The U.S. Hits the 9-Million Mark as Infections Keep Surging – The New York Times
October 31, 2020
Heres what you need to know:A drive-through testing site in El Paso this week. The virus has been surging there.Credit...Joel Angel Juarez for The New York Times
With daily reports of coronavirus cases in the United States surging to previously unseen heights, the country has crossed the threshold of nine million known infections since the pandemic began.
On Thursday, the U.S. set another record for new daily cases, more than 89,000, topping the record set last Friday when the country recorded 85,000. Its the equivalent of more than one new case every second.
There is no way to sugarcoat it: We are facing an urgent crisis, and there is an imminent risk to you, your family members, your friends, your neighbors, said Gov. Tony Evers of Wisconsin.
Over the past week, new cases in the United States have averaged more than 75,000 a day, and eight states reported daily records on Thursday. More total cases have been identified in the U.S. than in any other country, though some nations have had more cases in proportion to their populations.
In Wisconsin, more than 200 coronavirus deaths have been announced over the last week, and as case numbers explode, hospitals have been under increasing strain.
Wisconsin, home to eight of the countrys 15 metro areas with the highest rates of recent cases, was among the first states to lose control of the virus this fall. But the surge that started in the Upper Midwest and rural West has now spread far beyond, sending infection levels soaring in places as disparate as El Paso, Chicago and Rexburg, Idaho.
Idahos governor, Brad Little, this week imposed new restrictions on businesses and gatherings. Hospitals throughout the state are quickly filling up or are already full with Covid-19 patients and other patients, and way too many health care workers are out sick with Covid-19, Mr. Little said.
Twenty-one states added more cases in the seven-day period ending Wednesday than in any other seven-day stretch of the pandemic against a backdrop of a bitter presidential contest.
President Trump, in the closing days of his campaign, has assured voters that the virus is vanishing, brushing aside the devastation it has wrought and even mocking people who take precautions including measures his own health advisers recommend to slow the spread of the disease.
Daily reports of deaths from the virus remain far below their spring peaks, averaging around 780 a day. But those, too, have started to tick upward.
There are not many hopeful signs in the recent data.
Reports of new cases are increasing in 42 states. Northeastern states, including New Jersey and Rhode Island, are seeing infection numbers rise after months of stability. And in North Dakota, where more than 5 percent of the population has now tested positive the biggest share of any state reports of new cases continue to soar.
As the nation heads into what some public health experts warn could be a dark winter of coronavirus illness and death, a growing cadre is coalescing around Joseph R. Biden Jr.s call for a national mask mandate, even as they concede such an effort would require much more than the stroke of a presidential pen.
Over the past week, a string of prominent public health experts notably Dr. Anthony S. Fauci, the governments top infectious disease specialist, and Dr. Scott Gottlieb, a former commissioner of food and drugs under President Trump have said it is time to seriously consider a national mandate to curb the spread of the virus.
Overseas, President Vladimir V. Putin of Russia this week became the latest foreign leader to impose a national mandate for citizens to wear masks. Mr. Trump is opposed to a mandate, and Mr. Biden has conceded that a presidential order for all Americans to wear masks would almost certainly face and likely fall to a legal challenge.
Mr. Biden, who echoed warnings of a dark winter during the final presidential debate, is already using his bully pulpit to promote and reinforce a culture of mask wearing. If he is elected, he will almost certainly do more.
Mr. Biden has already said that, as president, he would mandate masks on all federal property, an executive order that could have wide reach. He could use his authority under federal transit law to require masks on public transportation. He could also prod governors who are resisting mask mandates to at least require masks in public buildings in their states.
But that is delicate political terrain in the United States, where Mr. Trump has turned the act of wearing a mask or not wearing one into a political statement. Public health and legal experts say it would be far better for Mr. Biden or Mr. Trump, for that matter to use his powers of persuasion to convince Americans that covering ones face to protect against disease is a patriotic or civic-minded action.
Instead of making it about the presidents coercive authority under law it should be about whether the president can support a norm that supports public health, which is in peoples self interest, said Harold Koh, a law professor at Yale University and an expert in national security and human rights.
Experts say the scientific evidence is growing that face masks can considerably reduce the transmission of respiratory viruses like the one that causes Covid-19. Even when mask wearing does not prevent infection, it can reduce the severity of disease by diminishing the intensity of a persons exposure to the virus. Research also shows that states that have passed mask mandates have had lower growth rates of Covid-19, beginning on the day the mandate was passed.
Even so, any hint of a sweeping federal requirement would go over like a lead balloon, and divide and harden areas of the country in opposition, said Joel White, a Republican strategist with expertise in health policy. Mr. White said the Trump administrations policy, of letting state and local leaders decide about masks, is a far better way to go.
But that has not produced the kind of compliance that public health experts say is necessary to reduce the spread of the virus. As of last week, 33 states and the District of Columbia required mask-wearing in public, according to a list compiled by AARP. But in certain parts of the country, especially heavily Republican states, resistance is deep even when cases are soaring.
In Belgium, all nonessential hospital work has been postponed to deal with an influx of new Covid-19 patients, whose numbers have nearly doubled in the past week, matching levels seen in the first wave of the pandemic in the spring.
Croatia has asked former doctors to come out of retirement to help in hospitals, while National Guard troops have flown from the United States to the Czech Republic to assist overwhelmed health care professionals there.
In the Netherlands, new coronavirus patients have had to be transferred by helicopter to Germany to relieve Dutch intensive-care units.
Across Europe, hospitals are filling up at an alarming pace that harks back to the darkest hours of the first wave of the pandemic in the spring. The authorities are scrambling to slow the spread of a virus that threatens to bring ailing health care systems to the brink of collapse.
Worldwide, more than 500,000 cases were tallied on Wednesday, a record since the start of the pandemic. All 20 countries with the highest rates of new cases over the last week are in Europe. Britain, France, Italy and Spain were among the countries that recorded their highest death tolls in months.
In announcing a new nationwide lockdown in France on Wednesday, President Emmanuel Macron predicted that the second wave of the virus would be more deadly than the first.
In France, one million people are currently estimated to be infected with the coronavirus, and 2,000 new patients are hospitalized every day, according to government data, the highest numbers in the country since mid-April. Doctors have warned that hospitals wont hold in the winter if the virus cant be stemmed, and Mr. Macron bluntly said on Wednesday that if France couldnt put the brakes on the pandemic, doctors would soon have to choose which Covid-19 patients to save.
In Germany, as hospitalizations have doubled in the past 10 days and nearly 1,500 patients are in intensive care, Chancellor Angela Merkel announced new lockdown measures on Wednesday as she vowed to avoid situations that are extremely difficult.
Exhausted health care workers and other epidemics, like the flu, that arrive in winter have led authorities to warn that the worst is yet to come. While in Western Europe, the fear of overwhelmed hospitals brought a feeling of dj-vu from the first wave in the spring, countries in Central and Eastern Europe, which escaped the first wave relatively unscathed, have faced a frighteningly new situation.
Countries like the Czech Republic and Poland imposed tough restrictions in the spring and saw lower infections rates, but soaring cases this fall have laid bare a critical shortage of nurses, doctors, and intensive care beds. In Bulgaria, scores of health care professionals are falling ill with the virus, and an acclaimed doctor became the 19th medical professional there to die of the virus earlier this month. In the Czech Republic, where cases are rising at one of the fastest paces in Europe, Prime Minister Andrej Babis has warned that the countrys health care system could collapse before mid-November.
What happened was somehow predicted but nobody expected its scope, Mr. Babis said after declaring a second national lockdown.
U.S. ROUNDUP
The virus is spreading at a swift pace across Montana, one of the Great Plains and Mountain West states that have been reporting major surges in new virus cases. The state ranks fourth in the country for the number of new cases relative to its population about 70 cases per 100,000 residents based on a seven-day average, compared to about 23 per 100,000 nationwide, according to a Times database.
Residents in some parts of Montana are defying a state mask mandate in the name of individual rights. And hospitalizations are up significantly, according to the Covid Tracking Project, which reports a nearly 100 percent increase between Oct. 3 and Oct. 28. With the spike in cases, health care officials across the state have been bracing for a strain on the system.
Montana is having a moment, but not the kind of #MontanaMoment that the states tourism bureau promoted in 2018. The state website for tourism and business promotion has a new slogan, Montana Aware.
In some ways, the state offers a snapshot of America less than a week from Election Day: divided along political lines and struggling to contain daily case counts that are running higher than at any time since the pandemic began.
Though the state is heavily Republican, it has competitive races this year for governor and for Senate. And President Trump, who won the state by 20 points in 2016, has seen his lead dwindle to single digits over his opponent, Joseph R. Biden Jr., in recent polls.
A Montana State University poll released earlier this month found that Democratic and independent voters are more concerned about health issues and support preventive measures like wearing masks in public.
If you combine that with the dissatisfaction with the direction of the country, I would argue that this benefits Democratic candidates especially in a higher turnout election environment, said David C.W. Parker, one of the university professors who conducted the survey.
Gov. Steve Bullock, a Democrat now running for Senate, mandated that people wear face coverings in public spaces across the state to help slow the spread of the virus. But some local officials have defied the order, creating a patchwork of precautionary measures sometimes varying within a single block.
Mike Cooney, the Democratic candidate for governor, is pro-mask mandate and is most often seen publicly wearing a mask, while the Republican candidate, Greg Gianforte, was recently criticized for hugging supporters without wearing a mask after he attended a concert that has since been linked to new virus cases.
A recent report prepared for the White House urged more precautions for the state, which the federal government has categorized in the red zone for cases.
Given extent of transmission, Montana should limit bar and gym hours and urgently enforce face mask, occupancy restrictions, and social distancing policies in all counties, said the report, which was dated Oct. 25.
Elsewhere in the United States:
Mayor Martin J. Walsh of Boston said on Thursday that city employees would get one paid hour off every two weeks, during normal work shifts, to get tested for the virus. The move is part of a new campaign, called Get the Test Boston, intended to encourage testing. The share of coronavirus tests coming back positive in Boston increased to 7.8 percent, from 6.2 percent a week earlier.
For a month beginning in November, United Airlines will test passengers over the age of 2 for the coronavirus before they board certain flights at Newark Liberty International Airport bound for Heathrow Airport in London. The trial program is intended to help persuade government officials that testing could be a crucial part of reopening international travel. Passengers will have to test negative to board the flights. Anyone who tests positive will be isolated and asked to get in touch with their health care provider, and the airline will help them rebook a flight for a later date.
A ninth-grade student who received a false negative result to a required coronavirus test triggered a super-spreading event that infected three-quarters of the 152 students, counselors and staff who attended a faith-based overnight summer school retreat in Wisconsin in July and August.
The illnesses were mild, and none required hospitalization, according to a description of the outbreak in a new report from the Centers for Disease Control and Prevention that was released on Thursday. The report did not identify the religious organization that sponsored the retreat, or say where in Wisconsin it took place.
The people who attended the boys retreat came from 21 states and territories and two foreign countries. They were required to provide either documentation of a positive test result for antibodies to the coronavirus that causes Covid-19, within the past three months, or proof of a negative result to a diagnostic test taken within a week of departing for the retreat. They were also asked to quarantine within their households for a week before the trip, and told to wear masks while traveling.
Once they were at the retreat, however, only the teachers observed social distancing and wore masks during classes. The students and counselors were not required to do so, and mixed freely.
Classes were held outside but students were seated less than six feet apart, and they slept in dormitories, four to six in a room, and in yurts, with up to eight in a room. Counselors also roomed together in dormitories and yurts. Only the teachers resided in separate housing units.
The ninth grader who was the index patient, and who had tested negative, developed a sore throat, cough and chills two days after arriving, and soon found out that a family member had just tested positive. Although he was quickly isolated and 11 of his close contacts were briefly quarantined, the virus spread. Ultimately at least 116 people at the retreat tested positive for the virus.
Among those who tested negative for the virus were 24 attendees who had previously been exposed to the virus and had antibodies before arriving at the retreat. The C.D.C. report notes that evidence to date is insufficient to determine whether the presence of detectable antibodies indicates protective immunity, or how long such immunity might persist.
The four staff members also tested negative, although one did develop symptoms of the illness and was classified as a probable case.
In April, the coronavirus killed more than 10,000 people in New York City. By early May, nearly 50,000 nursing home residents and their caregivers across the United States had died.
But as the virus continued its rampage over the summer and fall, infecting nearly 8.5 million Americans, survival rates, even for seriously ill patients, appeared to be improving. At a New York hospital system where 30 percent of coronavirus patients died in March, the death rate had dropped to 3 percent by the end of June.
Doctors in England observed a similar trend. In late March, four in 10 people in intensive care were dying. said John M. Dennis, a University of Exeter Medical School researcher. By the end of June, survival was over 80 percent.
Though the virus has been changing slowly as it spreads, most scientists say there is no solid evidence that it has become either less virulent or more virulent.
As older people took greater precautions to avoid infection, however, more of the hospitalized patients were younger adults, who are generally healthier and more resilient. By the end of August, the average patient was under 40.
Were the lower death rates simply a function of the demographic changes, or a reflection of advances in treatment that blunted the impact of the new pathogen?
Researchers at NYU Langone Health zeroed in on this question, analyzing the outcomes of more than 5,000 patients hospitalized at the systems three hospitals from March through August. They concluded the improvement was real, not just the result of a younger patient pool.
Even when they controlled for differences in the patients age, sex, race, underlying health problems and severity of Covid symptoms like blood-oxygen levels at admission they found that death rates had dropped significantly, to 7.6 percent in August from 25.6 percent in March.
A combination of factors contributed to the improved outcomes of hospital patients, experts said. As clinicians gained more experience with the disease, they became better able to manage it, incorporating the use of steroid drugs and non-drug interventions.
Researchers have also credited heightened community awareness. Patients are seeking care earlier in the course of their illness. And outcomes may also have improved as the load on hospitals lightened and there was less pressure on the medical staff.
We dont have a magic bullet cure, but we have a lot, a lot of little things, that add up, said Dr. Leora Horwitz, director of NYU Langones Center for Healthcare Innovation & Delivery Science. We understand better when people need to be on ventilators and when they dont, and what complications to watch for, like blood clots and kidney failure.
Once doctors became aware of the clotting risk, they began to quickly put patients on blood thinners when necessary.
Another problem in the spring was that as hospitals in hard-hit areas like New York City became overwhelmed, doctors who hadnt worked in critical care for many years were being drafted to care for seriously ill patients. Nursing departments, meanwhile, were short-staffed, and equipment was in short supply.
Medical experts worry that the surges in cases around the country could roll back the improvements in mortality rates. The number of hospitalized Covid patients has increased by 40 percent over the last month, and more than 41,000 patients are now hospitalized in the United States.
The United States reached a milestone, of sorts, when last week the Food and Drug Administration approved the first treatment for Covid-19: Veklury, better known by its scientific name, remdesivir.
But the F.D.A.s decision to grant the drug full approval which means its manufacturer, Gilead Sciences, can begin marketing it broadly to doctors and patients has puzzled several outside experts. They say that it may not deserve the agencys stamp of approval because it is, at best, a mediocre treatment for the disease caused by the coronavirus.
One large, government-run trial found that the drug shortens patients recovery times, but the two other studies the F.D.A. used to justify its approval sponsored by Gilead did not compare the treatments with a placebo, the gold standard for evaluating a drug. No studies have shown that it significantly lowers death rates. And a large study sponsored by the World Health Organization found that remdesivir provided no benefit to hospitalized patients.
Experts have also questioned whether Gilead deserves to pocket potential billions from the drug when the government has played a significant role in its development. On Wednesday, the company said that remdesivir, which has been authorized for emergency use since the spring, had brought in $873 million in revenue so far this year.
The F.D.A. doesnt exist to give monetary prizes to drug companies, said Dr. Peter B. Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. The F.D.A. exists to help inform doctors as to what drugs they should give patients in front of them today.
A health care worker in Solano County, Calif., is recovering after being simultaneously infected with both influenza and the coronavirus.
Citing patient confidentiality, health officials disclosed few details about the patient, including age or gender. They said the patient was between the ages of 20 and 65, works in the health care industry and has no other co-morbidities.
It is unclear whether this is the first case of influenza and coronavirus co-infection in the United States this flu season, but it may well not be the last, given the arrival of flu season in the midst of a raging pandemic. Health officials have warned that the nation might be confronted with what some call a twindemic.
Solano County, which sits roughly between Sacramento and the Bay Area, was also the site of the countrys first reported case of coronavirus transmitted through community infection. That occurs when someone is infected despite having had no known contact with anyone else who was infected or who had traveled overseas.
Dr. Bela T. Matyas, Solano Countys health officer, had been keeping in close contact with all health care and residential facilities in Solano County to spot possible outbreaks, and was able to quickly verify the community infection case when it happened in February. Then, in mid-October, Dr. Matyas directed that all people who show flulike symptoms in the county be tested for both influenza and the coronavirus.
The very same people who are at risk of a bad outcome for Covid are also the ones at risk of a bad outcome from flu, Dr. Matyas said in an interview. And having them at the same time, or one right after the other, greatly increases the likelihood of a severe outcome.
For Solano County, the case reported Thursday was not just the first known co-infection. It was also the first confirmed flu infection this season.
The whole point of this is to remind our community that flu is now present and people really need to get vaccinated for flu as quickly as possible, especially those people who are 65 and over, or who have underlying health conditions, Dr. Matyas said.
The patient became infected through contacts with friends and family members, not at work, according to Dr. Matyas. The patient began having symptoms last week, he said, tested positive over the weekend, and is now recovering in isolation.
In our county, over the past four months, over 95 percent of the cases where we are able to identify a source have been exposed when they let their guard down during family and social gatherings, Dr. Matyas said. People wrongly assume that family and friends are safe, and so they dont do social distancing with them, but thats where most of the spread is occurring.
transcript
transcript
I feel very confident that Joe Biden will be elected president on Tuesday, whatever the end count is. But on the election that occurs on Tuesday, he will be elected. On Jan. 20, he will be inaugurated president of the United States. So while we dont want to be overconfident or assume anything, we have to be ready for how we are going to go down a different path. Weve come to a fork in the road when it comes to the coronavirus. The president has taken us on a deadly path. The Heroes Act takes us on a scientific path to help save the lives, the livelihood and the lives of the American people. This weekend should be very interesting to see how many more people will vote in advance. I hope that people will not depend on the mail because they have done all they can to dismantle the postal system. But I salute our postal workers, our letter carriers and those who are making the best of the situation. But even the Postal Service is saying its too late now to mail. Well I want, I want a bill for two reasons. First and foremost, the American people need help, they need real help. And second of all, we have plenty work to do in the Joe Biden administration. Were going to build the infrastructure of America in a green way.
Speaker Nancy Pelosi said on Thursday that she wanted to reach a deal on an economic relief bill during Congresss lame-duck session after the election to clear the decks for a Joseph R. Biden Jr. presidency, expressing optimism that a deal could be done despite months of faltering negotiations.
I want a bill for two reasons, Ms. Pelosi, a California Democrat, said at her last news conference before the election on Tuesday. First and foremost, the American people need help, they need real help. Second of all, we have plenty to do in a Joe Biden administration.
Hours earlier, she had written to Treasury Secretary Steven Mnuchin, requesting a response to key differences in the stumbling relief talks as small businesses continue to struggle and millions of Americans remain out of work because of the coronavirus pandemic.
Your responses are critical for our negotiations to continue, Ms. Pelosi told Mr. Mnuchin.
On Thursday afternoon, Mr. Mnuchin shot back with a letter of his own to Ms. Pelosi, accusing her of a political stunt.
I woke up this morning and read your letter to me in the press, Mr. Mnuchin wrote. Because you sent it to my office at midnight and simultaneously released it to the press, I can unfortunately conclude that it is a political stunt.
Mr. Mnuchin noted that he had spoken to Ms. Pelosi almost daily for the last 45 days and accused her of mischaracterizing the status of their negotiations.
The list of unresolved issues include Democrats demand for aid to state and local governments, the amount of funding for schools and child care, and the terms of a national coronavirus testing plan that Ms. Pelosi has long sought.
Despite Ms. Pelosis wishes, lawmakers and the administration are unlikely to be able to reconcile their differences quickly, particularly given widespread concern among conservatives on Capitol Hill about the scope and size of the package.
Ms. Pelosi, however, has continued to insist that Mr. Mnuchin, the lead negotiator for the White House, agree to final language on a number of issues and respond to Democratic demands.
Ms. Pelosi said Mr. Mnuchin had yet to agree to final testing language, despite his declaration this month that well fundamentally agree with their testing language.
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The U.S. Hits the 9-Million Mark as Infections Keep Surging - The New York Times
