Dr. Fauci on COVID surge

Dr. Anthony Fauci, the nation’s top infectious disease expert, tells CBS Evening News anchor and managing editor Norah O’Donnell that Americans need to “double down” on mask-wearing and social distancing to help control a surge in new coronavirus cases.

He also spoke about President Trump’s recovery from COVID-19, progress towards a vaccine, and how the pandemic will affect this year’s holiday gatherings. Watch the full interview.

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.”

America’s newest wave of Covid-19 cases, explained

https://www.vox.com/coronavirus-covid19/2020/10/11/21511641/covid-19-us-cases-update-testing-deaths-hospitalizations

A new wave of Covid-19 cases is building across the United States, a harbinger of difficult winter months ahead.

America is now averaging nearly 48,000 new confirmed cases every day, the highest numbers since mid-August, according to the Covid Tracking Project. More than 34,500 Americans are currently hospitalized with Covid-19 in the US, up from less than 30,000 a week ago. Nearly 700 new deaths are being reported on average every day, too — and while that is down from August, when there were often more than 1,000 deaths a day, deaths are going to eventually start increasing if cases and hospitalizations continue to rise. It’s a pattern we have seen before.

Public health experts have been warning for months that fall and winter could lead to a spike in Covid-19 cases. Why? Because the best way to slow down the coronavirus’s spread is to keep your distance from other people and, if you are going to be around others, to be outside as much as possible — and both become harder when the weather gets cold.

We may now be seeing those predictions start to come true. The US already has more than 7.7 million confirmed cases and 214,000 deaths. Both numbers will continue to climb.

Eight months into the pandemic, America’s failures to contain Covid-19, and states’ eagerness to reopen even if they haven’t gotten their outbreaks under control, is once again leading to a surge in cases and hospitalizations.

Covid-19 cases are rising everywhere across the country

Earlier in the year, there was limited value to discussing “waves” because some states would have a decline in cases while other states were experiencing surges. What distinguishes this autumn wave is that it seems to be happening everywhere.

Case numbers are up in the Northeast, the Midwest, and the West. The South appears to be, at best, plateauing at a level even higher than that which the Northeast endured during the worst of New York’s outbreak.

What’s so worrisome is that no one state or region can be blamed for this new wave. Just 13 states have seen their number of new Covid-19 cases drop over the last two weeks, according to Covid Exit Strategy. Cases are up in all the others.

Raw case numbers can, of course, obscure important differences in population; 100 new cases means something different for California than it does for Wyoming. Experts will use another metric — new cases per million people — to gauge how saturated a given state is with Covid-19.

The goal would be to have fewer than 40 new cases per million people. But just three states — Maine, Vermont, and New Hampshire — meet that threshold. Meanwhile, North Dakota (627 cases per million), South Dakota (596), Montana (474), and Wisconsin (434) are some of the states seeing very high levels of new infections.

As Vox’s German Lopez reported this week, just one state — Maine — meets all of the benchmarks established by experts for a state to consider its Covid-19 outbreak contained. And yet, most states have reopened many of the businesses that were closed in the spring: 40 or so states have reopened restaurants, bars, gyms, movie theaters, and nonessential retail.

“Part of the problem is America never really suppressed its Covid-19 cases to begin with,” Lopez wrote, explaining why experts were anticipating a new surge in cases. “Think of a disease epidemic like a forest fire: It’s going to be really difficult to contain the virus when there are still flames raging in parts of the forest and small embers practically everywhere. The country always risks a full blaze with each step toward reopening and with each failure to take precautions seriously.”

Too many Covid-19 tests are coming back positive right now

Another closely watched indicator for renewed Covid-19 spread is the percentage of coronavirus tests that come back positive. The number of tests being conducted doesn’t actually tell you all that much; if a high percentage of them are positive, that suggests that many others aren’t being caught at all and the virus could continue to spread unchecked.

So while the US is now averaging nearly 1 million tests every day, that is not quite the triumph it might sound like (or President Donald Trump would like to believe it is). The country’s positive test rate is 5 percent, right at the threshold experts say would reflect adequate testing. Ideally, it would be even lower, 2 percent or less.

But even with that passable national positivity rate, most states are still not conducting nearly enough testing. Here are the 10 states with the highest positive test rates, according to Covid Exit Strategy:

  1. Idaho (25 percent)
  2. South Dakota (20.6 percent)
  3. Wisconsin (19.5 percent)
  4. Iowa (17.1 percent)
  5. Kansas (16.1 percent)
  6. Wyoming (15.5 percent)
  7. Utah (14.7 percent)
  8. Nevada (14.4 percent)
  9. Indiana (13.6 percent)
  10. Alabama (13.3 percent)

It’s really only a handful of better-performing states — namely, New York, with more than 115,000 tests conducted per day and a 1.2 percent positivity rate — that’s keeping the US’s overall positive test rate from looking a lot worse.

America has never had a cohesive Covid-19 testing strategy. Since February, there have been regular supply shortages delaying test results. States have been fighting each other for precious testing resources. Contact tracing has not been a priority for the federal government, and most states have still not hired nearly enough people to perform that work.

Wealthy countries like Germany and South Korea have used effective test-trace-isolate programs to keep their Covid-19 outbreaks in check. The US, meanwhile, is still struggling to perform enough tests or scale up its contact tracing capabilities. Just 11 states, plus the District of Columbia, could realistically expect to perform adequate contact tracing, according to Covid Exit Strategy, considering their positivity rate.

Without improvement in both of those areas, it will continue to be difficult for the US to contain the coronavirus before a vaccine becomes available.

More Americans are being hospitalized with Covid-19 too

Both case numbers and the positive test rate can be a little deceptive, depending on how many tests are being performed. They suggest what’s happening on the ground — in this case, Covid-19 is spreading — but they do have their limitations. There is some truth to the president’s claim that more tests will mean more cases, though that is not a reason to stop testing.

Hospitalizations, on the other hand, are more concrete. If more people are developing symptoms severe enough to warrant being hospitalized, that is a strong indicator that the real number of people being infected with Covid-19 is growing, regardless of whether they are getting tested.

And after a dip in September, the number of Americans currently in the hospital with Covid-19 is higher than it’s been in a month. That trend has been seen across the country.

The worry becomes that if hospitals take in too many patients, they’ll have to turn other people away, or that overwhelmed staff and facilities could lead to some patients receiving substandard care. According to Covid Exit Strategy, 20 states currently have reduced ICU capacity that puts them in a danger zone; 21 states have an elevated occupancy rate in their regular hospital beds.

Wisconsin, where the number of hospitalized Covid-19 patients has risen over the last month from about 300 to 876 today, recently established a new field hospital on its state park fairgrounds over fears that the state’s hospitals wouldn’t have enough beds given the recent surge in cases.

Fortunately, hospitals have gotten much better at treating Covid-19. They have proven treatments, like remdesivir and dexamethasone, that reduce the length of hospital stays and reduce mortality in patients with severe symptoms. They have learned techniques like putting patients on their stomach to improve breathing. Hospitals that have endured multiple spikes of Covid-19 cases report patients in the later waves are spending less time in the hospital and dying less frequently.

Nevertheless, more people developing severe symptoms, as we are starting to see, will inevitably lead to more deaths. Over the summer, people wondered why deaths were falling while cases and hospitalizations rose — until deaths did start to increase. There is a long lag between cases rising and deaths rising, because it can take a month or more between when a person first contracts Covid-19 and, if they die, when their death is reported.

That’s why these new Covid-19 trends in the US are so worrisome. Cases are rising, as are hospitalizations. It could be only a matter of time before deaths start to spike as well.

COVID-19 Goes Viral on College Campuses

COVID-19 Goes Viral on College Campuses

Freshman Sarah Anne Cook carries her belongings as she packs to leave the University of North Carolina at Chapel Hill, on August 18, because of a COVID-19 outbreak. All in-person undergraduate learning was canceled.

On August 10, students at the University of North Carolina at Chapel Hill (UNC) began the fall semester in person. Freshman Jasmine Baker was cautiously optimistic — as an incoming student in the Hussman School of Journalism, she was excited to experience college and get to know her suitemates. But she also worried that the university’s health and safety protocols would not prevent the spread of the coronavirus on campus.

She was right. Just one week after classes started, UNC announced that all undergraduate classes would move to remote learning for an indefinite period following a surge of COVID-19 cases. The case positivity rate on campus jumped from 2.8% to nearly 14%, Colleen Flaherty reported in Inside Higher Ed. After the second week, the positivity rate skyrocketed to 31%.

Baker, an out-of-state student, learned about the change in learning plans while attending an in-person class. “The email was very vague about housing,” she told Slate. “There were no specifics. Everyone kind of started freaking out. . . . We learned about it at the same time the professors did.” To top it off, she and a roommate soon tested positive for COVID-19. “We were all in such close quarters,” Baker said. “I know people that barely left their dorms, and they still ended up catching it.”

The situation at UNC is not unique.New York Times tracker has revealed at least 88,000 COVID-19 cases and 60 deaths at American colleges since the pandemic began. Photos and videos of students flouting public health guidelines at indoor parties or other gatherings have gone viral. Some university administrators have condemned the socializing as “reprehensible” and reprimanded students for “disrespectful, selfish, and dangerous” behavior.

Experts like Julia Marcus, PhD, MPH, an epidemiologist at Harvard Medical School, and Jessica Gold, MD, MS, a psychiatrist at Washington University, saw this coming from a mile away.Students will get infected, and universities will rebuke them for it; campuses will close, and students will be blamed for it,” they warned in the Atlantic over the summer. “Relying on the self-control of young adults, rather than deploying the public-health infrastructure needed to control a disease that spreads easily among people who live, eat, study, and socialize together, is not a safe reopening strategy.”

If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases. . . . I don’t know what colleges were expecting.

—UNC epidemiologist Whitney Robinson

As the Editorial Board of the Daily Tar Heel, UNC’s student newspaper, wrote one week into the semester, “Reports of parties throughout the weekend come as no surprise. Though these students are not faultless, it was the University’s responsibility to disincentivize such gatherings by reconsidering its plans to operate in person earlier on.” The local health department recommended that UNC implement remote learning for the first five weeks of the fall term, but administrators ignored that advice.

Lack of Guidelines for Safe Return

Throughout the summer, even as COVID-19 hot spots emerged across the country, President Donald Trump aggressively pushed for schools to reopen in person. Without federal guidance on how to do this safely, university administrators were left to cobble together their own plans for preventing coronavirus from spreading into the community.

“I don’t think there are two universities that have the same protocol,” Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University, told Politico. “It’s national chaos.

Universities have a strong financial incentive to reopen in person. Many are hoping to recover revenue from housing fees and out-of-state tuition payments that were lost when the pandemic forced them to suspend in-person classes in March. But as many universities have learned in recent weeks, reopening in person comes at a cost to the health of students, faculty members, and the surrounding community.

The New York Times reviewed 203 counties in which college students comprise at least 10% of the population and found that about half experienced their worst weeks of the pandemic after August 1, around the time students returned to campus. An analysis by USA Today revealed that communities with a significant college student population represent 19 of the 25 largest current coronavirus outbreaks in the US.

What has happened on campus hasn’t stayed on campus,” Shawn Hubler and Anemona Hartocollis wrote in the New York Times.

California Fares Better Than Other States

While California is not represented on USA Today’s list of big outbreaks, it is dealing with surges on some campuses. According to the New York Times campus tracker, there are nearly 2,600 coronavirus cases at 57 schools in California. (Because there is no national tracking system for coronavirus cases on college campuses, the New York Times is believed to have the most comprehensive count available.)

I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control.

—Boston University epidemiologist
Eleanor Murray

With 444 confirmed cases, San Diego State University tops the list among California schools, followed by the University of Southern California with 358 cases and UC San Diego with 237. By comparison, North Carolina has nearly 5,200 coronavirus cases at 42 schools, including 1,150 cases at UNC.

California’s relative success at mitigating the spread of COVID-19 on campus can be attributed in part to the conservative reopening plans of many schools. The California State University (CSU) system, California Community Colleges, and University of California (UC) schools moved nearly all fall classes online. UC Berkeley is fully remote for the fall semester. Stanford University planned to have half of its undergraduate students on campus during different quarters, but it switched to mostly remote learning as coronavirus cases continued to rise in the Bay Area over the summer.

Even a hybrid learning model, however, has failed to stave off new coronavirus cases on campuses. Chico State University and San Diego State University, both part of the CSU system, became the first and second California campuses to pause in-person classes after COVID-19 cases spiked, Ashley Smith reported for EdSource.

Resources are a factor in prevention efforts. Chico State’s health center doesn’t have coronavirus tests for students. San Diego State, which has more resources, has two coronavirus testing sites on campus. Across the CSU system, only 2 out of 23 campuses (CSU Maritime Academy and Humboldt State University) have tested all students living in dorms, according to CalMatters. The UC system, which has a budget roughly four times that of the CSU system, is testing all students living in dorms across all 10 campuses. (The UC system has restricted on-campus housing to students who have no alternative housing options.)

An Avoidable Situation

With the academic year off to a rocky start and students being sent home amid coronavirus outbreaks on campuses, experts across the country are nervously tracking the spread of the virus. “I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control,” Eleanor Murray, ScD, MPH, an epidemiologist at Boston University, told Ed Yong in the Atlantic.

COVID-19 surges on college campuses were preventable. “If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases,” Whitney Robinson, PhD, an epidemiologist at UNC, told Yong. “I don’t know what colleges were expecting.”

 

 

 

 

Battle over COVID-19 school openings goes to the courts

https://thehill.com/regulation/court-battles/514196-battle-over-covid-19-school-openings-goes-to-the-courts

Nearly 800 COVID-19 lawsuits have been filed, according to law firm's  tracker

Teachers unions are waging court fights across the country aimed at unwinding what they say are unsafe and politically motivated timetables for reopening schools that risk exposing personnel to the coronavirus pandemic.

State officials eager to ramp up brick-and-mortar operations are facing lawsuits from Florida to Texas to Iowa over reopening plans as well as access to the COVID-19 infection data needed to monitor the rate of spread within school communities. 

At the same time, lawsuits are flying from the opposition direction: Parents in several states, including New York, Massachusetts and Oregon, dissatisfied with web-based teaching alternatives, are suing to force state officials to reopen physical schools sooner as courts are increasingly called upon to referee the fight over education in the age of coronavirus.

“A legal storm is brewing as safety and social distancing requirements for a physical return to school begin to take shape around the country,” Maria Ferguson, executive director of the Center on Education Policy at George Washington University, wrote on the education website The 74.

As millions of students prepare for the first day of school — whether in-person, remote or a hybrid of the two — the fight over the reopening physical school buildings is likely to intensify.

The debate over in-person K-12 instruction planning is inseparably tied to the issues of child care needs and parents’ ability to return to the workforce to help revive the struggling economy, all of which is playing out against the backdrop of a fast-approaching November election in a country that has seen nearly 6 million cases and more than 181,000 deaths from COVID-19.

Perhaps the highest-profile legal battle is taking place in the courts of Florida, where Republican Gov. Ron DeSantis signed off last month on an emergency order over school reopenings.

Under the order, most Florida school districts would be required to hold in-person classes five days a week by the end of August or risk losing funding. President Trump, who counts DeSantis as a close ally, has also threatened to cut off federal funding for schools if they do not resume in-person learning this fall.

The Florida policy prompted a lawsuit from the Florida Education Association (FEA), a statewide teachers union, and several other plaintiffs in favor of a more cautious return to in-person teaching.

“Public schools are not designed for COVID safety, and indeed, the government has recognized that they are high-contact environments,” said Kendall Coffey, the lead plaintiff’s attorney in the Florida case, who likened prematurely opened schools to “disease factories” and called the Florida policy “financial bullying.”

There are any number of issues, in terms of hallway sizes, the flow of students in and out of classrooms, ventilation, even how many students go into the bathroom,” he told The Hill. “There are many elements that are virtually impossible to guarantee when you’re dealing with children in large amounts.”

On Aug. 24, a Florida judge ruled in favor of the union and temporarily halted the statewide order. In his decision, Judge Charles Dodson struck down the order’s unconstitutional provisions and blasted DeSantis for having “essentially ignored” the state’s constitutional requirement that schools be operated safely.

“The districts have no meaningful alternative,” wrote Dodson, of Leon County. “If an individual school district chooses safety, that is, delaying the start of schools until it individually determines it is safe to do so for its county, it risks losing state funding, even though every student is being taught.”

A Florida appeals court agreed to temporarily halt Judge Dodson’s order from taking effect while DeSantis appeals.

The state contends that the benefit of in-person instruction outweighs the health risks associated with reopening brick-and-mortar schools. Some Florida school officials have also declined to disclose incidents of positive COVID-19 cases to school communities, citing the need for patient privacy. 

Attorneys for Florida have also argued in hearings that courts should not substitute their judgment for that of policymakers who have balanced all the equities and decided a prompt in-person reopening is the best policy.

Randi Weingarten, president of the American Federation of Teachers (AFT), one of the largest teachers unions in the country, said Florida has its priorities backward.

“What their arguments show is that they don’t care about human life,” Weingarten told The Hill.

According to Weingarten, internal AFT polling in June showed that about 3 in 4 teachers said they would be comfortable returning to the classroom if guidelines from the Centers for Disease Control and Prevention (CDC) were implemented in schools.

But she predicts that attitudes among teachers have shifted dramatically in past months as the Trump administration has failed to adequately manage the virus to ensure schools can be reopened safely.

“We’re polling right now,” she said. “And my hunch is that just like the public polls, it’s totally flipped.”

The AFT is backing lawsuits in Florida, New Mexico and Texas. Before schools can reopen safely — for what Weingarten calls “the biggest move indoors that the nation has done since March” — the group says local positivity rates should be below 3 percent and schools should have visibility into daily transmission rates. 

The union is also pushing for protocols that involve testing, contact tracing and isolation and implement best practices from the CDC for things such as ventilation, cleaning, physical distancing, mask-wearing and other safeguards.

As teachers unions make their case in court, parents in at least five states have filed lawsuits of their own to accelerate school reopenings.

A nonprofit litigation group called the Center for American Liberty, co-founded by lawyer and GOP official Harmeet Dhillon, is backing one such suit in California. Democratic Gov. Gavin Newsom’s restrictions on in-person school openings in the Golden State will affect an estimated 80 percent of K-12 students.

“The effects of this ham-handed policy are as predictable as they are tragic,” the lawsuit filed in a federal court in California states. “Hundreds of thousands of students will essentially drop out of school, whether because they lack the technological resources to engage with ‘online learning’ or because their parents cannot assist them.”

The litigation raises concerns about everything from school closures exacerbating the achievement gap and disproportionately harming special needs students and those without convenient internet access to challenges over the constitutional validity of government health orders.

Weingarten, of AFT, said it’s important to remember that despite seemingly irreconcilable differences over the policy details, all parties want to see schools reopen as soon as it’s safe to do so.

“None of us believes that remote is a substitute,” she said. “It’s a supplement.”

 

 

Top U.S. Officials Told C.D.C. to Soften Coronavirus Testing Guidelines

The Centers for Disease Control and Prevention abruptly changed its recommendations, saying people without Covid-19 symptoms should not get tested.

 Trump administration officials on Wednesday defended a new recommendation that people without Covid-19 symptoms abstain from testing, even as scientists warned that the policy could hobble an already weak federal response as schools reopen and a potential autumn wave looms.

The day after the Centers for Disease Control and Prevention issued the revised guidance, there were conflicting reports on who was responsible. Two federal health officials said the shift came as a directive to the Atlanta-based C.D.C. from higher-ups in Washington at the White House and the Department of Health and Human Services.

Adm. Brett P. Giroir, the administration’s coronavirus testing czar, called it a “C.D.C. action,” written with input from the agency’s director, Dr. Robert R. Redfield. But he acknowledged that the revision came after a vigorous debate among members of the White House coronavirus task force — including its newest member, Dr. Scott W. Atlas, a frequent Fox News guest and a special adviser to President Trump.

“We all signed off on it, the docs, before it ever got to a place where the political leadership would have, you know, even seen it, and this document was approved by the task force by consensus,” Dr. Giroir said. “There was no weight on the scales by the president or the vice president or Secretary Azar,” he added, referring to Alex M. Azar II, the secretary of health and human services.

Regardless of who is responsible, the shift is highly significant, running counter to scientific evidence that people without symptoms could be the most prolific spreaders of the coronavirus. And it comes at a very precarious moment. Hundreds of thousands of college and K-12 students are heading back to campus, and broad testing regimens are central to many of their schools’ plans. Businesses are reopening, and scientists inside and outside the administration are growing concerned about political interference in scientific decisions.

Democratic governors who were weighing how to keep the virus contained as their economies and schools come to life said limiting testing for asymptomatic citizens would make the task impossible.

“The only plausible rationale,” Gov. Andrew M. Cuomo of New York told reporters in a conference call from Albany, N.Y., “is that they want fewer people taking tests, because as the president has said, if we don’t take tests, you won’t know the number of people who are Covid-positive.”

Over the weekend, the Food and Drug Administration, under pressure from Mr. Trump, gave emergency approval to expand the use of antibody-rich blood plasma to treat Covid-19 patients. The move came just days after scientists, including Dr. Anthony S. Fauci, the nation’s top infectious disease expert, and Dr. Francis S. Collins, the director of the National Institutes of Health, intervened to stop the practice because of lack of evidence that it worked.

The move echoed a decision by the Food and Drug Administration to grant an emergency use waiver for hydroxychloroquine, a malaria drug repeatedly sold by Mr. Trump as a treatment for Covid-19. The agency revoked the waiver in June, when clinical trials suggested the drug’s risks outweighed any possible benefits.

The testing shift, experts say, was a far more puzzling reversal. Dr. Giroir said the move was “discussed extensively by” members of the White House coronavirus task force, and he named Dr. Redfield, Dr. Atlas, Dr. Fauci and Dr. Stephen M. Hahn, the commissioner of food and drugs. Notably, he did not name Dr. Deborah L. Birx, the White House coronavirus response coordinator. But he said Dr. Fauci was among those who had “signed off.”

In a brief interview, Dr. Fauci said he had seen an early iteration of the guidelines and did not object. But the final debate over the revisions took place at a task force meeting on Thursday, when Dr. Fauci was having surgery under general anesthesia to remove a polyp on his vocal cord. In retrospect, he said, he now had “some concerns” about advising people against getting tested, because the virus could be spread through asymptomatic contact.

“My concern is that it will be misinterpreted,” Dr. Fauci said.

The newest version of the C.D.C. guidelines, posted on Monday, amended the agency’s guidance to say that people who had been in close contact with an infected individual — typically defined as being within six feet of a person with the coronavirus and for at least 15 minutes — “do not necessarily need a test” if they do not have symptoms.

Exceptions might be made for “vulnerable” individuals, the agency noted, or if health care providers or state or local public health officials recommended testing.

Dr. Giroir said the new recommendation matched existing guidance for hospital workers and others in frontline jobs who have “close exposures” to people infected with the coronavirus. Such workers are advised to take proper precautions, like wearing masks, socially distancing, washing their hands frequently and monitoring themselves for symptoms.

He argued that testing those exposed to the virus was of little utility, because tests capture only a single point in time, and that the results could give people a false sense of security.

“A negative test on Day 2 doesn’t mean you’re negative. So what is the value of that?” Dr. Giroir asked, adding, “It doesn’t mean on Day 4 you can go out and visit Grandma or on Day 6 go out without a mask on in school.”

The guidelines come amid growing concern that the C.D.C., the agency charged with tracking and fighting outbreaks of infectious disease, is being sidelined by its parent agency, the Department of Health and Human Services, and the White House. Under ordinary circumstances, administering public health advice to the nation would fall squarely within the C.D.C.’s portfolio.

Experts have called the revisions alarming and dangerous, noting that the United States needs more testing, not less. And they have expressed deep concern that the C.D.C. is posting guidelines that its own officials did not author. A former C.D.C. director, Dr. Thomas R. Frieden, railed against the move on Twitter on Wednesday:

Dr. Tom Frieden
@DrTomFrieden
Two unexplained, inexplicable, probably indefensible changes, likely imposed on CDC’s website. * Dammit, if you come from a place with lots of Covid, quarantine for 14 days * If you’re a contact, get tested. If +, we can trace your contacts and stop chains of spread. A sad day.

Later, in an interview, Dr. Frieden elaborated. He noted that the C.D.C. had recently dropped its recommendation that people quarantine for 14 days after traveling from an area with a high number of cases to one where the virus was less prevalent. And he reiterated that testing the contacts of those infected was an important means of curbing the spread of the virus.

“We don’t know the best protocol for testing of contacts: Should you test all contacts? That’s the kind of study that frankly needs to get done,” Dr. Frieden said. But absent the answer to that question, he added, “I certainly wouldn’t say, ‘Don’t test contacts.’”

Democrats, including Speaker Nancy Pelosi and two governors — Mr. Cuomo and Gavin Newsom of California — were outraged by the changes. Mr. Newsom said California would not follow the new guidelines, and Mr. Cuomo blamed Mr. Trump.

Representative Frank Pallone Jr. of New Jersey, a Democrat and the chairman of the House Energy and Commerce Committee, also chimed in on Twitter: “The Trump Admin has a lot of explaining to do. #COVID19 testing is essential to stopping the spread of the pandemic. I’m concerned that CDC is once again caving to political pressure. This simply cannot stand.”

Mr. Trump has suggested that the nation should do less testing, arguing that administering more tests was driving up case numbers and making the United States look bad. But experts say the true measure of the pandemic is not case numbers but test positivity rates — the percentage of tests coming back positive.

As Dr. Giroir denied that politics was involved, he encouraged the continued testing of asymptomatic people for surveillance purposes — to determine the prevalence of the virus in a given community — and said such “baseline surveillance testing” would still be appropriate in schools and on college campuses.

“We’re trying to do appropriate testing, not less testing,” he said.

Still, the revisions left many public health officials scratching their heads. They might have made sense when the United States was experiencing a shortage of tests, some experts said, but that no longer appears to be the case. Dr. Frieden, however, said it was possible the administration was trying to conserve testing in case of another surge.

“The problem is we have too many cases, so there is basically no way to keep up the testing if you have a huge outbreak,” he said.

Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said she was “not as up in arms about the content of the guidelines” as she was about the idea that the C.D.C.’s own experts did not write them — and that C.D.C. officials were referring all questions about them to the health department in Washington.

“These guidelines are clearly controversial, and many are calling on C.D.C. to explain its rationale for them, but C.D.C. is unable to comment,” she said in an email. “This is really dangerous precedent, and I fear it will erode public trust in C.D.C.”

 

 

 

 

Florida Hits 10,000 Coronavirus Deaths—The Fifth State To Reach That Mark

https://www.forbes.com/sites/nicholasreimann/2020/08/20/florida-hits-10000-coronavirus-deaths-the-fifth-state-to-reach-that-mark/#29e05eb438f3

Florida Hits 10,000 Coronavirus Deaths—The Fifth State To Reach ...

TOPLINE

Over 10,000 Floridians have now died of coronavirus, marking a grim milestone that comes weeks after the state led the record U.S. coronavirus case surge earlier this summer.

 

KEY FACTS

10,049 Florida residents have died of coronavirus, according to the state, reaching that mark after adding 117 deaths Thursday.

Florida is the fifth state in the U.S. to record over 10,000 deaths, joining New York and New Jersey, where most deaths happened during the spring coronavirus surge, along with California and Texas, where most deaths occurred during the summer.

Florida has been the nation’s recent coronavirus epicenter, but the pandemic’s spread seems to have slowed there over the past few weeks, even as deaths, which lag behind other statistics, have been at record highs in the state.

New cases have recently reached their lowest daily increases in two months, and hospitalizations have trended downward since late July.

The testing positivity rate, seen as one of the first indicators of increased coronavirus spread, dropped below 10% Thursday—the first time the state has been below that threshold since June 21, and less than half the 20.71% positivity rate the state had at its highest point on July 8.

 

BIG NUMBER

23.8%. Gov. Ron DeSantis said that’s what the positivity rate was Thursday for antibody testing at state-run drive-through sites. That number suggests a massive amount of Floridians, much higher than the record-setting confirmed case counts, were infected with coronavirus this summer.

 

SURPRISING FACT

There are five U.S. states that have over 10,000 deaths. That’s a number that only 14 countries around the world have hit, according to Johns Hopkins University. The U.S. continues to have by far the most coronavirus deaths of any country and could reach 175,000 deaths before the weekend.

 

KEY BACKGROUND

The U.S. as a whole is on a downward trend when it comes to coronavirus metrics, which seems to be influenced by large states, like Florida, having a reduction in coronavirus spread.

States like California, Texas and Florida, the nation’s three most populated, were all setting records when the U.S. had its highest confirmed coronavirus spike earlier this summer. They now seem to be pushing the country in the other direction.

 

 

 

 

School reopenings with COVID-19 offer preview of chaotic fall

https://thehill.com/policy/healthcare/public-global-health/512824-school-reopenings-with-covid-19-offer-preview-of

When Texas schools reopen, officials planning few required safety ...

Thousands of students and teachers across the country are quarantining just days into the new school year, highlighting the challenges of resuming in-person instruction during a pandemic.

While many schools aren’t scheduled to reopen until later this month or September, those that have are offering a preview of the chaos that awaits districts this fall, particularly in hot spots in the South and Midwest where the virus is spreading uncontrollably.

In Georgia’s Cherokee County School District, where students are not required to wear masks, nearly 2,200 students — mostly high schoolers — are quarantining after coming into contact with one of 116 students or 25 teachers and staff members with COVID-19. Another 53 teachers and staff members are also quarantining.

Those numbers are expected to increase with more test results. In the meantime, three of the district’s six high schools have moved classes online, at least until September.

Experts have warned for weeks that it will be extremely difficult to safely reopen schools in hot spots, but some districts are still charging ahead — some willingly, others after some prodding from state and national leaders.

The results, health officials say, are not surprising, though they are preventable.

“You go in, people get infected — boom, you close them down. So it’s better to ease in, perhaps with virtual, until you see what’s going on when you’re in a really hot zone,” Anthony Fauci said during a livestreamed event Tuesday, referring to schools that have already closed after reopening this year.

“When you’re in a red zone … you really better think twice before you do that because what might happen, is what you’ve seen,” Fauci added.

Schools in states like IndianaLouisianaOklahoma and Tennessee have shut down, at least temporarily, after finding COVID-19 in their hallways and classrooms.

The question of when and how to open schools has moved from a public health debate to a political one, with President Trump and his administration strongly advocating for full-time, in-person instruction, hoping in part that parents can then return to work and revamp an economy that’s been ravaged by the coronavirus recession.

Health experts and administration officials note that the consequences of missing in-person learning can be severe, especially for younger students. Finding a solution that minimizes harm to students while protecting public health has proven difficult.

Annette Anderson, a professor in the school of education at Johns Hopkins University, said there is no proven or agreed-upon approach to holding classes during a pandemic, no set protocols around when to return to in-person instruction or how to conduct testing and contact tracing.

“There’s a wild, wild west approach with all the different types of plans in reopening and because of that, a gold standard would just mean clarity around what schools should do. But we don’t have a tacit agreement about what that actually means,” she said.

Most states are deferring school opening decisions to local school districts. For example, while the Cherokee County School District is offering in-person learning five days a week, Atlanta Public Schools, just one county over, is beginning the year online.

Many school districts are opting for online instruction or pursuing hybrid models in which students alternate which days they are in class to limit the number of people in school buildings at one time.

Others, like some districts in Georgia, Arkansas, Florida and Texas, are moving full speed ahead with in-person learning, despite the challenges posed by cramped buildings and classrooms. Some of those districts also offer online options.

While in-person instruction might work for some states where transmission is relatively low, like New York, which gave districts the green light to fully reopen this year, it will be much harder in hot spots.

Fauci classified hot spots as areas with test positivity rates that exceed 10 percent.

While he didn’t specify any states, several across the country have positivity rates over 10 percent, according to figures compiled by Johns Hopkins University, and have districts pursuing in-person instruction. The list includes Florida, Georgia, Idaho, Iowa, Kansas, Mississippi and Texas.

“There’s one opportunity to do this well, because once you open you want the schools to stay open as much as possible, given how disruptive isolating schools and teachers can be,” said Thomas Tsai, assistant professor in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health.

He recommended schools consider shutting down if the virus appears to be widespread. If cases appear to be isolated to one cluster in a classroom, the rest of the school can probably remain open, while exposed students isolate at home.

That’s why it’s especially important for students to wear masks and keep their desks at least 6 feet apart, and avoid gatherings outside of classrooms, he said, otherwise the number of contacts per case can quickly grow, resulting in more students and teachers needing to be quarantined.

If there are clusters in multiple classrooms and hundreds of students and teachers need to quarantine, schools might need to consider shutting down, Tsai added.

The Centers for Disease Control and Prevention says in “most instances” a single case of COVID-19 should not warrant a school closure.

But if the spread of COVID-19 at a school is higher than within the community, or if the school is becoming the source of an outbreak, administrators should work with local health officials to determine whether temporary closures are needed.

Mississippi State Health Officer Thomas Dobbs said Monday that 245 teachers and 199 students have tested positive for the coronavirus in 71 of the state’s 82 counties. Almost 600 teachers and more than 2,000 students are now in quarantine, but none of the schools have closed.

Dobbs said many of the teachers and students likely contracted the virus outside of school but unknowingly “brought it with them” to class.

Classes are canceled indefinitely at a school district in Pinal County, Ariz., after more than 100 teachers and staff members refused to come to work, citing a concern with the spread of COVID-19 in the community.

The school district planned to resume in-person learning Monday, despite the county not meeting metrics recommended by the state’s health department for safely reopening, including a drop in the number of new cases, new COVID-19 hospitalizations and the percentage of people testing positive.

In Florida, 13 counties have reopened schools in the past week for in-person instruction; at least three districts have reported COVID-19 cases. In Martin County, more than 300 students and teachers are quarantining after coming into contact with infected classmates.

County officials said some parents are not keeping their kids at home while awaiting the results of COVID-19 tests. Instead, they’re waiting until the test is positive before notifying the school.

And in Florida’s Dade County, about 70 students and staff are quarantining after 11 people in the district tested positive. County officials have said that cases are to be expected and superintendents should call them before making any decisions about closures.

The confusion at all levels of government has frustrated both parents and school officials. In the lead-up to the new school year, Trump has offered mixed messages.

Last month, he said schools in hot spots might need to delay their reopening plans, but in August he renewed his push for a return to in-person instruction by tweeting: “OPEN THE SCHOOLS!!!”

 

 

 

 

Making coronavirus testing easy, accurate and fast is critical to ending the pandemic – the US response is falling far short

https://theconversation.com/making-coronavirus-testing-easy-accurate-and-fast-is-critical-to-ending-the-pandemic-the-us-response-is-falling-far-short-142366

Making coronavirus testing easy, accurate and fast is critical to ...

For many people in the U.S., getting tested for COVID-19 is a struggle. In Arizona, testing sites have seen lines of hundreds of cars stretching over a mile. In Texas and Florida, some people were waiting for five hours for free testing.

The inconvenience of these long waits alone discourages many people from getting tested. With the surge in cases, many public testing sites have been reaching maximum capacity within hours of opening, leaving many people unable to get tested for days. Those that do get tested often face a week-long wait to get their test results.

Every person who isn’t tested could be spreading COVID-19 unknowingly. These overstretched testing programs are a weak link in the U.S. pandemic response.

study public health policy to combat infectious disease epidemics. The key to overcoming this pandemic is to slow transmission of the virus by preventing contagious people from infecting others. A widespread quarantine would accomplish this, but is economically and socially burdensome. Testing offers a way to identify contagious people so they can be isolated to prevent the spread of the disease. This is especially important for COVID-19 because an estimated 40% or more of all people infected with SARS-CoV-2 have few or no symptoms so testing is the only way to identify them.

Some states are doing much better than others. But as a whole, the U.S. is falling far short of the amount of testing needed to control the pandemic. What are the challenges the U.S. is facing? And what is the way forward?

Testing should be free, easy, fast and accurate

The ultimate goal of testing is for everyone, regardless of symptoms, to know at all times whether they are infected with the coronavirus. To achieve this level of testing, tests should be free, very easy to perform and provide accurate results quickly.

Ideally, free COVID-19 tests would be delivered to everyone directly. The tests would be simple to perform – like a saliva test – and would give a perfectly accurate result within minutes. Everyone could test themselves weekly or anytime they were going to be in close contact with other people.

In this ideal scenario, most, if not all, contagious people would be detected before they could spread the virus to others. And because of the rapid results, there would be no burden of quarantining between doing the test and getting the result.

Researchers are working on better-quality tests, but access is a problem of infrastructure, not science. Right now, nowhere in the U.S. comes close to meeting surging demand for testing.

One of the worst cases: Texas

The difficulty of getting a COVID-19 test varies by state, but currently, people in Texas face some of the biggest obstacles, which results in far fewer tests being done than is needed to control the pandemic.

First, Houston – which is experiencing a surge in cases – and many testing sites across the state recommend or offer testing only to people who have symptoms, were exposed to a COVID-19 case or are a member of a high-risk group.

Even people recommended for testing still face challenges. It is possible to request an appointment for a free COVID-19 test, but testing facilities can handle only so many patients a day and testing slots fill up quickly. Even if someone gets an appointment, they may face an hours-long wait at the testing site.

Finally, public health experts recommend that people who may have been exposed to COVID-19 should quarantine at home for 14 days or until they receive a negative test result. In Texas, patients are supposed to get results through an online portal in three to five days, but many labs have been taking seven to nine days to return results. These long delays mean people face a much higher burden of quarantining while waiting for results.

All of these challenges make it clear that Texas is simply not testing enough people to keep the spread of COVID-19 in check.

To gauge the success of COVID-19 testing programs, epidemiologists use a measure called test positivity. This is simply the percentage of tests that come back positive. The lower the test positivity, the better, because that means very few cases are going undetected. A high test-positivity rate is usually a sign that only the sickest people are getting tested and many cases are being missed.

The World Health Organization guidelines say that if more than 1 out of 20 COVID-19 tests comes back positive – a test positivity of more than 5% – this is an indication that a lot of cases are not diagnosed and the epidemic is not under control. 

Texas currently has a test-positivity of around 16%, which means that a lot of infected people are not getting tested and may be unknowingly spreading the disease.

One of the best cases: New Mexico

In stark contrast to Texas is New Mexico, which has one of the strongest testing programs in the U.S.

First, public health officials there encourage everyone to get tested for COVID-19 regardless of symptoms or exposure. The state has also prohibited health providers from charging patients for tests. People seeking a test have the option to walk in or to make an appointment ahead of time, whichever is more convenient.

All of this relatively good access to testing has resulted in one of the highest per capita testing rates in the country, at over 20,000 tests per 100,000 people, and test-positivity rate of around 4%. New Mexico’s testing program is diagnosing a relatively high proportion of cases despite the state experiencing a recent surge.

New Mexico still has room for improvement. Long lines, wait times and limited capacity are becoming more common as cases surge, but the foundation of a strong testing program has helped the state cope with the increase in cases.

 

The big-picture problems

The pre-pandemic infectious disease testing capabilities in the U.S. are clearly unable to meet the current demand. A nationwide response is needed, and there are three things that Congress, the federal government and local governments can do to help ensure COVID-19 tests will be easy to get, fast and accurate.

First, Congress can provide funding to stimulate the testing supply chain, scale up existing testing programs and promote innovation in test development.

Second, governments can improve the management and coordination of testing programs to more efficiently use existing resources.

And third, innovative testing methods that reduce the need for lab capacity – like paper-strip tests and pooled testing – need be approved and implemented more quickly.

Every little improvement in testing capabilities means more COVID-19 cases can be caught before the virus is transmitted. And slowing the spread of the virus is the key to overcoming the pandemic.