [The Daily Californian]

Earlier this year, the name Boalt Hall was removed from the Berkeley Law School for a similar reason. [The New York Times]

An 800-mile firebreak once known as the Great Wall of California stands as an early lesson that wildfire prevention across the states vast forests is complicated, expensive and, often, unsuccessful. [The San Francisco Chronicle]

Octavia Butler has been rediscovered as a kind of prophet of our time. Her writing and her career were shaped by the libraries of Los Angeles. Take a tour of her city. [The Los Angeles Times]

California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.

Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles but she always wants to see more. Follow along here or on Twitter.

California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.

See the original post here:

Coronavirus in California: What Is the Purple Tier? - The New York Times

Half of people released early for coronavirus in Tulare County re-offended, says DA  KMPH Fox 26

See the original post:

Half of people released early for coronavirus in Tulare County re-offended, says DA - KMPH Fox 26

Several Republicans, including lawmakers who have had Covid-19, continue to resist wearing masks elsewhere in the Capitol, and a nasty spat broke out about the practice on Monday on the normally decorous Senate floor.

Late last week, House Democratic leaders abruptly transformed an elaborate dinner in Statuary Hall for their new members into a grab-and-go meal after facing a backlash online and internally for hosting such an event when most Americans are being warned to curtail or cancel holiday plans. And during orientation for new lawmakers which had already been largely subdued because of the virus Marjorie Taylor Greene, a QAnon-backing Republican, proudly announced in the middle of a discussion of pandemic safety that she had denounced face coverings.

It is a dynamic that bodes poorly for attendance in the waning days of the 116th Congress. On Tuesday, the absence of Mr. Grassley and Mr. Scott temporarily stalled the confirmation of Judy Shelton, Mr. Trumps Fed nominee, after Republicans fell short of the support necessary to advance to a final vote.

Theres this kind of macho, Well, Im not afraid of Covid thing going on, said Senator Brian Schatz, Democrat of Hawaii, who has one of the longest congressional commutes and has instructed his entire staff to work remotely. We have to run the government thats our obligation. Our obligation is not to show that were personally unafraid, because we have to pass legislation to address this crisis, and were no good to anybody if were sick or quarantining.

The partisan divisions were further underscored by a tense exchange on Monday evening between Senator Sherrod Brown, Democrat of Ohio, and Senator Dan Sullivan, Republican of Alaska, while Mr. Sullivan was presiding over the chamber.

When Mr. Brown rose to speak, he asked Mr. Sullivan, whose mask was off and lying on the desk in front of him, to please wear a mask, in part to protect the staff members required to sit on the dais just below, at a distance closer than the six feet recommended for proper distancing.

I dont wear a mask when Im speaking, like most senators, shot back Mr. Sullivan, who wears a mask around the Capitol but removes it to speak on the floor. I dont need your instruction.

Go here to read the rest:

As Grassley Tests Positive for Coronavirus, Virus Threatens to Stall Work in Congress - The New York Times