The European Unions chief drug regulator would approve a vaccine against Covid-19 even if trials showed that it was effective in less than half the people who take it, lower than thethreshold the U.S. Food and Drug Administration is likely to apply in assessing vaccine candidates for the U.S. population.
According to officials at the European Medicine Agency, the body would be willing to approve a Covid-19 vaccine even if it showed a so-called efficacy rate below 50%, as long as the shot were safe enough to justify the benefits.
AstraZeneca and Johnson & Johnson will restart trials of their vaccine candidates against coronavirus disease 2019 (COVID-19); the United States hits a record high 2-day total of COVID-19 infections; strategies can help ease stress amid the coming election.
After halting clinical trials to investigate safety concerns of their respective vaccine candidates against coronavirus disease 2019 (COVID-19), both AstraZeneca and Johnson & Johnson (J&J) announced plans to restart their studies. As reported by STAT, the trial by AstraZeneca had been stopped on September 6 after a study participant developed neurological symptoms, with an independent monitoring committee then determining the vaccine candidate was safe for the trial to resume. J&J, which had halted its trial on October 11, could begin enrolling patients as early as next week.
According to Reuters, the past 2 days have exhibited the highest ever number of new COVID-19 cases in the United States during that time frame, with 79,852 new cases reported on Saturday and a record of 84,244 cases on Friday. Notably, 29 states have set records for increases in new cases, including Ohio, Michigan, North Carolina, Pennsylvania, and Wisconsin. North Dakota has been indicated as the hardest hit state based on a recent analysis of new cases per capita.
With Election Day approaching, an article by NPR spotlights the prevalence of stress and how to cope with it. According to a survey from the American Psychological Association, 77% of Americans reported being worried about the countrys future and a further 71% of participants reported this time as the lowest point in the history of the United States. In highlighting how to cope with the added stress of the election, several strategies were noted, including preparing mentally for delayed results, doubling down on stress-reducing habits like sleep and exercise, and looking for signs of hope.
A COVID-19 vaccine once seemed a distant dream. Now, its a matter of when, not if, one is available.
For Charlotte Thomas, thats welcome news.
Each time the critical care nurse practitioner enters a COVID-19 patients room at Scripps Mercy Hospital Chula Vista, she dons a black helmet with a broad, clear face shield. She calls it her Star-Lord mask, because it resembles the high-tech mask worn by the Guardians of the Galaxy superhero.
Weve all been really looking forward to the day where we can come to the hospital with that extra suit of armor and feel really confident that we are going to be able to care for these patients and not get sick and not take it home, Thomas said.
Nurse Practitioner Charlotte Thomas gets her supplies ready to stabilize a patient who was just intubated inside a negative pressure isolation room at the ICU at Scripps Mercy Hospital in Chula Vista, Calif., on April 23, 2020.
(Marcus Yam / Los Angeles Times)
That urgent desire for a sense of safety and a return to normalcy has fueled an unprecedented search for a vaccine against the worst pandemic humanity has faced in a century.
CEOs of Pfizer and Moderna, two of the vaccine developers furthest along in that search, have said they could request emergency-use authorization for their COVID-19 vaccines by late November and December, respectively, depending on results from trials that have enrolled tens of thousands of volunteers (including San Diegans).
On Wednesday, Health and Human Services secretary Alex Azar said there could be enough doses of a COVID-19 vaccine for those most vulnerable to the disease by the end of 2020, with enough vaccine for all Americans by early April.
Many experts say that is overly optimistic. But regardless of the exact timeline, public officials are already planning how to distribute the first doses of a vaccine and assure the public that it has been thoroughly vetted.
Its unclear how effectively and quickly a vaccine would quell a pandemic that has killed more than 223,000 Americans. Some vaccines have totally or nearly eradicated diseases think smallpox and polio. But dont expect a COVID-19 vaccine to be a panacea, says Dr. Davey Smith, UC San Diegos director of infectious diseases and global public health.
If you have a vaccine, thats just another tool in your toolbox, Smith said.
That toolbox includes strategies public health officials have stressed throughout the pandemic. Testing. Contact tracing. Social distancing. And wearing a mask, which researchers estimate could save nearly 130,000 lives by the end of February.
When combined with these measures, a vaccine could substantially slow the spread of COVID-19, reducing your chances of getting infected or developing serious illness.
Thats the approach Vista educator Rick Worthington plans to take. Hes a wellness teacher at Vista High School, which reopened this past week, and says he would take the vaccine if its available.
I would still take precautions. I would still wear a mask. I would err on the side of caution, Worthington said.
Rick Worthington, who teaches wellness at Vista High School, says he would take a COVID-19 vaccine but would continue wearing a mask and washing his hands.
(Jarrod Valliere / The San Diego Union-Tribune)
Whats unclear is how many people will do the same.
Expect people to react to the prospect of a COVID-19 vaccine in radically different ways, says On Amir, a researcher at UCSDs Rady School of Management who studies how we make decisions and weigh risks.
We have to acknowledge that there are different groups of people out there, both with respect to adherence and with respect to vaccination, Amir said.
He thinks peoples behavior will likely fall into a few categories. In one, those tired of following public health precautions might trust that a vaccine will be the ultimate fix and throw caution to the wind.
That may already be happening, as the number of community outbreaks in San Diego County has trended upward, and the countys latest COVID-19 case rate nearly pushed it into the states most-restrictive reopening tier. Infectious disease experts like Davey Smith worry about these developments, as driving up transmission of the virus could cancel out a vaccines protective effects.
But the sense that a vaccine is on the horizon could also have the opposite effect, Amir says, citing what researchers call the goal gradient effect. The idea: The closer you are (or think you are) to completing a task, the more motivated you are to stick it through for the reward. In this case, that reward would be some semblance of a return to normalcy.
How people react, he says, will depend on whether public officials frame the rollout of a vaccine as an instant triumph or a series of steps.
For instance, making clear a vaccine would be rolled out in phases.
In early October, the National Academies of Sciences, Engineering and Medicine released a four-phase guideline for distributing the first doses of a COVID-19 vaccine when one becomes available.
At the front of the line would be front-line health care workers, first responders and those who provide cleaning and transportation services for health care facilities about 5 percent of the population.
Without these people, the health care system breaks down. And routinely working in high-risk settings has taken its toll. One study found that front-line health care workers in the U.S. and U.K. had about 12 times the risk of getting COVID-19 as the general population.
That would place Mark Selapack, a paramedic with American Medical Response in San Diego, among the first to get a vaccine. In February, Selapack became one of the first health care providers in the region to handle COVID-19 cases among evacuees quarantined at Marine Corps Air Station Miramar. Since then, hes handled coronavirus surges at skilled nursing facilities and stabilized and transported countless patients.
As a front-line worker, I feel obligated to get the vaccine because we are helping some of the most vulnerable people, Selapack. If I can do my part, I will get the vaccine.
Mark Selapack, a paramedic with American Medical Response San Diego, stands by an ambulance on Oct. 22, 2020. Selapack would be among the first to receive a COVID-19 vaccine.
(Jarrod Valliere / The San Diego Union-Tribune)
The next-highest priority group, about 10 percent of the public, includes those with multiple medical conditions strongly associated with severe disease, such as cancer or serious heart conditions. About 90 percent of COVID-19 patients who end up in the hospital have at least one underlying condition.
Also in this group are adults 65 and older living in nursing homes, homeless shelters and other group living settings. Thats because about 80 percent of COVID-19 deaths have been among people 65 and up, and close quarters make it hard to follow social-distancing guidelines.
From there, vaccine access would gradually broaden to all older adults, teachers, other essential workers and, eventually, the entire population.
Thats the idea, anyway.
The National Academies report, totaling more than 200 pages, wont matter if no one is willing to take a vaccine.
A recent poll by STAT and The Harris Poll found that 58 percent of Americans said they would get a vaccine once it was available, down from 69 percent in August, in part due to a sense that the push for a vaccine has become polluted by politics.
There are efforts underway to allay those fears. On Monday, California Gov. Gavin Newsom announced a scientific panel that would independently review any authorized vaccine. That panel includes Dr. Rodney Hood, president and founder of the Multicultural Health Foundation, a consortium of health providers serving San Diego Countys most diverse neighborhoods.
Its unclear if these efforts will boost the percentage of people willing to get a vaccine. That percentage matters, as it will determine whether we reach what epidemiologists call herd immunity the point where a disease outbreak slows because enough people in a community are protected, leaving the virus with nowhere to go.
The Centers for Disease Control and Prevention estimates between 55 percent and 82 percent of the public would need to be protected against the virus, either by getting a vaccine or recovering from the disease, to reach herd immunity.
That percentage range is so broad because it depends on two unknown factors: How well the vaccine works (and for how long), and how widely the coronavirus is spreading at the time vaccination begins.
We cant control the first factor, but we can control the second, says UCSD psychologist and mindfulness expert Karen Dobkins. And thats one key thing to keep in mind during these uncertain times.
I dont have control over when the vaccines going be ready, I just dont. I do have control about whether I want to put a mask on or not, Dobkins said. If people could get a little better at discriminating between those areas of risk where they do and dont have control, thered be less anxiety.
The worlds most promising coronavirus vaccine candidates need to be kept in cold storage to be safe and effective.
Health officials have noted progress in equipping developing countries with the machinery needed to keep the vaccine cold. Yet nearly 3 billion people live in places where temperature-controlled storage is lacking for a vaccination campaign to bring the virus under control.
The result: Poor people who were among the hardest hit by COVID-19 are also likely to be the last to recover from it.
Maintaining the cold chain for coronavirus vaccines will not be easy even in the richest countries. To stay effective, some vaccines must be kept in temperatures of around minus 70 degrees Celsius. Investment in cooling technology is lower this year because of the COVID-19 health crisis. So is spending for transportation and other infrastructure.
Experts warn that large parts of the world lack the refrigeration equipment necessary to administer an effective vaccination program. This includes most of Central Asia, much of India and Southeast Asia, parts of Latin America, and all but a very small part of Africa.
Broken cold chain
The cold chain breaks down at Gampela, a small medical center in the West African nation of Burkina Faso. The center serves a population of 11,000. And it has gone nearly a year without a working refrigerator.
After its refrigerator broke last year, the center could no longer keep vaccines against diseases such as tetanus, yellow fever, and tuberculosis. Nurse Julienne Zoungrana said workers used motorbikes to get vaccines from a hospital in the capital, Ouagadougou. They made the 40-minute round-trip on a narrow road.
Adama Tapsoba is a mother of two small children. She often walks four hours under the hot sun to get vaccinations for her baby and waits hours more to see a doctor. Recently, her 5-month-old son had missed a scheduled vaccine shot because Tapsobas daughter was sick and she could only bring one child on foot.
It will be hard to get a (COVID-19) vaccine, Tapsoba said, People will have to wait at the hospital, and they might leave without getting it.
To maintain the cold chain in developing nations, international organizations have added tens of thousands of solar-powered vaccine refrigerators. From the time vaccines are made until they are given to patients, the cold chain also requires mobile refrigeration, dependable electricity, good roads and careful planning.
For poor countries like Burkina Faso, the best chance of receiving a coronavirus vaccine is through the Covax initiative. It is a project of the World Health Organization (WHO) and the Gavi vaccine alliance.
The goal of Covax is to place orders for several promising vaccine candidates and to provide the safest, most successful ones to all nations.
The United Nations childrens agency (UNICEF) began preparing for the distribution of COVID-19 vaccines months ago in Copenhagen. There UNICEF crews are busy at work in the worlds largest supply center for humanitarian aid. They are trying to predict shortages by learning from the past, like when protective equipment disappeared from airports or was stolen.
The WHO says 42 coronavirus vaccine candidates are currently being tested in human volunteers. The vaccines most likely to be offered by the Covax initiative must be stored at 2 to 8 degrees Celsius.
The American drug company Pfizer is testing one of the most promising vaccine candidates. It requires storage at temperatures of minus 70 degrees Celsius. The company has designed a special carrying case for its vaccine. Pfizer has signed deals to supply the vaccine to the United States, Europe and Japan. It has also expressed an interest in Covax.
Medical freezers that go down to minus 70 degrees Celsius are rare even in U.S. and European hospitals. Many experts believe some West African countries may be best positioned. Those areas suffered through the Ebola health crisis from 2014 to 2016. Like the coronavirus vaccine, the Ebola vaccine requires very cold storage.
Since 2017, Gavi and UNICEF have worked to supply much of Africa and Asia with freezers for storing vaccines. UNICEF is now offering governments a list of what they will need to maintain a vaccine supply chain and they are asking them to develop a plan.
The governments are in charge of what needs to happen in the end, said Benjamin Schreiber, who is among the directors of the UN agencys vaccination program.
Transporting vaccines
Vaccines do not last long. Container ships are not equipped to refrigerate drugs for long periods. Shipping vaccines by air costs a lot more.
The WHO estimates that as much as half of vaccines are lost internationally because of waste, theft or heat during shipping.
The German shipping company DHL estimated that 15,000 flights would be needed to send COVID-19 vaccines around the world. That would stretch the availability of aircraft and supplies of cooling materials such as dry ice to protect the vaccines.
We need to find a bridge for every gap in the cold chain, Katja Busch of DHL said. Were talking about investments ... as a society, this is something we have to do.
Gavi and UNICEF have experimented with sending vaccines by drone aircraft. Indian officials have also suggested the idea of setting aside part of the countrys large food storage system for coronavirus vaccines.
In countries such as India and Burkina Faso, a lack of public transportation presents another barrier to protecting citizens before vaccines go bad. When parts of Venezuela lost power for a week last year, the largest childrens hospital in the country had to throw away thousands of shots of vaccines for diseases like diphtheria.
Back in Burkina Faso, a solar-powered freezer finally arrived days after reporters from The Associated Press visited the health center near the capital. Health workers are waiting to be sure the freezer works before storing it with vaccines.
Nationwide, Burkina Faso needs another 1,000 medical freezers. Health officials said less than 40 percent of the health centers that provide vaccines have working freezers.
If Burkina Faso were given 1 million shots of coronavirus vaccine today, the country would not be able to administer the vaccine program.
Jean-Claude Mubalama is UNICEFs head of health and nutrition for the African nation. He said, If we had to vaccinate against the coronavirus now, at this moment, it would be impossible.
I'm Dorothy Gundy.
And I'm Jonathan Evans.
The Associated Press reported this story. Hai Do adapted the story for Learning English. George Grow was the editor.
________________________________________________________________
maintain - v. to provide support, to keep something in good condition
chain - n. a series of things that are connected to each other
nurse - n. a person who is trained to care for sick or injured people
scheduled - adj. planned at a certain time
solar - adj. of or relating to the sun
distribution - n. the act of delivering something
gap - n. space where something is missing
Posted: Oct 26, 2020 / 04:34 AM EDT / Updated: Oct 26, 2020 / 06:17 AM EDT
AUGUSTA, Ga. (WJBF) A local home healthcare company is part of the research to help find COVID-19 treatment and potentially a vaccine. Theyre called Interim Healthcare of Augusta.
Interim Healthcare Company is going to trial participants homes and gathering data for 3 different clinical trials. They work with Regeneron.
Thats the pharmaceutical company that made the antibody cocktails President Donald Trump received.
Interim Healthcare works with Augusta University. They found it could lessen symptoms and reduce viral loads, which reduces medical visits.
Director of Business Development at Interim Healthcare of Augusta, Cutter Mitchell, says, look, I think any time you can be a part of history I think thats pretty neat, and I think if you can do it while positively impacting your community and the people around you like I said, we take care of these clients day in and day out.
Trial participants are low to medium risk patients and those who have come out of the hospital and are recovering at home.
You know, were there with the immunocompromised kids. Were there with the 70 year-old man who, you know, his kids live in a different state, and he needs some help, and we care about what happens to them, says Mitchell.
They check on these patients and make sure they dont see negative effects. The spokesperson says so far they have not. If you tested with AU and are positive and would like to participate, it is advised to call AU and ask.
As optimistic voices say that there may be an approved COVID-vaccine before the end of the year, the race is on to ensure its safe and efficient transportation. Finnair, the first carrier in the world to receive IATAs pharmaceutical air cargo certification, is preparing to provide a reliable supply chain.
While the world is still waiting for a functioning COVID-19 vaccine to arrive, airlines and airports are busy making preparations so that they can transport and store it safely when it does. Several companies have now declared that their vaccines have entered the final stage of development.
Stay informed:Sign up for ourdaily aviation news digest.
Air cargo will most likely be one of the main forms of transportation for the vaccine. However, one does not simply load vaccines into the cargo hold and store it along with other products. All pharmaceutical transports are sensitive, but vaccines particularly so. In order to ensure their viability and efficiency, the so-called cold chain must remain unbroken.
Those responsible for logistics and storage must make sure they have contingency plans in place in case of a power short-cut. Finnairs cargo branch is busy doing just that.
It is a known fact that there is always a risk when transporting temperature-sensitive items, thats why our job is to make sure we protect the product integrity in all possible ways, Tommie Voss, Head of Operations at Finnair Cargo, said in a statement seen by Simple Flying.
We have a dedicated pharma area to manage the arrival and build-up of temperature-controlled cargo. And our aircraft can be parked right outside the terminal, which makes the process fast; temperature-sensitive items can be loaded in the plane in under 30 minutes, Voss continued.
Finnair was the first airline in the world to receive IATAs CEIV Pharma certificate in 2015. CEIV stands for the Center of Excellence for Independent Validators in Pharmaceutical Logistics. The certification binds airlines to standards for transporting and storing medicines. Originally conceived to help increase air cargos market share of the global pharma logistics industry, its role has now taken on different proportions entirely.
CEIV Pharma defines consistent and recognized standards for transporting the vaccine, or vaccines, ensuring international reliability. While much of the global economy may remain stagnant until a vaccine is widely available, the ability to trust in its efficiency post-transportation will also be of utmost importance.
Since 2018, Finnair already boasts a state-of-the-art cargo terminal at Helsinki Airport. Its COOL Nordic Cargo Hub is generally considered one of the most advanced in Europe. Its solar-paneled roof generally covers fresh seafood, flying the short route to Asia from Norway to Japan.
However, medicines are stored in an area of the terminal dedicated to pharmaceutical goods. There, sensors record and control the temperature, and an alarm goes off if the readings are even a little bit of track.
We have a history of excellence in pharma logistics, and with our new terminal, we have lifted all the monitoring and control to 100% in our premises, Fredrik Wildtgrube, Head of Global Sales at Finnair Cargo, said Monday.
Do you think we will see a vaccine approved and available before the end of the year? Let us know your thoughts in the comments.
There was plenty to mull over after Thursdays US Food and Drug Administration (FDA) meeting on the
To continue reading The Pharma Letter please login,subscribeorclaim a 7 dayfree trial subscriptionand access exclusive features, interviews, round-ups and commentary from the sharpest minds in the pharmaceutical and biotechnology space.
Or, if you're only interested in reading the content about a specific topic (M&A, coronavirus/COVID-19, pricing, reimbursement and access, outsourcing, CRO and CMO, and regulation), then you can take our 10 per month channel subscription offer, which gives you access to all our news articles and in-depth content on this subject.
World Polio Day, on 24 October, is when the world comes together to celebrate the determination that has brought us 99% of the way to ending polio, and reflect on the heights we must scale to defeat the disease completely.
This year, Africa was declared free of wild poliovirus, a testimony to the outstanding work of thousands of health workers and their supporters over many decades.
Despite this, 2020 may be the toughest year polio eradicators have ever faced. In the last eight months, immunization services have taken a devastating hit. An estimated 80 million children under one may have missed critical vaccines. Vaccine-preventable diseases including polio have spread in the most vulnerable contexts. This year, new outbreaks of vaccine-derived polio have been detected in the Eastern Mediterranean and African regions, including in Yemen, Sudan and South Sudan.
WHO is working closely with national Governments to urgently respond to outbreaks and repair immunization systems affected in the early months of the pandemic. In the context of a significant budget shortfall and increased costs of delivering health interventions due to the pandemic, outbreak response for both polio and measles will require additional funding and urgent action.
Below, learn about the work of polio personnel around the world to deliver polio vaccines and close immunity gaps, whilst continuing to fight COVID-19.
Nasrin Ahmadi, District Polio Officer in Afghanistan
I chose to continue to do public health awareness during the COVID-19 pandemic. I wanted to help save peoples lives and continue to serve my people, says Nasrin Ahmadi, a polio worker and volunteer for the COVID-19 response in Balkh province in Afghanistan.
Eight months since the first COVID-19 case was reported in Afghanistan, polio programme frontline workers continue to support outbreak response. During the pandemic, Nasrin has taken on extra duties to identify suspected COVID-19 cases, share accurate information with communities, and trace individuals returning from abroad to encourage them to isolate. Throughout, she has continued to educate families on the importance of polio vaccination.
Read more about Nasrin
Mohamed Sharif Mohamed, Regional Polio Eradication Officer in Somalia
In addition to his polio duties, Mohamed provides COVID-19 support to 17 districts in Banadir, Somalia through coordinating and training COVID-19 teams, carrying out active surveillance visits to health facilities and reviewing reports submitted by district polio officers on the pandemic response.
In September, he took part in the first immunization campaign to resume in Somalia since COVID-19 arrived in the country. All children who took part in the campaign were offered deworming tablets and vitamin A in addition to measles and polio vaccines. Delivering multiple services is crucial in the context of ongoing polio and measles outbreaks in Somalia, and low overall population immunity.
Read more about integrated polio and measles campaigns in Somalia
Dr Samreen Khalil, Polio Eradication Officer in Pakistan
Polio teams in Pakistan have been working to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio.
In Peshawar, the team has adapted existing acute flaccid paralysis (AFP) surveillance networks embedded in hospitals and health facilities to detect COVID-19 as well as polio. Polio staff like Dr Samreen Khalil have been helping with testing and have trained health workers on infection prevention and control. Polio data management systems across the country and a call centre in the capital, Islamabad, assist in addressing misinformation and helping to detect suspected COVID-19 cases.
Dr Sylvester Maleghemi, Polio Team Lead in South Sudan
In the African region, the polio eradication programme has a long history of responding to other disease outbreaks and health emergencies. With its unmatched technical expertise, disease surveillance and logistics capacities as well as wide community networks, the polio team was perfectly placed to mobilise a large-scale emergency response to COVID-19, while maintaining polio eradication efforts.
Dr Sylvester Maleghemi, WHO Polio Team Lead in South Sudan, explains, Across Africa, polio infrastructure and staff are found at district, province, all the way to the national level, so whenever theres an outbreak, polio teams are always the first to respond.
As the pandemic progresses, polio staff and resources across the globe continue to tackle COVID-19, while pushing to rid the world of all forms of polio, close the immunity gap, and contribute towards universal health coverage.
Read more about Africas polio infrastructure
Exceptional support from the global donor community and the immense efforts of health workers, parents and local leaders have brought us 99% of the way to eradicating polio worldwide. On World Polio Day, the Global Polio Eradication Initiative, of which the WHO is a leading partner, would like to thank everyone dedicated to delivering a polio-free world.
More on the Global Polio Eradication Initiative and WHOs work to end polio.
Heres what you need to know:The vice presidents chief of staff, Marc Short, is one of at least four staff members who have tested positive for the coronavirus recently.Credit...Doug Mills/The New York Times
At least three top aides to Vice President Mike Pence have tested positive for the coronavirus in the last few days, people briefed on the matter said. The test results raise fresh questions about the safety protocols at the White House, where masks are not routinely worn.
The vice presidents chief of staff, Marc Short, has tested positive, according to Devin OMalley, a spokesman for Mr. Pence, who leads the White House coronavirus task force. A person briefed on Mr. Shorts diagnosis said it was received on Saturday.
Vice President Pence and Mrs. Pence both tested negative for Covid-19 today, and remain in good health, Mr. OMalley said. While Vice President Pence is considered a close contact with Mr. Short, in consultation with the White House Medical Unit, the vice president will maintain his schedule in accordance with the C.D.C. guidelines for essential personnel.
The statement did not come from the White House medical unit, but instead from a press aide. Two people briefed on the matter said that the White House chief of staff, Mark Meadows, had sought to keep news of the outbreak from becoming public.
On Sunday, in an appearance on CNNs State of the Union, Mr. Meadows denied that he had tried to suppress news of the outbreak, saying he had acted out of concern about sharing personal information.
A Trump adviser briefed on the outbreak, who was not authorized to speak publicly, said that the Pence adviser Marty Obst also tested positive this week. Mr. Obsts positive test was first reported by Bloomberg News.
Another person briefed on the developments, who also was not allowed to speak publicly, said that three additional Pence staff members had tested positive. Mr. OMalley did not immediately respond to a question about others who have tested positive.
Mr. Pences decision to continue campaigning, despite his proximity to his chief of staff, is certain to raise fresh questions about how seriously the White House is taking the risks to its staff members and to the public as the pandemic has killed nearly 225,000 people in the United States. The vice presidents office said that both Mr. and Mrs. Pence tested negative again on Sunday.
President Trump, the first lady and several aides and advisers tested positive for the virus roughly three weeks ago. Mr. Trump spent three nights at Walter Reed National Military Medical Center, and he was treated with an experimental antibody cocktail as well as the powerful steroid dexamethasone.
The administration decided not to trace the contacts of guests and staff members at the Rose Garden celebration on Sept. 26 for the Supreme Court nominee Amy Coney Barrett, which also included a reception inside the White House. That event was linked to an outbreak that grew to more than 20 cases, as evidence mounted that the administration had done little to prevent or contain the viruss spread.
Mr. Trump, at rallies over the past two days, has insisted the country is rounding the turn on the virus, even though the single-day record for new cases was shattered on Friday. The United States has averaged more than 68,000 new cases a day over the last week, the countrys highest seven-day average of the pandemic.
Reports of new infections poured in at alarming levels on Saturday as the coronavirus continued to tear through the United States. Six states reported their highest-ever infection totals and more than 78,000 new cases had been announced by evening, one day after the country shattered its single-day record with more than 85,000 new cases.
The countrys case total on Saturday was the second highest in a single day. Case numbers on weekends are often lower because some states and counties do not report new data, so the high numbers on Saturday gave reason for alarm.
This is exploding all over the country, said Gov. Andy Beshear of Kentucky, whose state is among 17 that have added more cases in the past week than in any other seven-day stretch. Weve got to tamp down these cases. The more cases, the more people that end up in the hospital and the more people die.
Officials in Alaska, Ohio, Oklahoma, Colorado, New Mexico and Illinois announced more new cases on Saturday than on any other day of the pandemic. On Sunday, Alaska reported a record for the third straight day.
Rural areas and small metropolitan regions have seen some of the worst outbreaks in recent weeks, but by Saturday, many large cities were struggling as well.
The counties that include Chicago, Oklahoma City, Minneapolis, Anchorage and El Paso all set single-day records for new infections on Saturday. Across the country, hospitalizations have grown by about 40 percent since last month, and they continued to rise on Saturday. Around Chicago, where new restrictions on bars and other businesses took effect Friday, more than twice as many cases are now being identified each day than at the start of October.
This moment is a critical inflection point for Chicago, Mayor Lori Lightfoot has said.
States in the Midwest and Mountain West have been reporting some of the countrys most discouraging statistics, but worrisome upticks are occurring all over. New cases have emerged at or near record levels recently in Pennsylvania, Tennessee, Arkansas and New Mexico.
Over the next week, two weeks, three weeks, please be extremely conservative in deciding how much time to spend outside of the home, Gov. Michelle Lujan Grisham of New Mexico said Friday as she imposed new restrictions on businesses. The visit to friends can wait its not worth your life, or theirs.
Experts worry that the growing numbers in need of hospital care will only get worse if cases continue to mount, especially in rural areas where medical facilities could be quickly overwhelmed.
The high case count in part reflects increased testing. With about one million people tested on many days, the country is getting a far more accurate picture of how widely the virus has spread than it did in the spring.
But public health officials warn that Americans are heading into a dangerous phase, as cooler weather forces people indoors, where the virus spreads easily. It could make for a grueling winter that tests the discipline of the many people who have grown weary of masks and of turning down invitations to see family and friends.
Dr. Anthony S. Fauci, the nations top infectious disease expert, said on Friday that the country should consider implementing a first-ever national mandate requiring masks, to help control a surge in coronavirus cases across the United States that has become the most severe to date.
Appearing on CNN, Dr. Fauci said that enforcing such a mandate would be difficult. But with conditions worsening across disparate regions of the country, he said he could be inclined to recommend the dramatic measure.
Theres going to be a difficulty enforcing it, he said, but if everyone agrees that this is something thats important and they mandate it and everybody pulls together and say, you know, were going to mandate it but lets just do it, I think that would be a great idea to have everybody do it uniformly.
Most states have imposed mask requirements to varying degrees, covering different spheres such as indoor and outdoor spaces at some point during the pandemic.
However, a minority of states, including Iowa, have resisted issuing directives on masks even as case counts have begun to climb to new highs. And even states and cities that have more restrictive orders in place tend to allow some exceptions, such as when people are exercising.
The White House has obstructed federal efforts that would have mandated masks in a more limited way, blocking an order drafted by the Centers for Disease Control and Prevention last month that would have required masks on public transportation.
But with more than a dozen states reporting more cases over the past week than in any other seven-day stretch during the pandemic, Dr. Fauci said that it may be necessary to have a more coordinated, national approach.
I get the argument saying, Well if you mandate a mask, then youre going to have to enforce it and thatll create more of a problem, he said. Well, if people are not wearing masks then maybe we should be mandating it.
Even as cases have risen to their highest levels yet in the United States, the White House Coronavirus Task Force has been meeting less frequently, Dr. Fauci said on Friday, appearing on MSNBC.
Recently, the group has been meeting weekly less frequent than the sometimes daily meetings during the early spring, he said.
The last time that President Trump was at one of the White House coronavirus task force meetings, which are now virtual, was several months ago, Dr. Fauci said, adding: Direct involvement with the president in discussions I have not done that in a while.
Vice President Mike Pence leads the task force, and relays guidance from the groups medical experts to the president, Dr. Fauci said.
U.S. Roundup
More than 800 North Dakotans who tested positive for the coronavirus have been belatedly notified after the state health department faced a backlog of cases, health officials said this week.
The backlog was caused by the sharp increase in cases in the state, the health department said in a statement. Members of the North Dakota National Guard who had been helping the states contact tracing efforts since early last month were reassigned to notify the people who tested positive, a health department spokeswoman said.
With 5,613 new cases in the state over the past week 737 cases per 100,000 people the state has the highest levels of infection per person in the country, according to a New York Times database. New York State had 56 cases per 100,000 people over the past week.
To address the backlog, contact tracers began calling people who tested positive, rather than their normal duties of calling those positive cases close contacts.
People who came in close contact with someone who tested positive will no longer be contacted by public health officials, the department said, except for people in health care, K-12 schools and universities.
Instead, people who test positive will be asked to self-notify their close contacts.
In other developments around the country:
Gov. Greg Abbott of Texas asked the U.S. Health and Human Services Department on Saturday to authorize the use of an Army medical center on Fort Bliss for non-coronavirus patients in an effort to create more space for coronavirus patients at hospitals in the El Paso area.
A state of emergency issued in March by Gov. Kevin Stitt of Oklahoma was extended this week for another 30 days as the state faces record infection levels. As positive cases hit a new peak in the state, there have been an average of 1,312 new cases per day over the past week, an increase of 17 percent from the average two weeks earlier.
Warning signs flashed on Saturday that the pandemic has entered a dangerous phase across Europe, with several countries shattering daily infection records and uncertainty mounting about how the continent will battle its worst outbreak to date.
Deaths from the coronavirus in Germany surpassed 10,000 on Saturday, a disconcerting milestone in a country that has been widely admired for its ability to manage the pandemic. The number of new infections in a 24-hour period also reached a record level 14,714 although the countrys public health authority said that some of those cases should have been factored in earlier in the week but had not been because of technical issues.
Officials in Poland announced on Saturday that President Andrzej Duda had tested positive for the coronavirus at a time when the countrys de facto leader, Jaroslaw Kaczynski, was already in self-isolation after coming into contact with somebody earlier in the week who was infected.
The Belgian government, alarmed by the quickening pace of infections in the country of 11 million the second-worst in Europe behind the Czech Republic inched closer to a total lockdown with a spate of new restrictions on daily life. Officials moved up by two hours a curfew put in place last week, to 10 p.m. instead of midnight, for the next month, and required that all cultural and fitness venues such as gyms, pools, galleries and museums shut down. Commercial stores will be required to close at 8 p.m.
On Friday, several other countries, including France and Italy, recorded single-day records for new infections, according to data compiled by The New York Times. And the surge of new cases across the continent has pushed hospitalizations to alarming levels in countries such as Bulgaria, the Czech Republic and Hungary.
France, after months of falling numbers of patients in intensive care, is now facing a frightening second wave. It has recorded over one million cases and set a single-day record Friday with 42,032 new cases. The government this week expanded its nightly curfew to 38 more regions and Polynesia.
The local health authorities in Germany, who are responsible for the contact tracing of infected people, said they were increasingly overwhelmed, despite help from hundreds of soldiers who have been dispatched to communities across the country. In Frankfurt, a city of about 750,000 that serves as Germanys banking capital, the number of new cases has quadrupled since the beginning of this month, and health officials there conceded that their ability to stop chains of infection had collapsed.
It is no longer possible to trace each case, the head of Frankfurts office of public health, Ren Gottschalk, told ZDF public television on Friday.
In Italy, which reported 19,143 new cases on Friday, officials are considering closing public gyms and swimming pools, according to a Reuters report. Bars and restaurants would be closed at 6 p.m. and people would be discouraged from traveling outside their local areas.
The coronavirus has made a routine trip to the gym feel like a health threat.
Many epidemiologists consider gyms to be among the highest-risk environments, and they were some of the last businesses to reopen in New York City in early September.
Now, gyms must comply with a long list of regulations. Checking in requires a health screening; masks are mandatory, even during the most strenuous workouts; only one-third of normal occupancy is allowed; and everyone must clean, then clean some more.
At a Planet Fitness in Brooklyn, Dinara Izmagambetova, who wore a floral face mask and had a sheen of sweat after completing a two-hour workout, said she was thrilled to be back in a gym. But safety measures had made it a less sociable experience, she said.
I could ask someone how to use a machine before the outbreak, Ms. Izmagambetova said. Now Im doing a lot of Googling.
But even as gyms have reopened, their future remains unclear. Some of them have had to shut down again after Gov. Andrew M. Cuomo recently designated parts of Brooklyn and Queens coronavirus hot spots.
Despite scientists concerns, infection clusters connected to gyms in the United States have been relatively rare so far, though they have been reported in Hawaii and California.
Were not seeing outbreaks tied to gyms as heavily as something like a bar or school, said Saskia Popescu, an epidemiologist at George Mason University in Virginia.
Still, a number of the 2,000 or so gyms in New York State and fitness centers across the country face a fight for life. At least one-fourth of the more than 40,000 gyms in the United States could close by the end of the year, according to the International Health, Racquet and Sportsclub Association, an industry group. A study by Yelp said that more than 2,600 already had.
As Colorado fights a spate of late-season wildfires, with residents hoping that a predicted blizzard on Sunday will finally bring things under control, the states governor is warning that the thick smoke spreading across mountain towns could hide coronavirus outbreaks.
We do worry that the impact on respiratory conditions of the fires could mask the spread of Covid, Gov. Jared Polis said at a news conference this week, asking residents to please consider getting tested if they have a cough or sore throat.
Crews in northern Colorado have spent several grueling days battling the East Troublesome fire amid 60-mile-an-hour wind gusts. Firefighters are struggling to control the 188,000-acre wildfire, which has destroyed an unknown number of homes while roaring through ranches, lakeside resorts and Rocky Mountain National Park.
Symptoms of smoke exposure such as wheezing, coughing and shortness of breath are hard to distinguish from symptoms of the coronavirus, experts have said, making it difficult for many sufferers to know what is causing their discomfort.
The early symptoms of Covid look a lot like breathing bad air for a period of hours, Mr. Polis said.
Wildfire smoke can also make people more susceptible to catching the virus.
When your immune system is overwhelmed by particles, its not going to do such a good job fighting other things, like viruses, Sarah Henderson, a senior environmental health scientist at the British Columbia Center for Disease Control, said this summer.
As of Saturday night, there have been almost 94,000 confirmed coronavirus cases and 2,241 deaths in Colorado since the start of the pandemic, according to a New York Times database. Over the past week, the state has averaged more than 1,300 new cases per day, an increase of 79 percent from the average of two weeks earlier.
Giulia McDonnell Nieto del Rio
The day before its first kickoff of 2020, the Big Ten Conference was still unveiling rules for a football season that had been postponed, revived, truncated and compromised in efforts to contain the pandemic.
On Thursday, the conference announced a no contest rule for games canceled if team personnel tested positive for the virus which seemed inevitable because the schedule has no bye weeks and, therefore, no wiggle room for last-minute changes. The intention is to play nine games in nine weeks to catch up to the three Power Five conferences that have already started.
But just over a month ago, no one thought the Big Ten made up of 14 schools across the Midwest and Northeast would begin football on Friday night, with the University of Illinois at the University of Wisconsin, even as the home teams state ranked fourth in the country in per capita cases over the past seven days, and first among the states with Big Ten programs.
Having football while I cant go to class in a way, its nice that were having this one thing thats unifying, said Anne Isman, a sophomore at Wisconsin who is living in an apartment in Madison. At the same time, the timing feels a little off.
Fans and parties will be barred from all of the leagues stadiums, but the precautions have not fully reassured the mayors of certain Big Ten towns.
They know that what happens at the stadiums will be only one part of footballs return. Fear of groups breaking recommended social-distancing protocols led 12 mayors of areas surrounding 11 Big Ten schools to send a letter to the conference this week, citing concerns about what bringing football back means for college towns as fans congregate to watch games the virus an omnipresent risk freely floating between face paint, beer bottles and potlucks.
We know the history of football games within our cities, the mayors wrote. They generate a lot of activity, social gatherings and consumption of alcohol.
A spokesman for President Andrzej Duda of Poland said on Saturday that Mr. Duda had tested positive for the coronavirus and would go into isolation, just days after Jaroslaw Kaczynski, the deputy prime minister and head of the governing party, entered quarantine after exposure to somebody who had been infected.
The announcement came amid a moment of crisis for Poland, which has been combating one of the most severe outbreaks in Europe, with hospital beds filling at an alarming rate.
Poland largely avoided the first wave of the pandemic by imposing an early lockdown in March, and nearly a third of its more than 240,000 total cases have emerged in the past week.
The latest wave of cases has forced the country to implement new restrictions on public life and to convert the national stadium in Warsaw into a temporary field hospital that can accommodate 500 virus patients. Mr. Duda visited the stadium on Friday and met with site managers.
The new restrictions will require all cafes, bars and restaurants to close, except for takeout; gyms and swimming pools were also shut. Residents must use face coverings outside their homes, and remote teaching will become the norm for older children in primary schools, as well as in high schools and at universities.
Several months into the pandemic, Mr. Duda joined the ranks of leaders who have contracted the virus, including President Trump, Prime Minister Boris Johnson of Britain and President Jair Bolsonaro of Brazil.
The spokesman who announced Mr. Dudas condition said he was feeling well.
Monika Pronczuk and Tess Felder
global roundup
The Czech Republics prime minister has demanded the resignation of the countrys health minister after the health minister was photographed leaving a restaurant without a face covering.
The health minister, Roman Prymula, an epidemiologist who began his job in late September, has so far refused to resign. The prime minister has threatened to fire him, but he does not have the power to do so.
The Czech Republic is in the midst of the coronavirus crisis. Cases are rising faster than anywhere else in Europe, with 81,970 cases recorded over the past week. The government has been imposing more and more restrictions in the hope of containing the spread of the virus.
Mr. Prymula had announced a partial lockdown beginning Thursday that closed shops and services, barred people from leaving their homes except for vital business and limited contact with people from other households. Restaurants, bars and cafes have been closed since Oct. 14, with the exception of carryout until 8 p.m. nightly.
Despite this, Mr. Prymula was photographed by a tabloid newspaper, Blesk, leaving the premises of a restaurant after midnight wearing no face mask after a meeting with a politician, Jaroslav Faltynek, who is first chairman of Prime Minister Andrej Babiss ANO movement.
Such a mistake cannot be excused, Mr. Babis said on Friday at a news conference. I do not care what Minister Prymula and Mr. Faltynek did there, who they invited and why. We cannot preach water and drink wine. He said he would fire Mr. Prymula if he did not resign and that Mr. Faltynek would also be resigning his ANO post.
In refusing to resign, Mr. Prymula said at a news conference, I did not break any rules, I walked through the restaurant to private premises.
Though Mr. Babis can recommend that Mr. Prymula be fired, the president must agree and usually that is what happens. But President Milos Zeman has voiced doubts about the move in this case. The two were meeting in the afternoon.
In other developments around the world:
Abdelmadjid Tebboune, the president of Algeria, said on Saturday that he would quarantine himself after senior government officials had been infected with the coronavirus. He said he was feeling well and that he would continue working during his quarantine.
The Metropolitan Police arrested 18 protesters in London on Saturday following clashes between demonstrators and the police that left three officers with minor injuries, the police said. The demonstration against lockdowns attracted a large number of protesters, with many not social distancing, violating coronavirus regulations, Cmdr. Ade Adelekan said.
Messenger RNA may not be as famous as its cousin, DNA, but its having a moment in the spotlight. This crucial intermediary in the protein-making process is now being harnessed by scientists to to try to protect us from disease including Covid-19.
Companies like Moderna and Pfizer are working on mRNA vaccines that allow people to build immunity to viruses like SARS-CoV-2, the coronavirus that causes Covid-19. These vaccines contain specifically designed mRNA that instructs cells how to make viral proteins. Find out how mRNA vaccines can trigger immune cells, in this video.
