President-elect Biden announces coronavirus task force made up of physicians and health experts

Joe Biden Live Updates: President-Elect Talks Mask Wearing, Pandemic - The  New York Times

President-elect Joe Biden on Monday announced the members of his coronavirus task force, a group made up entirely of doctors and health experts, signaling his intent to seek a science-based approach to bring the raging pandemic under control.

Biden’s task force will have three co-chairs: Vivek H. Murthy, surgeon general during the Obama administration; David Kessler, Food and Drug Administration commissioner under Presidents George H.W. Bush and Bill Clinton; and Marcella Nunez-Smith, associate dean for health equity research at the Yale School of Medicine. Murthy and Kessler have briefed Biden for months on the pandemic.

Biden will inherit the worst crisis since the Great Depression, made more difficult by President Trump’s refusal to concede the election and commit to a peaceful transition of power. The Trump administration has not put forward national plans for testing, contact tracing and resolving shortages in personal protective equipment that hospitals and health-care facilities are experiencing again as the nation enters its third surge of the virus.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” Biden said in a statement. “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.”

The United States is recording more than 100,000 new coronavirus cases a day and, on many days, more than 1,000 deaths, a toll expected to worsen during the crucial 10-week stretch of the transition. It remains unclear whether Trump or his top aides will oversee and lead a robust response to the pandemic during the transition, which could further exacerbate the crisis Biden and Vice President-elect Kamala D. Harris inherit.

The 13-member task force also includes former Trump administration officials, including Rick Bright, former head of the Biomedical Advanced Research and Development Authority, who, after being demoted, spoke out against the administration’s approach to the pandemic. Luciana Borio, director for medical and biodefense preparedness on Trump’s National Security Council until 2019, is also on the panel.

The group includes several other prominent doctors:

· Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

· Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School who is a prolific author.

· Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

· Eric Goosby, global AIDS coordinator under President Barack Obama and professor of medicine at the University of California at San Francisco School of Medicine.

· Celine R. Gounder, clinical assistant professor of medicine and infectious diseases at New York University’s Grossman School of Medicine.

· Julie Morita, executive vice president of the Robert Wood Johnson Foundation, a philanthropy focused on health issues.

· Loyce Pace, president and executive director of the Global Health Council, a U.S.-based nonprofit organization dedicated to global health issues.

· Robert Rodriguez, professor of emergency medicine at the UCSF School of Medicine.

Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center, and Beth Cameron, director for global health security and biodefense on the White House National Security Council during the Obama administration, are serving as advisers to the transition task force.

Task force members will work with state and local officials to craft public health and economic policies to address the virus and racial and ethnic disparities, while also working to reopen schools and businesses, the transition team said in a news release.

While the makeup of the task force garnered widespread praise, Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said the group needs more geographic diversity.

“They are all from the Acela corridor or the [San Francisco] Bay Area,” he said. “Who is going to be the field marshal or the supreme allied commander who goes into middle of the country and get this done? The coasts are doing okay but the red states are being hammered and the deaths are going to be extraordinary. There needs to be a frank reckoning between leaders of the two parties, to say we cannot let this happen.”

Public health experts said Biden should use the transition to provide leadership as the pandemic continues through a deadly stretch and begin communicating a strong national message.

“Clearly from the election outcomes, half the country doesn’t believe we’re in a crisis,” said Kavita Patel, a fellow at the Brookings Institution who worked on health policy in the Obama administration. Biden and Harris “have an incredible platform that can be used for communication. The country needs clear daily briefings that we thought we’d get from the White House coronavirus task force. They have an incredible platform, if not an official platform.”

Biden plans to call Republican and Democratic governors to ask for their help in developing a consistent message from federal and state leaders, according to three Biden advisers who spoke on the condition of anonymity because they were not authorized to speak publicly about these matters. He will urge governors to adopt statewide mask mandates and to provide clear public health guidance to their constituents, including about social distancing and limiting large gatherings.

The task force will have subgroups that focus on issues related to the response, including testing, vaccine distribution and personal protective equipment, according to two people familiar with the plans who spoke on the condition of anonymity to reveal plans that were not yet public.

In his victory speech Saturday, Biden addressed challenges in bringing the pandemic under control.

We cannot repair the economy, restore our vitality or relish life’s most precious moments — hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us — until we get this virus under control,” Biden said. “That plan will be built on a bedrock of science. It will be constructed out of compassion, empathy and concern. I will spare no effort — or commitment — to turn this pandemic around.”

Yet the plans Biden laid out on the campaign trail are set to collide with political realities. That includes a deeply divided nation in which more than 71 million people voted for Trump and the possibility of having to navigate a Republican-controlled Senate disinclined to support a greater federal role in testing and contact tracing, among other responsibilities now left mostly to the states.

Biden’s most ambitious plans will require significant congressional funding. Senate Majority Leader Mitch McConnell (R-Ky.) has said he would like to pass new coronavirus relief measures during Congress’s lame-duck session, and Congress faces a Dec. 11 government funding deadline. Biden and his team are poised to begin engaging with congressional Democrats on their priorities.

Biden’s plans include dramatically expanding testing and building a U.S. public health jobs corps to have 100,000 Americans conduct contact tracing. They also include ramping up production of personal protective equipment and implementing a vaccine distribution plan.

Murthy, who served as the 19th U.S. surgeon general, is a physician whose nomination was stalled in the Senate for more than a year because of his view that gun violence is a public health issue. Three months into the Trump administration, he was replaced as “the nation’s doctor” with more than two years left on his four-year term.

In 2016, he wrote a landmark report on drug and alcohol addiction, which put that condition alongside smoking, AIDS and other public health crises that previous surgeons general addressed. The report called the addiction epidemic “a moral test for America.” Murthy’s office sent millions of letters to doctors asking for their help to combat the opioid crisis.

The son of immigrants from India, he earned medical and MBA degrees at Yale before joining the faculty at Harvard Medical School, where his research focused on vaccine development and the participation of women and minorities in clinical trials.

After leaving his post as surgeon general, he wrote a book on loneliness and social isolation, including their implications for health, that grew out of his conversations with people in clinical practice and as surgeon general.

Several public health officials celebrated Nunez-Smith’s leadership role on the task force. Her research focuses on promoting health and health-care equity in marginalized populations, according to her Yale biography. She has also studied discrimination that patients endure in the health-care system — expertise that many said was welcome in an epidemic that is disproportionately affecting people of color.

Kessler was FDA commissioner from 1990 to 1997, during the George H.W Bush and Clinton administrations. He is well-known for his attempts to regulate cigarettes — an effort that resulted in a loss in the Supreme Court, which ruled that the agency did not have the authority. That prompted Congress to pass a law, enacted in 2009, that explicitly gave the agency that power.

Kessler, a pediatrician and lawyer, worked at the FDA to accelerate AIDS treatments and on food and nutrition issues. He oversaw the FDA’s development of standardized nutrition labels and notably ordered the seizure of orange juice labeled “fresh” because it was made from concentrate. He has written several books on diet, mental illness and other topics, and has served as dean of the medical schools at Yale and UCSF.

Coronavirus cases exceed 100,000 in one day for the first time, even as the nation is split on the pandemic vs. the economy

https://www.washingtonpost.com/health/covid-19-cases-record-100000/2020/11/04/9733adcc-1ec8-11eb-b532-05c751cd5dc2_story.html

COVID-19 cases exceed 100,000 a day for the first time, even as the nation  is split on the pandemic versus the economy | The Seattle Times

The coronavirus pandemic reached a dire milestone Wednesday when the number of new U.S. infections topped 100,000 in one day for the first time, continuing a resurgence that showed no sign of slowing.

The pandemic is roaring across the Midwest and Plains states. Seven states set records for hospitalizations for covid-19, the disease caused by the virus. And Connecticut, Iowa, Maine, Michigan, Minnesota, Nebraska and North Dakota saw jumps of more than 45 percent in their seven-day rolling average of new infections, considered the best measure of the spread of the virus.

The record, 104,004 cases, was reached a day after the deeply divided nation went to the polls to choose between President Trump and Democratic nominee Joe Biden, an election widely seen as a choice between fully reopening the economy and aggressively quelling the outbreak.

Just as they split almost down the middle on the two candidates, voters broke into almost equal camps on how to address the pandemic that has killed more than 233,000 people and infected nearly 9.5 million people in the United States.

“It’s clear we’re heading into a period where we’re going to see increasing hospitalization and deaths in the U.S. And it worries me how little we’re doing about it,” said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration. “We know by now how fast this virus can move. You have to get ahead of it.”

After more than nine months of restrictions, some state leaders are hesitant to risk further pandemic fatigue, Frieden said.

But if case counts continue rising at the current rate and strong action isn’t taken, viral transmission may soon reach a point in some areas where nothing will stop the virus except another shutdown, he said.

“The numbers keep going up, and we’re only getting closer and closer to Thanksgiving and Christmas,” when some families are expected to congregate indoors and risk spreading the virus further, said Eleanor Murray, an assistant professor of epidemiology at Boston University. “For so many reasons, the next few weeks are going to be bad for us and good for covid.”

With Trump and his aides fighting to hold on to the White House, the federal response to the pandemic, which already leaves major responsibilities to the states, may be even more fractured, Murray said.

“Something that deeply worries me is either way this election goes, Trump will still be in charge the next few weeks, when cases are higher than they’ve ever been,” she said. “And he’s made clear there will be no top-down, coordinated action coming from the federal government.”

Despite months of surveys that clearly indicated strong voter disapproval of the president’s response to the pandemic could weigh heavily against his reelection effort, more voters chose the economy as the primary issue in casting their ballots, exit polling showed.

Even if Biden captures the White House, the results appear to signal that, for many people, covid-19 is not as daunting as the prospect of being unable to pay their bills or send their children to school.

“I got news for you, pal. Covid-19 is over. It’s done,” said Nick Arnone, owner of HLSM, a software company for the power sports industry in Plains, Pa. “We have therapeutics, so deaths are way down. We are very close to a vaccine. We’ve got to ride it out now.

About 35 percent of voters said the economy was the most important issue for them, while about 17 percent cited the pandemic and about 2 in 10 were motivated most by racial inequality.

At the same time, however, just over half the voters said it is more important to contain the virus, even if that hurts the economy, while slightly more than 4 in 10 said rebuilding the economy is most critical, even if that impairs work to quell the virus.

In El Paso, where the pandemic is surging, James Clark said he voted for Biden because of the uncontrolled outbreak.

Covid was the main reason . . . and the things he was saying specifically about it,” Clark said. “I mean there were some things Trump was doing well, too, but overall it was covid.”

Some analysts were surprised and concerned that voters appeared to view the decision before them as a choice between the virus and their livelihoods, rather than as intertwined problems that could be solved together.

“That was shocking to me, that Trump could convince so many people it was a choice between the economy and pandemic,” said Eric Topol, a cardiologist and head of the Scripps Research Translational Institute in San Diego. “I’m amazed the extent he pulled that off, because it’s so obviously a false dichotomy. There’s no way for the economy to thrive unless we get control of the pandemic.”

On the campaign trail, Biden warned voters of a “dark winter” and invoked empty chairs in homes where families grieved the death of a loved one. He suggested he would follow science and tighten restrictions in places where that was necessary.

Trump repeatedly declared that the country was “rounding the turn” on the pandemic and said a vaccine was almost ready to be distributed. “You know what we want? We want normal,” Trump said this past weekend in Butler, Pa.

The two political messages were consistent with the viewpoints of each candidate’s base, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.

Biden has much more support among urban voters and people of color who, until recently, have been hit harder by the pandemic. Trump’s base is more White and rural, constituencies that have been slammed by the virus only in recent weeks, as the number of infections soared in the Upper Midwest and Plains states, she said.

“Who’s more likely to know someone’s who’s died? People who are already more likely to be Democrats than Republicans,” Jamieson said. “The lived experience of the two constituencies, the base vote for each side, is different.”

In Florida, which Trump carried more easily than expected, Biden’s emphasis on the pandemic hampered grass-roots campaigning, said Susan MacManus, an emerita professor of political science at the University of South Florida. With Biden emphasizing social distancing, the Democratic campaign there followed his lead.

“The Republicans never let their foot off the pedal in terms of continuing to register [voters] and going door to door, all through the covid,” she said. “The Democrats, once covid hit, they made a conscious effort, not going door to door.”

Rep. Donna Shalala (D-Fla.), who appeared to be headed toward losing her seat to television newscaster Maria Elvira Salazar (R) in Miami, campaigned heavily on Trump’s response to the virus.

Stefan Baral, a physician and epidemiologist at Johns Hopkins School of Public Health, Wednesday faulted Democrats’ pandemic messaging, saying Biden did not adequately express empathy for the economic hardships caused by the pandemic-related shutdowns.

“This is a terrible virus. But empathy for all the folks who have lost their jobs and lost their opportunities and kids who are out of school — I just never felt that message of empathy come across at all,” Baral said.

When some people heard Biden talk about the dark winter ahead, they thought, “The first thing he’s going to do is close my business,” Baral said.

Voters also had to make up their minds amid a torrent of misinformation and purposeful distortion about the pandemic, said Matthew Seeger, a risk communication expert at Wayne State University in Michigan, who helped the CDC develop its past communications plans.

“The messaging around the pandemic has been deliberately confused and strategically manipulated to downplay its significance,” Seeger said. “You combine that with the fact that this is a slow-moving crisis with risk fatigue starting to settle in, and you can see why public perception is what it is.”

In Chandler, Ariz., a suburb southeast of Phoenix last week, Al Fandick said he considers the pandemic wildly overblown and masks largely pointless. Fandick, 53, who runs a transport company, said he found it absurd that he was required to wear a mask to enter a restaurant but could remove the face covering once he sat down.

“Having a face mask on while I walk into that restaurant, but then I can take that face mask off, that’s like having a peeing section in a pool,” Fandick said.

Aside from trips to visit people in the hospital, he never wore a mask until Maricopa County began mandating it for public spaces, a policy he vehemently opposes, he said.

“Don’t need the hassle,” he said.

On the other side of the gulf are those who see the accelerating pandemic and a possibly very deadly period ahead.

“It is demoralizing to feel like: Here we are in November. A third surge is not just underway, but has already surpassed past surges. And people still don’t understand what’s happening and what’s at stake,” said Murray of Boston University.

“We are in the middle of an emergency. We have cases higher than they have ever been since this pandemic started, and yet you will have people paying less attention than ever to covid,” Murray said. “We as a country are not in a place right now where it’s safe to do that.”

Top Trump adviser bluntly contradicts president on covid-19 threat, urging all-out response

https://www.washingtonpost.com/health/2020/11/02/deborah-birx-covid-trump/

“This is not about lockdowns. … It’s about an aggressive balanced approach that is not being implemented,” says internal White House report that challenges many of Trump’s pronouncements.

A top White House coronavirus adviser sounded alarms Monday about a new and deadly phase in the health crisis, pleading with top administration officials for “much more aggressive action,” even as President Trump continues to assure rallygoers that the nation is “rounding the turn” on the pandemic.

“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” said the Nov. 2 report from Deborah Birx, coordinator of the White House coronavirus task force. “This is not about lockdowns — it hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”

Birx’s internal report, shared with top White House and agency officials, contradicts Trump on numerous points: While the president holds large campaign events with hundreds of attendees, most without masks, she explicitly warns against them. While the president blames rising cases on more testing, she says testing is “flat or declining” in many areas where cases are rising. And while Trump says the country is “rounding the turn,” Birx notes that the country is entering its most dangerous period yet and will see more than 100,000 new cases a day this week.

Through a spokesperson, Birx did not respond to a request for comment.

Other health experts, including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, have warned of record surges in cases and hospitalizations as the United States records more than 9 million cases and 230,000 deaths.

“We’re in for a whole lot of hurt,” Fauci told The Washington Post late Friday, predicting a long and potentially deadly winter unless there’s an “abrupt change” — prompting Trump to suggest that he planned to fire the scientist after the election.

But Birx’s daily missives go further, revealing how much the administration’s internal reports are in direct conflict with Trump’s public pronouncements that downplay the seriousness of the threat and erroneously suggest that few people are dying. They also speak to the increasing desperation of health officials to spotlight the risks of a pandemic that is forecast to take thousands more lives as the weather worsens unless people change their behaviors. Some officials are also concerned about recouping their reputations in a post-Trump era.

The increasingly dire tone of Birx’s reports has gotten little traction, according to an administration official who works with her and spoke on the condition of anonymity to share sensitive information. “She feels like she’s being ignored,” the official said.

Birx’s message “has been urgent for weeks,” said another administration official, “as has the plea for the administration to ask the American people to use masks, avoid gatherings and socially distance, basically since it became apparent that we were heading into a third surge.”

The report hits hard on the worsening situation: “Cases are rapidly rising in nearly 30 percent of all USA counties, the highest number of county hotspots we have seen with this pandemic,” it said. “Half of the United States is in the red or orange zone for cases despite flat or declining testing.”

Sounding a similar theme to past reports, it calls for “much more aggressive action from messaging, to testing, to surging personnel around the country before the crisis point.”

What is “essential at this time point,” the report said, is “consistent messaging about uniform use of masks, physical distancing and hand washing with profound limitation on indoor gatherings especially with family and friends.”

It adds: “This is about empowerment Americans with the knowledge and data for decision-making to prevent community spread and save lives.”

The president appears unpersuaded by such messages, convinced by new medical adviser Scott Atlas, a neuroradiologist with no infectious-disease experience, that allowing healthy people to return to daily activities without restrictions will hasten herd immunity and bolster the economy, say some advisers who spoke on the condition of anonymity because they were not authorized to speak publicly.

Trump plans to hold a large indoor gathering for 300 to 400 guests at the White House on Tuesday to watch the election returns, only a few weeks after a White House event to announce his Supreme Court nominee Amy Coney Barrett became a superspreader event.

White House communications director Alyssa Farah disputed the report’s suggestion that the administration’s response has been inadequate to the crisis. She said the White House has “significantly increased” the U.S. national stockpile to ensure the country has sufficient personal protective equipment; bought 150 million coronavirus tests and distributed them to the most vulnerable populations, including nursing homes, assisted-living facilities and Native American tribal areas; and sent special teams to states and nursing homes with the most cases.

In addition, she said, the administration continues to work to “safely rush therapeutics” to the sick and develop vaccines. “We are working around-the-clock to safely treat the virus and ultimately defeat it,” Farah said.

Birx’s report goes to pains to dispute Trump’s false claims that coronavirus cases are increasing only because of increases in testing. Monday’s report notes that although testing is flat, a rising number of tests are positive, suggesting “community spread is much worse than is evident by current [measurements].”

An earlier, Oct. 17 report sounded the same theme: It cited increasing daily hospital admissions, rising fatalities and emergency room visits, and bluntly stated, “this is not due to increased testing but broad and ever-increasing community spread.”

That report added these words highlighted in bold: “There is an absolute necessity of the Administration to use this moment to ask the American people to wear masks, physical distance and avoid gatherings in both public and private spaces.” On that day, Trump held two large rallies, according to his public schedule, one in Michigan and one in Wisconsin.

Birx’s report goes to pains to dispute Trump’s false claims that coronavirus cases are increasing only because of increases in testing. Monday’s report notes that although testing is flat, a rising number of tests are positive, suggesting “community spread is much worse than is evident by current [measurements].”

An earlier, Oct. 17 report sounded the same theme: It cited increasing daily hospital admissions, rising fatalities and emergency room visits, and bluntly stated, “this is not due to increased testing but broad and ever-increasing community spread.”

That report added these words highlighted in bold: “There is an absolute necessity of the Administration to use this moment to ask the American people to wear masks, physical distance and avoid gatherings in both public and private spaces.” On that day, Trump held two large rallies, according to his public schedule, one in Michigan and one in Wisconsin.

Officials describe Birx as frustrated with Atlas’s growing influence. She has challenged his views in task force meetings, suggesting that reopening society without any restrictions would lead to thousands of deaths.

In recent weeks, Birx has crisscrossed the country, traveling to dozens of virus hot spots, where she has urged state and local officials to mandate masks, close bars and restaurants and encourage distancing.

Birx is said to be close to Vice President Pence, but he’s been on the road campaigning in recent weeks, taking his attention away from the coronavirus, according to a senior administration official who spoke on the condition of anonymity to share internal discussions.

Unlike Fauci, a highly regarded civil servant who Trump has criticized as a “Democrat,” Birx was chosen by the administration to helm the response and has been lavishly praised in the past by Trump.

Fauci said in his interview Friday that he and Birx lost the president’s ear as Trump worried increasingly about a sputtering economy and his reelection prospects.

“They needed to have a medical message that was essentially consistent with what they were saying, and one of the ways to say: ‘The outbreak is over. [Mitigation strategies are] really irrelevant because it doesn’t make any difference. All you need to do is prevent people from dying and protect people in places like the nursing homes,’ ” Fauci said.

How Are Americans Catching the Virus? Increasingly, ‘They Have No Idea’

How Are Americans Catching the Virus? Increasingly, 'They Have No Idea' -  The New York Times

New outbreaks used to be traced back to crowded factories and rowdy bars. But now, the virus is so widespread not even health officials are able to keep up.

When the coronavirus first erupted in Sioux Falls, S.D., in the spring, Mayor Paul TenHaken arrived at work each morning with a clear mission: Stop the outbreak at the pork plant. Hundreds of employees, chopping meat shoulder to shoulder, had gotten sick in what was then the largest virus cluster in the United States.

That outbreak was extinguished months ago, and these days, when he heads into City Hall, the situation is far more nebulous. The virus has spread all over town.

“You can swing a cat and hit someone who has got it,” said Mr. TenHaken, who had to reschedule his own meetings to Zoom this past week after his assistant tested positive for the virus.

As the coronavirus soars across the country, charting a single-day record of 99,155 new cases on Friday and surpassing nine million cases nationwide, tracing the path of the pandemic in the United States is no longer simply challenging. It has become nearly impossible.

Gone are the days when Americans could easily understand the virus by tracking rising case numbers back to discrete sources — the crowded factory, the troubled nursing home, the rowdy bar. Now, there are so many cases, in so many places, that many people are coming to a frightening conclusion: They have no idea where the virus is spreading.

“It’s just kind of everywhere,” said Crystal Watson, a senior scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, who estimated that tracing coronavirus cases becomes difficult once the virus spreads to more than 10 cases per 100,000 people.

  • The election. And its impact on you.

In some of the hardest-hit spots in the United States, the virus is spreading at 10 to 20 times that rate, and even health officials have all but given up trying to figure out who is giving the virus to whom.

There have been periods earlier in the pandemic when infections spread beyond large, well-understood clusters in prisons, business meetings and dinner parties, tearing through communities in ways that were nearly impossible to keep track of. But for the most part, that experience was isolated to hard-hit places like New York City in the spring and portions of the Sun Belt in the summer.

This time, the diffuse, chaotic spread is happening in many places at once. Infections are rising in 41 states, the country is recording an average of more than 79,000 new cases each day, and more Americans say they feel left to do their own lonely detective work.

“I was so careful,” said Denny Taylor, 45, who said he had taken exacting precautions — wearing a mask, getting groceries delivered — before he became the first in his family and among his co-workers to test positive for the virus. Lying in a hospital bed in Omaha this past week, he said he still had no idea where he caught it.

Uncovering the path of transmission from person to person, known as contact tracing, is seen as a key tool for containing the spread of the coronavirus. Within a day or two of testing positive, residents in many communities can expect to get a phone call from a trained contact tracer, who conducts a detailed interview before beginning the painstaking process of tracking down each new person who may have been exposed.

“We were pretty successful and we were very proud of how the case numbers went down,” said Dr. Sehyo Yune, who supervised a team of contact tracers in Massachusetts this spring. It was one of several strategies that helped tamp down earlier outbreaks in places like Massachusetts, New York and Washington, D.C.

But as cases skyrocket again in many states, many health officials have conceded that interviewing patients and dutifully calling each contact will not be enough to slow the outbreak. “Contact tracing is not going to save us,” said Dr. Ogechika Alozie, chief medical officer at Del Sol Medical Center in El Paso, where hospitalizations in the county have soared by more than 400 percent and officials issued a new order for residents to stay at home.

The problem, of course, is that failing to fully track the virus makes it much harder to get a sense of where the virus is flourishing, and how to get ahead of new outbreaks. But once an area spins out of control, trying to trace back each chain of transmission can feel like scooping cupfuls of water from a flood.

In some places, overwhelmed health officials have abandoned any pretense of keeping up.

In North Dakota, state officials announced they could no longer have one-on-one conversations with everyone who may have been exposed. Aside from situations involving schools and health care facilities, people who test positive were advised to notify their own contacts, leaving residents largely on their own to follow the trail of the outbreak.

In Philadelphia, where cases recently spiked to more than 300 per day, city officials acknowledged that they now must leave some cases untracked. Most people, they said, are catching the virus through family and friends.

“We weren’t supposed to get to this point,” said Dr. Arnold S. Monto, a professor of epidemiology at the University of Michigan, who said the process of tracking cases and notifying people who may have been exposed is a gold standard of disease prevention but impractical after a certain level of infection.

“If you have five clusters going on at the same time,” he said, “it’s hard to say where it came from.”

When a first major outbreak hit Grand Forks, N.D., in April, the problem was clear: More than 150 employees of a wind turbine blade factory were infected. The factory shut its doors for several weeks, and public health officials tested and contact traced each case.

For the rest of the summer, Grand Forks, a college town of 56,000 on the border with Minnesota, saw almost no new infections. An uptick in August was quickly tied to students at the University of North Dakota and largely contained.

Now, though, any sense of control has vanished. Active cases of Covid-19 have quadrupled since the beginning of October to 912 in Grand Forks County, and about half the people contacted by the health department say they are not sure how they became infected.

“People are realizing that you can get it anywhere,” said Kailee Leingang, a 21-year-old nursing student who also works as a state contact tracer in Grand Forks. Even Ms. Leingang has fallen ill, along with several of her colleagues. She traces her case to her parents, who first started showing symptoms. Beyond that, the trail goes cold.

“They have no idea,” she said of where her parents came in contact with the virus.

Ms. Leingang, isolating at her home with her cat, feels sicker by the day. Dishes have piled up in the sink — she is too weak to stand long enough to wash them. But she is still working, calling at least 50 people a day to notify them that their tests came back positive, though her job is no longer to track who else they may have infected. “With the high number of cases right now,” she said, “our team can’t afford to have somebody not work.”

In earlier, quieter periods of the pandemic, the virus spread with some degree of certainty. In all but the hardest-hit cities, people could ask a common question — “Where did you get it?” — and often find tangible answers.

A popular college bar in East Lansing, Mich., Harper’s Restaurant and Brewpub, became a hot spot this summer after dozens of people piled into the bar, drinking, dancing and crowding close together. At least 192 people — 146 people at the bar and 46 people with ties to those at the bar — were infected. Afterward, Gov. Gretchen Whitmer shut down indoor dining in bars in parts of the state.

In Ingham County, which includes much of East Lansing, it is far harder to tell where the virus is spreading now. Of the county’s 4,700 reported cases over the course of the pandemic, more than 2,700 have come since the beginning of September.

Much of the new spread may be tied to students at Michigan State University, where students are living off campus and taking classes online. But every day, employers and residents call the Health Department to report random cases that defy easy explanation.

“It’s just a hodgepodge,” said Linda Vail, the Ingham County health officer.

Heidi Stevens is among the newly infected who considers her case a mystery. As a columnist at The Chicago Tribune, Ms. Stevens works from home. Her children attend school online. She wears a mask when she goes for a run, and she has not had a haircut since January.

So when she got a precautionary test a few weeks ago, with the hopes of inviting friends over to have cake for her daughter’s 15th birthday, Ms. Stevens was shocked to learn she was positive.

“I would drive myself crazy if I tried to really nail it down,” said Ms. Stevens, 46, who was hospitalized for three days and still wakes up with headaches. Did she pick up an infected apple at the grocery store and somehow touch her eye? Should she have been wearing a face shield, in addition to her mask? The possibilities feel endless.

“It’s just out there,” she said.

The norms around science and politics are cracking

https://www.axios.com/science-politics-norms-cracking-f67bcff2-b399-44f4-8827-085573f5ae52.html

Illustration of a hand holding a cracked microscope slide containing the U.S. flag.

Crafting successful public health measures depends on the ability of top scientists to gather data and report their findings unrestricted to policymakers.

State of play: But concern has spiked among health experts and physicians over what they see as an assault on key science protections, particularly during a raging pandemic. And a move last week by President Trump, via an executive order, is triggering even more worries.

What’s happening: If implemented, the order creates a “Schedule F” class of federal employees who are policymakers from certain agencies who would no longer have protection against being easily fired— and would likely include some veteran civil service scientists who offer key guidance to Congress and the White House.

  • Those agencies might handle the order differently, and it is unclear how many positions could fall under Schedule F — but some say possibly thousands.
  • “This much-needed reform will increase accountability in essential policymaking positions within the government,” OMB director Russ Vought tells Axios in a statement.

What they’re saying: Several medical associations, including the Infectious Diseases Society of America, strongly condemned the action, and Democrats on the House oversight panel demanded the administration “immediately cease” implementation.

  • “If you take how it’s written at face value, it has the potential to turn every government employee into a political appointee, who can be hired and fired at the whim of a political appointee or even the president,” says University of Colorado Boulder’s Roger Pielke Jr.
  • Protections for members of civil service allow them to argue for evidence-based decision-making and enable them to provide the best advice, says CRDF Global’s Julie Fischer, adding that “federal decision-makers really need access to that expertise — quickly and ideally in house.”

Between the lines: Politics plays some role in science, via funding, policymaking and national security issues.

  • The public health system is a mix of agency leaders who are political appointees, like HHS Secretary Alex Azar, and career civil servants not dependent on the president’s approval, like NIAID director Anthony Fauci.
  • “Public health is inherently political because it has to do with controlling the way human beings move around,” says University of Pennsylvania’s Jonathan Moreno.

Yes, but: The norm is to have a robust discussion — and what has been happening under the Trump administration is not the norm, some say.

  • “Schedule F is just remarkable,” Pielke says. “It’s not like political appointees editing a report, [who are] working within the system to kind of subvert the system. This is an effort to completely redefine the system.”
  • The Center for Strategic and International Studies’ Stephen Morrison says that the administration has been defying normative practices, including statements denigrating scientists, the CDC and FDA.

The big picture: Public trust in scientists,which tends to be high, is taking a hit, not only due to messaging from the administration but also from public confusion over changes in guidance, which vacillated over masks and other suggestions.

  • Public health institutions “need to have the trust of the American people. In order to have the trust of the American people, they can’t have their autonomy and their credibility compromised, and they have to have a voice,” Morrison says.
  • “If you deny CDC the ability to have briefings for the public, and you take away control over authoring their guidance, and you attack them and discredit them so public perceptions of them are negative, you are taking them out of the game and leaving the stage completely open for falsehoods,” he adds.
  • “All scientists don’t agree on all the evidence, every time. But what we do agree on is that there’s a process. We look at what we know, we decide what we can clearly recommend based on what we know, sometimes when we learn more, we change our recommendations, and that’s the scientific process,” Fischer says.

What’s next: The scientific community is going to need to be proactive on rebuilding public trust in how the scientific process works and being clear when guidance changes and why it has changed, Fischer says.

Cartoon – Caught Not Wearing a Face Mask

Granlund cartoon: Face coverings - Opinion - Daily Review Atlas - Monmouth,  IL

COVID response leads voters’ healthcare concerns

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

The upcoming election has huge implications for healthcare, far beyond how COVID is managed, ranging from how care is covered to how it’s delivered. The graphic above shows a continuum of potential policy outcomes of the November 3rd vote.

If President Trump wins a second term and Republicans control at least one house of Congress, there will likely be more attempts to dismantle the ACA, as well as continued privatization of Medicare coverage.

 If Democrats win the presidency and sweep Congress, actions to expand the Affordable Care Act (ACA), or even create a national public option, are on the table—although major healthcare reform seems unlikely to occur until the second half of a Biden term.

In the short term, we’d expect to see more policy activity in areas of bipartisan agreement, like improving price transparency, ending surprise billing and lowering the cost of prescription drugs, regardless of who lands in the White House.
 
While healthcare emerged as the most important issue for voters in the 2018 midterm elections, the COVID pandemic has overshadowed the broader healthcare reform platforms of both Presidential candidates heading into the election. As shown in the gray box, many Americans view the election as a referendum on the Trump administration’s COVID response. Managing the pandemic is one of the most important issues for voters, especially Democrats, who now rank the issue above reducing the cost of healthcare or lowering the cost of drugs. 

In many aspects, the COVID policies of Biden and Trump are almost diametrically opposed, especially concerning the role of the federal government in organizing the nation’s pandemic response.

The next administration’s actions to prevent future COVID-19 surges, ensure safe a return to work and school, accelerate therapies, and coordinate vaccine delivery will remain the most important aspect of healthcare policy well into 2021.

Experts Slam The White House’s ‘Herd Immunity’ Plan

Experts warn Trump's misinformation about coronavirus is dangerous

The White House is reportedly embracing a herd-immunity approach focused on “protecting the elderly and the vulnerable” but experts are calling the plan dangerous, “unethical”, and equivalent to “mass murder”.

The news comes following a petition titled The Great Barrington Declaration, which argued against lockdowns and school and business closures and got almost 500,000 signatures – although some of them were fake.

“Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states, adding, “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

Essentially, herd immunity is when enough people are immune to a disease, like Covid-19, that the disease can’t be transmitted as easily and thus provides indirect protection.

It’s been rumoured that the government has been leaning towards this plan of action for some time now, although this is the first real admission.

In response to today’s news, experts around the world have been voicing their concerns.

And this isn’t the first time we’ve heard experts say herd immunity is not a good idea.

For example, the head of the World Health Organization said Monday that allowing the novel coronavirus to spread in an attempt to reach herd immunity was “simply unethical.”

Similarly, the National Institutes of Health (NIH) director Francis Collins also denounced herd immunity as a viable plan.

“What I worry about with this is it’s being presented as if it’s a major alternative view that’s held by large numbers of experts in the scientific community. That is not true. This is a fringe component of epidemiology. This is not mainstream science. It fits into the political views of certain parts of our confused political establishment,” he said in an interview.

Not to mention studies continue to show that Sweden’s attempts at herd immunity have failed and have resulted in a higher Covid-19 death toll than expected.

As more research comes out, scientists are starting to learn that Covid-19 immunity, even in those who were severely infected, can fade after a few weeks.

This is why we’ve seen cases of reinfection and why many experts are advising against a herd immunity plan.  

Currently less than 10% of the population in the U.S. are immune to Covid-19 but for herd immunity to be achieved most experts estimate between 40% to 80% of the population would need to be infected.

To put that into context, that means around 197 million people would need to be infected in America. And assuming that the Covid-19 fatality rate is somewhere between 0.5% and 1%, based on numbers from the World Health Organization (WHO), more than 1 million people would die – at minimum.

William Haseltine, Chair and President of ACCESS Health International, told CNN “herd immunity is another word for mass murder. We are looking at two to six million Americans dead – not just this year but every year.”  

This is an unmitigated disaster for our country – to have people at the highest levels of our government countermanding our best public health officials. We know this epidemic can be put under control. Other countries have done it. We are doing the opposite.”

Shapes of Recovery: When Will the Global Economy Bounce Back?

Shapes of Recovery: When Will the Global Economy Bounce Back?

Visual Capitalist on Twitter: "Shapes of Recovery: When Will the Global  Economy Bounce Back? 📉📈 Full infographic and post:  https://t.co/40ABIBUFCx… "

The Shape of Economic Recovery, According to CEOs

Is the glass half full, or half empty?

Whenever the economy is put through the ringer, levels of optimism and pessimism about its potential recovery can vary greatly. The current state mid-pandemic is no exception.

This graphic first details the various shapes that economic recovery can take, and what they mean. We then dive into which of the four scenarios are perceived the most likely to occur, based on predictions made by CEOs from around the world.

The ABCs of Economic Recovery

Economic recovery comes in four distinct shapes—L, U, W, and V. Here’s what each of these are characterized by, and how long they typically last.

  • L-shape
    This scenario exhibits a sharp decline in the economy, followed by a slow recovery period. It’s often punctuated by persistent unemployment, taking several years to recoup back to previous levels.
  • U-shape
    Also referred to as the “Nike Swoosh” recovery, in this scenario the economy stagnates for a few quarters and up to two years, before experiencing a relatively healthy rise back to its previous peak.
  • W-shape
    This scenario offers a tempting promise of recovery, dips back into a sharp decline, and then finally enters the full recovery period of up to two years. This is also known as a “double-dip recession“, similar to what was seen in the early 1980s.
  • V-shape
    In this best-case scenario, the sharp decline in the economy is quickly and immediately followed by a rapid recovery back to its previous peak in less than a year, bolstered especially by economic measures and strong consumer spending.

Another scenario not covered here is the Z-shape, defined by a boom after pent-up demand. However, it doesn’t quite make the cut for the present pandemic situation, as it’s considered even more optimistic than a V-shaped recovery.

Depending on who you ask, the sentiments about a post-pandemic recovery differ greatly. So which of these potential scenarios are we really dealing with?

How CEOs Think The Economy Could Recover

The think tank The Conference Board surveyed over 600 CEOs worldwide, to uncover how they feel about the likelihood of each recovery shape playing out in the near future.

The average CEO felt that economic recovery will follow a U-shaped trajectory (42%), eventually exhibiting a slow recovery coming out of Q3 of 2020—a moderately optimistic view.

However, geography seems to play a part in these CEO estimates of how rapidly things might revert back to “normal”. Over half of European CEOs (55%) project a U-shaped recovery, which is significantly higher than the global average. This could be because recent COVID-19 hotspots have mostly shifted to other areas outside of the continent, such as the U.S., India, and Brazil.

Here’s how responses vary by region:

Region L-shape U-shape W-shape V-shape
Global (N=606) 32% 42% 16% 11%
U.S. (N=103) 26% 42% 23% 9%
Europe (N=110) 29% 55% 12% 4%
China (N=122) 25% 43% 11% 21%
Japan (N=95) 49% 26% 23% 1%
Gulf Region (N=16) 57% 26% 17%

 

In the U.S. and Japan, 23% of CEOs expect a second contraction to occur, meaning that economic activity could undergo a W-shape recovery. Both countries have experienced quite the hit, but there are stark differences in their resultant unemployment rates—15% at its peak in the U.S., but a mere 2.6% in Japan.

In China, 21% of CEOs—or one in five—anticipate a quick, V-shaped recovery. This is the most optimistic outlook of any region, and with good reason. Although economic growth contracted by 6.8% in the first quarter, China has bounced back to a 3.2% growth rate in the second quarter.

Finally, Gulf Region CEOs feel the most pessimistic about potential economic recovery. In the face of an oil shock57% predict the economy will see an L-shaped recovery that could result in depression-style stagnation in years to come.

The Economic Recovery, According to Risk Analysts

At the end of the day, CEO opinions are all over the map on the potential shape of the economic recovery—and this variance likely stems from geography, cultural biases, and of course the status of their own individual countries and industries.

Despite this, portions of all cohorts saw some possibility of an extended and drawn-out recovery. Earlier in the year, risk analysts surveyed by the World Economic Forum had similar thoughts, projecting a prolonged recession as the top risk of the post-COVID fallout.

It remains to be seen whether this will ultimately indeed be the trajectory we’re in store for.

 

 

 

CDC pulls revised guidance on coronavirus from website

https://thehill.com/policy/healthcare/517387-cdc-says-revised-guidance-on-airborne-coronavirus-transmission-posted-in

National coronavirus updates: CDC provides detailed guidance on reopening -  ExpressNews.com

The Centers for Disease Control and Prevention (CDC) said Monday pulled revised guidance from its website that had said airborne transmission was thought to be the main way the coronavirus spreads, saying it was “posted in error.”

The sudden change came after the new guidance had been quietly posted on the CDC website on Friday.

“CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2 (the virus that causes COVID-19),” the CDC wrote. “Once this process has been completed, the update language will be posted.”

The CDC guidance on the coronavirus is now the same as it was before the revisions.

The change and the the reversal comes as the CDC comes under extensive scrutiny over whether decisions by and guidance from government scientists are being affected by politics.

Just last week, President Trump contradicted CDC Director Robert Redfield on the timing of a vaccine and the necessity of wearing masks. 

Public health experts were pleased with the updated guidance, saying evidence shows COVID-19 can be spread through the air and that the public should be made aware of that fact. 

The World Health Organization issued a warning in July, saying that coronavirus could be spread through people talking, singing and shouting after hundreds of scientists released a letter urging it to do so.

The CDC said the guidance posted Friday was a “draft version of proposed changes.”

It is not clear if that draft will eventually become the CDC’s guidance, or if it will go through additional changes.

CNN first reported the new guidance on Sunday.

The now-deleted guidance had noted that the coronavirus could spread through airborne particles when an infected person “coughs, sneezes, sings, talks or breaths.”

“There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet (for example, during choir practice, in restaurants, or in fitness classes),” the agency had written. “In general, indoor environments without good ventilation increase this risk.”

“These particles can be inhaled into the nose, mouth, airways, and lungs and cause infection,” the deleted guidance said. “This is thought to be the main way the virus spreads.”