As Virus Hits Rural U.S., Numbers May Be Small, but the Impact Is Not – The New York Times
October 18, 2020
Heres what you need to know:A coronavirus warning sign at a Republican campaign rally in Belgrade, Mont., last month.Credit...Tommy Martino/Associated Press
The spread of the coronavirus in the United States in recent weeks has been worse than it seems, not because of how it has been spreading but where.
The virus has been pummeling some of the least populous states in the country, but the relatively low numbers can be deceptive. The surges in rural areas have been just as severe as the spikes in densely populated cities in the Sun Belt over the summer.
North Dakota, South Dakota and Montana, for example, have announced the countrys highest number of cases on a per capita basis. Already, the North Dakota and South Dakota numbers exceed the per capita figures seen at the peak of summer surges in the Sun Belt.
Other states with large rural areas including Wyoming, Idaho, West Virginia, Nebraska, Iowa, Utah, Alaska and Oklahoma have recently recorded more cases in a seven-day stretch than in any other week of the pandemic.
We, as North Dakotans, find ourselves in the middle of a regional Covid storm, Gov. Doug Burgum said Wednesday.
But population can skew perspective.
Wessington Springs, S.D., or Shelby, Mont., are unlikely to produce the same alarming imagery amid a pandemic as New York City or Houston, where mobile morgues and packed E.R. hallways became icons of suffering.
In the last seven days, Florida had the highest number of virus-related deaths in the nation, 764. But the state has more than 21 million residents.
North Dakota had only 78 deaths but it has a population of 762,000.
Governor Burgum warned of additional adversity and perhaps deadlier outcomes after months of watching from afar as other places faced large outbreaks.
And, he said, were doing this at a time when perhaps our citizens and parents and many are fatigued at the stress of managing this for so long.
It is hardly just the countrys less populated regions that have health experts worried. Numbers are up across the country, and around the world.
I dont know why anybody would think its not so bad, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and an expert on contagious diseases. We went to a low of around 35,000 cases per day late in the summer. Now were up to over 50,000, with those numbers climbing every day. Nationally, its going back up, and Im really worried that were seeing a big increase.
But the pattern appears to be shifting.
In the more populous states where case increases are being seen, including Wisconsin and Illinois, the worst numbers are not coming from the largest population centers.
In Wisconsin, rural counties in the states northeast, as well as midsize metropolitan areas like Oshkosh, Appleton and Sheboygan, are reporting the most discouraging data. In Illinois, cases are rising around Chicago, but the per capita figures are much worse around the far-smaller cities of Rockford and Decatur, as well as in rural counties in the states south.
The weekly number of new coronavirus cases in Europe is now at its highest point since the start of the pandemic, a top World Health Organization official said on Thursday, urging governments to impose tighter, targeted controls on social gatherings.
The number of confirmed cases in Europe rose by a million to seven million in just 10 days, Hans Kluge, the WH.O.s director for Europe, told reporters, and the number of daily deaths had passed the level of 1,000 for the first time in months. (An earlier version of this item stated incorrectly the last time daily deaths in Europe had passed 1,000; it was earlier this year, not ever.)
His warning came as Britain announced tightened restrictions on several areas, including London, where people from different households will be barred from meeting indoors starting after midnight on Friday. People will also be discouraged from using public transportation.
The new measures will also apply to the city of York, in northern England, as well as to parts of central and southeastern England.
Many European countries are adopting stricter controls, which Dr. Kluge called absolutely necessary, as increased caseloads are raising fears of another surge as winter approaches.
On Wednesday, President Emmanuel Macron of France announced that, starting on Saturday, the authorities would impose a curfew from 9 p.m. to 6 a.m. in the Paris region and around eight other major cities. The curfews will run for at least four weeks.
The measure is part of a renewed state of emergency that allows the national government to restrict public gatherings and movement countrywide. It was first declared in the spring but had ended in July.
We need this and if we dont want to take harsher measures in 15 days, or three weeks, or one month, we have to do it and comply with it, Mr. Macron said.
In Germany, Chancellor Angela Merkel and state governors have also agreed to nationwide restrictions on social gatherings and domestic travel, in response to a rise in infections.
I am convinced that what we do and what we dont do in these coming days and weeks will be decisive in how we get through this pandemic, Ms. Merkel at a news conference on Wednesday.
Nick Saban, the University of Alabamas coach and one of the most powerful figures in college sports, said Wednesday that he had tested positive for the coronavirus.
Sabans announcement came as for the second time this week the Southeastern Conference postponed a game because of the coronavirus, unnerving fans and players less than a month into the season that sustains an economic and cultural juggernaut throughout the South.
During a news conference conducted over Zoom, Saban, seemingly alone and wearing a face mask around his neck, said he had been very surprised to learn he was infected. He was tested as part of Alabamas daily screening of its football program.
I personally think I did a really good job of trying to manage my personal space, Saban said. And that would be what Ive informed our players to try to do, because you have to respect this disease.
Saban said in a statement that he was asymptomatic and staying at his home in Tuscaloosa. Alabamas athletic director, Greg Byrne, also tested positive, the university said.
Both immediately left the facility and went to their homes to self-isolate after receiving that information, Dr. Jimmy Robinson, Alabamas team doctor, and Jeff Allen, the football teams head athletic trainer, said in a statement. At this point in time, the positive tests are limited to those two individuals. All individuals who are considered high-risk contacts have been notified and will follow quarantine guidelines.
Saban, Alabamas coach since 2007, has won five national championships at Alabama and one at Louisiana State. He said that Steve Sarkisian, the offensive coordinator, would oversee game preparations at the football complex while he worked from home.
The second-ranked team is scheduled to play No. 3 Georgia on Saturday.
But the Southeastern Conference said Wednesday that Saturdays game between No. 10 Florida and Louisiana State, the reigning national champion, would not be played until at least Dec. 12, a week before the conference title game.
The postponement came two days after Floridas coach, Dan Mullen, described the football program as a model of safety during the pandemic and a day after the team paused football activities because of an increase in positive tests for the virus.
Floridas game against L.S.U., which was to be played in Gainesville, Fla., is the 29th Football Bowl Subdivision game since last August to be upended because of the pandemic.
The Big 12 Conference announced on Sunday that Baylor and Oklahoma State would not play this weekend because of an outbreak at Baylor. And on Monday, the conference postponed a game between Missouri and Vanderbilt after Vanderbilt concluded that once injuries, opt-outs and virus-related concerns were considered, it would not have enough scholarship players available to compete on Saturday.
Dr. Anthony S. Fauci, the nations leading infectious disease expert, took issue on Wednesday with President Trumps repeated claims that 100 million doses of coronavirus vaccine would be ready by the end of the year.
For a vaccine that is proven safe and effective, its not going to be 100 million doses, Dr. Fauci said in an interview streamed live with the CBS Evening News anchor and managing editor Norah ODonnell.
Dr. Fauci agreed that there may be millions of vaccine doses ready by January from the six companies now developing them in partnership with the federal government, but he stressed that they must each be vetted before they would be made available to the public. Right now, there are several vaccine candidates whose safety and effectiveness should be known by November or December, Dr. Fauci said.
He said he expected that there would be widespread distribution of a vaccine by the end of April. The federal governments goal is 700 million doses, he said.
Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, has had an increasingly contentious relationship with Mr. Trump as the pandemic has spread. During the interview with Ms. ODonnell, he made no secret of his concerns about Mr. Trumps continued campaign events, which tend to include many maskless participants.
When you have congregate settings and people are close to each other, and you dont have everyone wearing a mask, that is a risky situation, Dr. Fauci said. Even a partially open space, such as an airplane hanger, is not safe, according to Dr. Fauci.
He said he was pleased by Mr. Trumps recovery from the virus, but cautioned that others in the presidents position age 74 and overweight should not assume they would also do as well.
Such thinking, Dr. Fauci said, would be like watching someone drive 95 miles an hour without crashing and thinking, So, I can go ahead and speed and not get into an accident.
There are a lot of people his age and weight that did not do as well as the president did, Dr. Fauci said.
After receiving a heavy infusion of monoclonal antibodies to treat his bout of Covid-19, President Trump declared that he is immune to the virus that causes it and talked privately about wearing a Superman T-shirt under his dress shirt when he left the hospital.
Even as the president has exulted in his supposed imperviousness to the coronavirus that is resurging across parts of the country, he has delighted in portraying former Vice President Joseph R. Biden Jr. as vulnerable and cloistered, wearing masks every time you see him.
But if the president is in fact now immune to the virus, he may not remain so, scientists warn. His treatment may have prevented his body from making the antibodies necessary for long-term protection.
The experimental monoclonal antibodies Mr. Trump received were produced by the drug company Regeneron and will wane in a matter of weeks, as the synthetic molecules are known to do. Unless they are replenished, Mr. Trump may be left more susceptible to the virus than most patients who had Covid-19 and recovered, several experts warned.
Moreover, the steroid treatment the president received early in the course of his illness suppresses the bodys natural immune response, including its propensity to make antibodies of its own.
He may be not protected the second time around, especially because he didnt develop his own antibodies, said Akiko Iwasaki, an immunologist at Yale University.
Most people who are infected with the coronavirus produce antibodies that should protect them from a second infection. Its unclear how long this immunity lasts. Research into other coronaviruses suggests that it may be up to a year, experts have said.
As New York State continues to fight the apparent resurgence of the coronavirus in several hot spots, Gov. Andrew M. Cuomo threatened at one point on Wednesday to withhold state funds from local governments that do not successfully enforce shutdowns on schools and restrictions on gathering.
During a morning call with reporters, Mr. Cuomo specifically mentioned New York City and Orange and Rockland counties in the northern suburbs, including the town of Ramapo and village of Spring Valley, all of which have areas with the highest positivity rates in the state. Mr. Cuomo said he was frustrated by reports of continued gathering in those areas, including at schools and houses of worship, despite restrictions imposed by the state last week.
Hopefully that will motivate them, the governor said of local governments.
The governor did not provide details on what sources of funding could be withheld, or how much money could be denied to local governments, though he said the state could impound all funds. His office later said no withholding of funds was imminent, characterizing Mr. Cuomos comments as a warning. (Later in the day, he issued an executive order authorizing such moves.)
Still, a spokesman for Mayor Bill de Blasio of New York City criticized the governors comments, suggesting that such tactics were counterproductive.
What drives NYCs COVID response and enforcement is the threat of a second wave, not threats of federal or state funding cuts, the spokesman, Bill Neidhardt, said on Twitter.
The Rockland County executive, Ed Day, said in a statement that he generally supported the governors restrictions and that the county had taken steps to enforce them. But he singled out both Ramapo and Spring Valley, saying that those localities, which have a majority of the countys cases, flat out refuse to enforce the governors executive orders.
Mr. Cuomo also said that the state could withhold funds from both public and private schools that had already violated state orders, including those in red zones, or areas with the most severe restrictions, that had not closed as required. The schools would be notified in letters beginning on Wednesday, he said.
Statewide, the daily rate of positive test results was 1.1 percent, Mr. Cuomo said. But in the red zones, the positivity rate was at 6.29 percent, up from 4.13 the day before.
And hospitalizations in the state increased to 938, up 15 from the day prior, the governor said. The state has seen a sustained increase in hospitalizations over the last 10 days.
transcript
transcript
And what were seeing well go over the indicators in a little bit but were seeing, thankfully, is some leveling off, certainly in the city. Overall, some leveling off in the communities that have been most affected. So far, the overall picture is steady and that is good news. We need to see more progress obviously in the zones of greatest concern. We need to keep an eye on other neighborhoods, surrounding areas. Make sure that the situation is contained. But what were seeing overall, in terms of the city indicators, suggests that we are making some progress. And Ive said, this is a decisive week, truly decisive. We have to stop a second wave from hitting New York City. And we have the power to do it. Its really important to wear that mask regularly. If you go to work. If you go to a store, if you are any place with people you dont live with, wear that mask. It makes a huge difference its the simplest tool. Its made such a difference for the city. Especially with colder weather coming on, more indoor activity, that people cannot let the guard down need to keep that mask as a central part of our strategy. That plus social distancing plus testing will be the key to stopping this threat of a second wave and moving us forward.
In a news conference earlier on Wednesday, Mr. de Blasio said that the citys seven-day average positivity rate was at 1.46 percent. He also sounded an upbeat note on positivity rates in the red zones.
Leveling off is the right phrase, Mr. de Blasio said, without specifying positivity rates in the zones.
At his briefing, Mr. Cuomo also criticized a Sept. 25 birthday party on Long Island that left 37 people infected and 270 in quarantine. Steve Bellone, Suffolk Countys executive, said in a statement that there were 81 guests in attendance, well over the 50 currently permitted under state rules.
In an interview on Wednesday, Mr. Bellone said that there had been multiple complaints about health rule violations at the inn before the party. The owners of the inn, which has closed temporarily, will be fined $12,000, officials said Wednesday.
Decisions about whether to reopen schools in the United States this fall were driven more by politics and teachers unions than by scientific evidence about the risk of coronavirus infection, according to research by political scientists at Boston College and the University of North Texas.
Their working paper, which draws on a database of school reopening plans for more than 10,000 of the nations roughly 13,000 school districts, has not been peer reviewed. But its findings are in line with those of previous research on what has driven decisions about school reopenings during the pandemic.
The authors, Michael T. Hartney and Leslie K. Finger, evaluated the influence of different factors on a districts decision. They found that a school systems size and the share of the vote won there by Donald J. Trump in 2016 were by far the strongest predictors of whether schools opened in person far more so than the average daily rate of new coronavirus cases in the county where a district was located.
Independent public health experts argued that school districts should make decisions about reopening based on local data about the transmission of the virus, as well as schools ability to put in place safety measures like social distancing and adequate ventilation. But the decisions quickly took on a political bent, the authors said.
President Trumps demands that schools reopen and his insistence that the worst of the pandemic was behind the country were embraced by his followers, who pushed for schools to reopen, while hardening the conviction of some educators and parents that teaching in person was unsafe.
Senior White House officials put pressure this summer on the Centers for Disease Control and Prevention to play down the risks of sending children back to the classroom, frustrating public health experts.
At the same time, as caseloads began to climb again in some parts of the country, teachers unions increasingly sought to protect their members by opposing in-person instruction. As a result, most large districts started the year remotely.
There may not be a Democratic or Republican way to clean the streets, the papers authors wrote, but, according to our findings, there are two distinctly partisan approaches to reopening Americas schools.
More than seven months into the coronavirus pandemic, the rules and regulations that govern daily life in the United States continue to vary widely, forcing people to interpret a checkerboard map of mask requirements, restaurant occupancy restrictions and travel guidelines.
What a person can and cannot do go to a nightclub, throw a Halloween party, get a nose piercing largely depends on where that person lives.
Many residents of Florida are free to work out at indoor gyms, eat inside at restaurants and mingle in crowded bars. But a resident of Los Angeles County, Calif., can do none of those things.
Right now we really have 50 different experiments going on, said L. Scott Benson, a professor at the University of Utahs Division of Public Health.
Throughout the pandemic, discordant protocols across state lines have frustrated governors and public health officials trying to contain the spread of the coronavirus.
In March, Gov. Andy Beshear of Kentucky lamented that residents could hop the border into neighboring Tennessee and eat at indoor restaurants. Those types of variations continue today, and even exist within individual states.
Theyre realizing that, well, if bars across the river are open, you can always go over to the bar over there, said Robert D. Duval, a professor in West Virginia Universitys Department of Health Policy, Management and Leadership. He added that people have to understand that such behavior prolongs the need for the rules in the first place.
On Tuesday, Gov. Gary Herbert of Utah unveiled new rules that apply on a county-by-county basis depending on the rates of virus transmission. Under the restrictions, a resident of Wasatch County could attend a social gathering of 10 people or fewer, while a person in neighboring Duchesne County could attend a gathering with as many as 50 people.
Mr. Benson and other public health experts said a one-size-fits-all coronavirus response would be impractical. People in rural areas require different rules than those in dense, urban populations, they say.
With cases surging in Wisconsin, Gov. Tony Evers issued an order last week that would limit indoor dining at most bars and restaurants to 25 percent capacity. But that order was blocked on Wednesday by a county circuit judge over concerns that it disproportionately affected smaller businesses that would be unable to operate profitably under such tight restrictions.
This is a dangerous decision that leaves our state without a statewide effort to contain this virus, said Britt Cudaback, a representative for Mr. Evers. We will be challenging the decision, and in the meantime, we need Wisconsinites to stay home and help us prevent the spread of Covid-19.
This week, two high-profile, late-stage clinical trials Johnson & Johnsons test of a coronavirus vaccine and Eli Lillys study of a Covid-19 drug were put on pause because of possible safety concerns. Just a month earlier, AstraZenecas vaccine trial was paused after two volunteers became seriously ill.
Clinical trials experts said these delays were comforting, in a way: They show that the researchers were following proper safety procedures. But for now, details about the nature of the volunteers illnesses are scant. And although pauses of vaccine trials are not unusual, some experts said that pausing treatment trials like that of Eli Lillys antibody drug is rarer, and perhaps more worrisome.
That trial was testing the treatment on hospitalized patients a group that was already sick, and in which declines in health would not be surprising. So for a trial like that one to be paused, the safety concerns must have been significant, they said.
Ive done 50-plus monitoring committees, and its quite a rare thing to do, said Tim Friede, a biostatistician at University Medical Center Gottingen in Germany, referring to his role as a safety monitor for drug trials.
For now, the companies behind the trials arent saying much. In a statement in September, AstraZeneca said it had paused its trial to investigate a single event of an unexplained illness. But two vaccinated volunteers reportedly developed the same condition, an inflammation of the spinal cord called transverse myelitis.
Johnson & Johnson said that it was pausing its vaccine trial because of an unexplained illness. Eli Lillys trial of the antibody treatment was paused because of a so far undisclosed health difference between the group that received the drug and the group that received a placebo.
When people volunteer for a late-stage trial, known as Phase 3, they randomly get a treatment or a placebo, and neither they nor their doctor knows which one they received. In the weeks that follow, theyre carefully monitored. People in a vaccine trial may get a checkup each month and record any symptoms they experience in a journal. People who get a drug while theyre hospitalized may be given blood tests and medical exams.
Barron Trump, the presidents youngest son, tested positive for the coronavirus at one point, Melania Trump, the first lady, revealed on Wednesday, adding that he has since tested negative.
The White House had previously said that Barron Trump, 14, had tested negative for the virus. But Mrs. Trump said in a statement Wednesday that my fear came true when he was tested again and it came up positive.
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As Virus Hits Rural U.S., Numbers May Be Small, but the Impact Is Not - The New York Times