GRAND RAPIDS, MI -- As Kent Countys coronavirus cases surge to new highs, hospitals also are seeing peak or near-peak levels of coronavirus patients.
Spectrum Health data shows 111 inpatients at its health care facilities on Wednesday, Oct. 21. That a few more patients than the previous high, in the low 100s, who occupied hospital beds in early May.
But its drastically higher than in June, when Spectrum inpatient COVID-19 cases were in the 30s.
The higher patient loads are coming as Kent County appears to be a hot zone for new cases, although the entire state is trending upward.
The county now has 12,094 cases, up from about 9,400 cases on Oct. 1. The county currently has a seven-day average of 165 cases per day, thats up from 80 cases per day on Oct. 1.
Spectrum Health administrators, in a written statement, said they are watching the inpatient numbers.
We are seeing a large number of COVID patients right now, more than we had seen during our peak last spring. We are watching our capacity closely to be sure we have the team members and rooms for COVID-19 patients as well as other patients who need care, according to the statement.
RELATED: Despite new records, Michigan almost certainly had more coronavirus cases in spring
At the moment, concern is low about hospital capacity issues.
We have planned for this and are ready with testing supplies, PPE and staffing and operational plans. We ask the community to please get your flu shots and continue the COVID-19 prevention practices, including wearing masks, social distancing of at least 6 feet and washing hands often. We know these behaviors work and we need the community to help us by staying the course! It will save lives and keep people out of the hospital, according to the statement.
Other Kent County hospitals also have seen increases in inpatient numbers.
At Mercy Health St. Marys Hospital, there are now 26 inpatients with COVID-19. Thats slightly below the 29 patients recorded in early May but significantly higher than the coronavirus patient load in early September. Then, there were just four COVID-19 patients.
At Metro Health, there are now 13 inpatients with confirmed or suspected COVID-19. Thats more than early May, when the hospital had nine patients. In early September, there was just one coronavirus inpatient.
Kent County Health Director Adam London said now is a critical time for both Kent County and Michigan to keep coronavirus spread in check. With the weather colder, more people are indoors and the conditions for transmission will be greater.
When we look back at the first wave we had (in April), we had the benefit of the weather improving, London said.
London said hes concerned because the new cases are cutting across all demographics and ages. One of the most vulnerable groups is people 80 and older.
In September, there was 21 cases. So far in October, there are 97 cases involving people 80 or older.
Until a vaccine is widely available, London said the best way to prevent coronavirus spread is by the usual health recommendations -- wearing masks, social distancing and frequent hand washing.
I think the majority of the people are following the recommendations, but they are not fool proof, he said.
We need everyone to follow them, London said of the guidelines designed to limit the spread of coronavirus.
He cautioned people against having large Halloween parties or election day parties, warning that coronavirus cases could grow even more from them.
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In the last 24 hours, close to 600 cases of the coronavirus have been diagnosed in South Dakota, an increase of nearly 40% from two weeks ago. The small state has had 333 deaths since the pandemic began.
In North Dakota, the numbers are so high that a Financial Times analysis shows that if the tiny state was a country, it would have the world's most severe COVID-19 outbreak, surpassing that of the Czech Republic.
Those infection rates are overwhelming rural community hospitals, where medical resources are limited. Dr. Thomas Dean practices at the Jerauld Community Health Center in rural Wessington Springs, South Dakota. It's one of 32 rural clinics operated by Horizon Healthcare. He joins host Robin Young to talk about the dire situation.
New reported cases by day in the United States, 7-day average
New reported cases by day in the United States, 7-day average
New reported cases by day in the United States, 7-day average
New reported cases by day in the United States,
7-day average
Note: Rural areas are those counties located outside of metropolitan areas, as defined by the United States Department of Agricultures Economic Research Service. They may include small cities and towns.
The coronavirus was slow to come to Foster County, N.D., a community of just over 3,000 people in the eastern part of the state. When virus cases surged in the Northeast in the spring, the county recorded just one positive case. When national case counts peaked in mid-July, it had recorded just two more.
But by Tuesday, about one in every 20 residents had tested positive for the virus. More than half of those cases were reported in the past two weeks.
Most of the worst outbreaks in the United States right now are in rural places like Foster County. Where earlier peaks saw virus cases concentrated mainly in cities and suburbs, the current surge is the most geographically dispersed yet, and it is hitting hard remote counties that often lack a hospital or other critical health care resources.
Since late summer, per capita case and death rates in rural areas have outpaced those in metropolitan areas.
New reported deaths by day in the United States, 7-day average
New reported deaths by day in the United States, 7-day average
New reported deaths by day in the United States, 7-day average
New reported deaths by day in the United States,
7-day average
Note: Rural areas are those counties located outside of metropolitan areas, as defined by the United States Department of Agricultures Economic Research Service. They may include small cities and towns.
The total number of coronavirus cases and deaths in rural places remains smaller than those in cities because of the comparatively low population in rural areas. But the rural share of the virus burden has grown over time.
Now, about one in four deaths from the virus is recorded in a rural county. That stands in contrast to March and April, when almost every death was in a metropolitan area, as the virus tore through the Northeast, after early clusters in the Seattle area and populous parts of California.
These maps show the case rates in rural areas at different points of the national outbreak:
Avg. daily cases per million in the past week
Metro areas
are not shown
Cases in rural areas when cases peaked over the summer
The summer surge spread
to many rural counties
in the South.
Cases in rural areas when cases first peaked
Clusters at
meatpacking plants
in Iowa
Counties outside
Albany, Ga.
Avg. daily cases per million in the past week
Metro areas
are not shown
Cases in rural areas when cases peaked over the summer
The summer surge spread
to many rural counties
in the South.
Cases in rural areas when cases first peaked
Clusters at
meatpacking plants
in Iowa
Counties outside
Albany, Ga.
Avg. daily cases per million in the past week
Metro areas
are not shown
Cases in rural areas when cases peaked over the summer
The summer surge spread
to many rural counties
in the South.
Cases in rural areas when cases first peaked
Clusters at
meatpacking plants
in Iowa
Counties outside
Albany, Ga.
Avg. daily cases per million in the past week
Metro areas
are not shown
Cases in rural areas when cases peaked
over the summer
Cases in rural areas when cases first peaked
Avg. daily cases per million in the past week
Metro areas
are not shown
Cases in rural areas when cases peaked over the summer
The summer surge spread
to many rural counties
in the South.
Cases in rural areas when cases first peaked
Clusters at
meatpacking plants
in Iowa
Counties outside
Albany, Ga.
During the summer surge, rural outbreaks occurred more often than they had in the spring, but reported cases per million remained higher in cities and their suburbs than in rural counties.
It was not until August, when the outbreak was receding from Sun Belt cities like Houston, Miami and Phoenix that per capita rates of cases and deaths in rural areas surpassed those in metropolitan areas.
Now, with the national case count and hospitalization rates approaching a third peak, none of the countrys biggest hotspots are in a large city. Almost all the counties with the largest outbreaks have populations under 50,000, and most have populations under 10,000. Nearly all are in the Midwest or the Mountain West.
Though the outbreaks geographic spread is expanding, many of the same kinds of places remain at risk for clusters of infections. In Norton County, Kan., the hardest-hit county in the country relative to its population, all 62 residents of one nursing home have been infected with the virus, and 10 have died. A state prison in the county also has an outbreak.
Hospitals across the Upper Midwest and the Mountain West are also feeling the surge. Facilities are struggling with capacity, and in some cases residents are finding that the nearest hospital with available beds is hours away, or in another state.
Earlier this month, hospitals in North Dakota had to turn patients away. Bismarck, the states capital, had one staffed I.C.U. bed available as of Monday.
Overwhelmed by the record case numbers, North Dakota suspended its contact tracing program this week. New Mexicos governor, also seeing hospital beds fill up in her state, plans to put in effect new restrictions on restaurants, bars and retail stores.
And Alaska, which is experiencing record numbers, provides a cautionary tale: Even with extensive testing and robust contact tracing, the virus is poised to thrive as temperatures drop and people move activities indoors.
Most of the counties with the worst per capita outbreaks now have fewer than 10,000 people
JACKSON COUNTY, MI -- Health officials are showing increasing concern about the spread of coronavirus in Jackson County as the weather turns colder.
Daily new cases of COVID-19 are almost double the daily rate of September and four times greater than August, Jackson County Health Department officials reported on Wednesday, Oct. 21.
Related: As COVID-19 workload increases, Jackson County Health Department wans to hire more nurses
Hospitalizations have also increased, officials said, with Henry Ford Allegiance Health reporting 22 people at the hospital for in-patient treatment as of Tuesday, Oct. 20.
There have been 1,595 positive cases of COVID-19 in county residents since March, mostly in Jackson and its immediately surrounding townships, according to health department data. About 587 are considered active cases. Sixty residents have died from the virus.
The epidemiological curve for COVID-19 cases in Jackson County as of mid-October. Officials say the increasing daily rate is concerning as the weather cools and people spend more time indoors. (Courtesy of Jackson County Health Department)
About 4.7% of county residents tested for the virus receive positive results, according to the states seven-day average for the week ending on Oct. 17.
Health department officials are worried about how the virus will spread as days get shorter and colder, forcing people to spend more time indoors. The department asks people who have tested positive for COVID-19 to call close contacts to let them know as soon as possible and to immediately start their quarantine.
Health officials also remind people that receiving a negative COVID-19 test after an exposure does not mean they wont develop symptoms or test positive at a future time within the 14-day quarantine period.
Related: Michigan coronavirus numbers moving in the wrong direction, Whitmer says
Anyone with questions about the virus can contact the Jackson County Health Department at 517-788-4420, option 9, and leave a message. Call 911 if there is an emergency.
For COVID-19 testing in Jackson County, residents can contact the Henry Ford Allegiance Health COVID-19 Patient Hotline at 517-205-6100, or the Center for Family Health Hotline at 517-748-5363.
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ANNAPOLIS, Md. (WJZ) Gov. Larry Hogan on Thursday called for all 24 jurisdictions in Maryland to move to the third phase of the states coronavirus recovery plan, which several counties have not yet done.
Anne Arundel, Montgomery and Prince Georges counties, as well as Baltimore City, remain in the second phase of the recovery plan, according to the governors office.
During a news conference Thursday afternoon, Hogan said while the conditions on the ground made reopening at a slower rate earlier a prudent decision, the health metrics show more reopening can be done safely.
CORONAVIRUS RESOURCES:
Solving and slowing the spread of this virus and saving lives continues to be our most important priority, Hogan said, And with our health metrics continuing to remain low and stable, local jurisdictions should be focused on our economic health and well-being as well.
Much of the state moved to the third phase at 5 p.m. on September 4. Under that phase, movie theaters and live entertainment venues can operate at up to 50% capacity or 100 people at indoor and 250 people at outdoor venues. Retail stores, churches and houses of worship moved to 75% capacity.
The governor also said he is disappointed that a number of counties have not allocated funding from the state to help Marylanders and small businesses. Hogan said only 35% of the CARES Act funding the state allocated for 19 smaller counties in the state has been spent.
Gov. Larry Hogan Plans To Use $250M From States Rainy Day Fund For Businesses Struggling During COVID-19 Pandemic
For the latest information on coronavirus go to the Maryland Health Departments website or call 211. You can find all of WJZs coverage on coronavirus in Maryland here.
New York has added several states and territories to its travel restriction list as coronavirus cases continue to surge across the country, Governor Andrew Cuomo announced Tuesday. People who are traveling to New York from the restricted areas are required to quarantine for 14 days.
"We are now in a situation where 43 states meet the criteria for our travel advisory. This is really a bizarre outcome, considering New York once had the highest infection rate," Cuomo said in a statement.
"There is no practical way to quarantine New York from Pennsylvania, New Jersey and Connecticut. There are just too many interchanges, interconnections, and people who live in one place and work in the other. It would have a disastrous effect on the economy, and remember while we're fighting this public health pandemic we're also fighting to open up the economy. However, to the extent travel between the states is not essential, it should be avoided."
Here's the updated list of restricted states and territories:
Alaska, Alabama, Arkansas, Arizona, Colorado, Delaware, Florida, Georgia, Guam, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, New Mexico, Nevada, Ohio, Oklahoma, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, Wyoming
"It's not that I don't want to. But the patients keep on coming," said Varon, a critical care doctor and chief of staff at United Memorial Medical Center in Houston.
It used to be worse. After Covid-19 crushed the hospital earlier this year, his team juggled as many as 88 patients at once with the disease. But in the last few weeks, as few as 10 coronavirus patients needed their care.
"Then the last five days have been hell. We're getting a lot of patients. And the patients are coming in very, very ill."
For example, ventilators -- once widely used early in the pandemic -- are now used less frequently, as doctors have learned how they may injure Covid-19 lungs.
But in some places, nurses still don't have enough protective equipment. People keep flouting masks and social distancing. And rapid, at-home testing remains a pipe dream.
Here's where experts say the US stands as it enters the next phase of the Covid-19 pandemic.
What doctors have learned about treatments
Many Covid-19 patients who entered hospitals earlier this year did not make it out alive.
Since then, "the death rate per case ... has definitely dropped. And that's a tribute to modern medicine," epidemiologist Dr. Larry Brilliant said.
But as more patients survive, many are also stuck at the hospital with long-term complications.
"Before, people would come in when they were just dying. Now, we keep them alive. But many of them have very bad lung disease, and they will require long-term care," Varon said.
These days, Varon said he's again seeing patients come in with more advanced Covid-19.
"Part of that is based on what I call Covid fatigue syndrome. People are tired ... they are looking the other way. If they have symptoms, (they think) it's no big deal. And then by the time they come to us, they are very sick."
It's critical to seek medical care immediately because "at the early start of the illness when you have Covid, the virus is multiplying like there is no tomorrow," Varon said.
"The evidence on convalescent plasma as a treatment for severe cases of COVID-19 is promising but incomplete," Dr. Francis Collins, director of the National Institutes of Health, said in a written statement last month.
For now, the NIH treatment guidelines don't recommend for or against using convalescent plasma to treat Covid-19.
But this month, the World Health Organization said remdesivir has "little or no effect on mortality" for patients hospitalized with Covid-19 and it doesn't seem to help patients recover any faster, either.
Despite the ever-evolving research, "we have learned a lot," Varon said. "What I do today is not what I was doing three, four months ago."
Why ventilators might be bad for Covid-19
With many patients, "we learned that putting somebody on a ventilator is basically signing their death sentence," Varon said.
"We learned the hard way that putting pressure into your lungs in somebody that has damaged lungs, like Covid patients, was creating more injury than benefit."
Brilliant said it's "good news" that hospitals aren't using ventilators as much on Covid-19 patients.
"Doctors are not shoving ventilators down people's throats quite as quickly. That's a wonderful thing," he said.
"You know how everybody thinks that an oxygen (level) of more than 90% is good, and that's where you need to stay? We learned that because we were causing so much damage (with ventilators), maybe we should tolerate a little lower oxygen. So if it came down to 85%, we probably would be OK."
That's different from his previous methods with non-coronavirus patients, in which those with "85% (oxygen) gets a (breathing) tube. 89% gets a tube. So we learned that we can actually allow lower oxygen concentrations."
Doctors have also learned that laying patients facedown on their stomachs can help increase the amount of oxygen that's getting to their lungs.
"We're saving lives with this," Dr. Mangala Narasimhan, regional director for critical care at Northwell Health in New York, said in April.
"It's such a simple thing to do, and we've seen remarkable improvement. We can see it for every single patient."
When patients lie on their backs, the weight of the body effectively squishes some parts of the lungs.
But "by putting them on their stomachs, we're opening up parts of the lung that weren't open before," said Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital.
How hospital capacity has improved -- or not
Across the country, many hospitals are already starting to max out due to soaring Covid-19 cases, said emergency medicine physician Dr. Megan Ranney, who directs the Brown-Lifespan Center for Digital Health in Rhode Island.
"My colleagues across the country are sharing stories of their ERs getting overwhelmed, their ICUs being full, running out of nursing staff because their nurses are getting sick," Ranney said.
"We are facing the same situation that we were in in April and May in the Northeast and in July in the South. And the trouble now is that we're seeing it literally across the country," she said.
"We're hearing similar stories from my colleagues literally across the country, including here in the Northeast. We're starting to see hospitalizations tick up. We are seeing people who are much sicker than they have been since that first wave in the Northeast in the spring."
Infectious disease specialist Dr. Aileen Marty, a professor at Florida International University, said Covid-19 hospital admissions are going up in her state.
"We're balancing those by being able to get people out of the hospital sooner than we were because we've learned a lot," she said. "But it's still happening."
Some health care workers still don't have enough PPE
Fast-forward to October, and PPE shortages are still a concern, according to National Nurses United, the largest union of registered nurses in the US.
"We must currently rely on firsthand accounts from our members because hospitals are only required to report PPE stock levels to the US Department of Health and Human Services, which does not publicly release the data," the union said in a written statement.
"The lack of transparency on PPE stock and supply is outrageous."
Without sufficient PPE, health care workers treating coronavirus patients are at high risk because "the viral load -- the amount of virus -- does determine the severity of your illness," said emergency medicine physician Dr. Leana Wen, a former Baltimore health commissioner.
"So that could happen in the case of health care workers who are exposed to a lot more Covid-19 as a result of their work -- that they get more severely ill."
"Let's be clear that this pandemic is not over. Cases are rising again in many areas of the country," the union said this week.
"We are still demanding that President Trump activate the Defense Production Act to mass produce PPE, and that federal OSHA promulgate an emergency temporary standard on infectious diseases to mandate that our employers give nurses optimal PPE."
Insufficient testing is holding the US back
"We have more people infected. We have more states, we have our rural areas affected. Once again, we have hospitals filling up -- this time, not just in our major metropolitan areas, but in more rural areas. The death rates are going up," he said.
Americans should have quick, easy access to testing, Haseltine said. But that's still not the case in many places.
"One of my grandchildren had a cold. And we had to get tested. It was murderous. In New York City, there were two places that could do the rapid tests," he said. "Two places in Manhattan. That is unbelievable. And we had to wait hours -- six hours just to get tested."
Since the beginning of the pandemic, "we are a little bit better at testing, (but) not much," Haseltine said.
Haseltine said tests have gotten more accurate in recent months, and some are more affordable -- as cheap as 50 cents.
"My recommendation is make (tests) universally available to every household, and if somebody in the household is positive ... we make it economically possible by paying them to stay home -- the whole family -- for 14 days," Haseltine said.
"That could end this epidemic within three to four months."
Haseltine said he has calculated the estimated costs for "a program to get everybody three or four months' worth of free tests -- they can test everybody in their family -- and pay everybody $500 to stay home for two weeks, for their entire family" if someone tests positive.
This plan is "comparatively inexpensive, compared to what we are putting up with," Haseltine said. "If we decided to push the button now, go full-speed ahead, we could probably have this epidemic over and done with by March."
So why don't we all have Covid-19 tests in our medicine cabinets yet?
"From the President on down, most of the official leadership has been deeply misguided," Haseltine said. "They have focused first on treatment and not on prevention."
Adm. Brett Giroir, the White House testing czar, said Covid-19 testing has improved dramatically in the US.
But Giroir has repeatedly said, "We can't test our way out of this" pandemic.
"He's right in a limited way," Haseltine said. "He's right that testing isn't enough. Testing plus isolation is the way to drive this down to zero ... voluntary testing followed by paid isolation."
As for the theory that Covid-19 cases are surging just because of increased testing, "that is absolutely not the case," Haseltine said.
"That is not why hospitalizations are going up. That's not why deaths are going up."
'A war against stupidity'
Doctors are "better prepared. We're better studied. But patients are coming in. And people are being stupid," said Varon, the critical care doctor who's worked every day for seven months.
"I am fighting two wars. I am fighting a war against Covid, and I'm fighting a war against stupidity. It is unbelievable."
After spending 16 to 20 hours a day at work, Varon said he's disgusted by images of people socializing without face masks.
"I just had one of the worst weekends (at work) I've had for a very long period of time," he said. "This is not a hoax. This is real. And anybody who doesn't believe me, they can come and spend a day with me."
As for young people, "if you think nothing bad is going to happen to you, you are wrong," he said. "And I would hate to see you on long-term oxygen or being crippled, having to be on a wheelchair or a walker for the rest of your life."
That's not hyperbole.
He vividly recalls a 32-year-old man with no pre-existing conditions and was "healthy as a horse" -- until he came down with coronavirus.
"He ended up here with us in the hospital. He was a very sad story," Varon said. "He spent with us close to 70 days and eventually went home on oxygen -- probably for the rest of his life."
But there are ways to get out of this pandemic, Haseltine said.
"The first thing that we have to do right away is for everybody to take what you hear every public health official say, which is wear a mask and socially distance," he said.
"The second thing is we have to have a federal policy that we are going to do everything we can to get rapid tests in everybody's hands immediately. And we are going to pay people to stay home so they don't infect other people when they are potentially infectious."
If we take those steps, he said, "we could put this close to zero in four months."
CNN's Jen Christensen and Elizabeth Cohen contributed to this report.
Also, some experts have called for much more frequent random testing in all schools something that city officials are considering in order to increase the odds of discovering an outbreak early.
So far, most coronavirus testing for school workers has taken place at city-run sites outside the purview of the education department.
Out of 37,000 tests of staff members at city sites, 180 were positive, a city official said.
According to separate data reported to the state by local school districts, 198 public school students in New York City have tested positive since Sept. 8. (Gov. Andrew M. Cuomo in early September ordered those conducting coronavirus tests to collect school information on children, but so far compliance has been spotty, state officials said.)
The citys new schools testing regimen, which began Oct. 9, calls for 10 to 20 percent of the school population to be tested once a month, depending on the size of the school. The city is applying this testing to its 1,600 traditional public schools; the citys 260 charter schools are not included.
Some researchers have questioned the efficacy of that approach, saying it could miss a large outbreak.
Its great that New York City is doing some level of random testing, said Dr. Ashish Jha, dean of the Brown University School of Public Health. Its not at the level that would be ideal.
One study recommended testing half the students twice a month.
Michael Mulgrew, president of the teachers union, said the city is looking to increase testing to as much as three times a month citywide. Such frequency, he said, would be much more valuable in terms of keeping the virus in check.
Heres what you need to know:
key data of the day
In Ohio, more people are hospitalized with the coronavirus than at any other time during the pandemic. North Dakota, which is leading the nation in coronavirus cases per capita, reported more than 1,000 cases on Tuesday, the states worst daily total yet. And as of Monday, 16 states had added more cases in the prior week than in any other seven-day stretch.
After weeks of spread and warnings in certain areas, a third surge of coronavirus infections has now firmly taken hold across much of the United States.
The latest wave which is raging most acutely in the Midwest and the West, but is also spreading in various areas around the country threatens to be the worst of the pandemic yet.
Its arrival comes as cooler weather is forcing people indoors, setting up a grueling winter that will test the discipline of many Americans who have grown weary of wearing masks and turning down invitations to see family and friends. Over the last week, the country has averaged about 59,000 new cases a day, the most since the beginning of August. The daily total could soon surpass 75,687, a record previously set on July 16.
The high case count which has so far not translated to soaring deaths 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 the latest developments also reflect a serious new level of the outbreak. Hospitalizations, the most accurate picture of how many people are seriously sick from the virus, are on the rise nationwide, worrying many public health officials. A rise in deaths tends to lag behind a spike in cases. And deaths are creeping up in places: Officials in Wisconsin reported 36 on Tuesday, a single-day record.
Deaths among hospitalized patients have also dropped, to 7.6 percent from 25.6 percent in the spring, according to one study. That may be because doctors have better treatments at hand, and the patients are younger and in better health on average than those in the first wave.
Still, Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota, recently offered an ominous warning: With infections rising and compliance eroding, he said, the next six to 12 weeks are going to be the darkest of the entire pandemic.
The pandemic has caused nearly 300,000 deaths in the United States through early October, the Centers for Disease Control and Prevention said in a report released Tuesday. The tally includes not only deaths directly caused by the coronavirus but also nearly 100,000 fatalities that are indirectly related but would not have occurred if not for the virus.
The study is an attempt to measure excess deaths fatalities from all causes that statistically exceed those normally occurring in a certain time period.
Many experts believe this measure tracks the pandemics impact more accurately than the case fatality rate. The figure includes deaths from Covid-19 that were misclassified or missed and deaths from emergencies like heart attacks that went untreated because people were afraid to go to the hospital.
Hidden in the new numbers from the C.D.C. is a statistic that may not mean as much as it appears: While the pandemic has taken the greatest toll on older citizens, the biggest percentage increase in excess deaths has occurred among young adults ages 25 to 44, among whom there was a 26.5 percent increase as compared with an increase of 14.4 percent in those over 85, a group with a large proportion of the nations excess deaths.
But in nonpandemic times, the death rate among people in that age group is very low, so a disaster such as Covid-19 can easily bump up their death statistics without adding up to large numbers of excess deaths.
Excess deaths among Black people and Hispanics of all age groups also rose compared with previous years, the C.D.C. reports. Hispanics experienced a 54 percent increase, while Black people saw a 33 percent rise.
By comparison, the increase for white Americans was 12 percent, according to the C.D.C.
Another report, published in the Proceedings of the National Academy of Sciences, found that in April nearly half of the nations excess deaths were in New York and New Jersey. A third were in people over age 85.
But excess deaths are only part of the story, noted the authors of that paper, led by Amy Finkelstein, a professor of economics at M.I.T. While deaths last spring were concentrated in New York and New Jersey, the economic ravages from the pandemic extended nationwide, even in states with almost no deaths.
Job losses in New York and New Jersey were just a small fraction 7 percent of job losses throughout the country. And while deaths were concentrated in older people, half of those who lost their jobs nationwide were ages 25 to 44.
Concentrating on case counts or death counts, they conclude, provides only a partial picture of the pandemics devastation.
Health crises concentrated in one part of the country and one age group may have substantial economic spillovers that are felt throughout the rest of the country and on other age groups, the authors wrote.
In what might be the final months of the Trump administration, Dr. Stephen M. Hahn, the head of the Food and Drug Administration, seems to be trying to save the agency from the fate of the Centers for Disease Control and Prevention, whose scientists have been stripped of much of their authority and independence in responding to the pandemic.
To many F.D.A. scientists, Dr. Hahn has been a disappointment. Under his leadership, the F.D.A. authorized hydroxychloroquine for hospitalized Covid-19 patients despite a lack of evidence, only to reverse the decision once the drug was tied to severe side effects.
In late August, Dr. Hahn made a significant error at a news conference with the president announcing the approval of plasma treatments for Covid-19, greatly exaggerating its benefits. He later publicly corrected the record.
That debacle seems to have been a turning point for Dr. Hahn and agency scientists.
On Sept. 10, F.D.A. directors wrote a joint statement, warning that political interference could destroy the agencys credibility. Dr. Hahn tweeted his support of the statement, and later that day noted that new vaccine guidelines were coming.
Experts in the Office of Vaccines Research and Review drafted new guidelines, to make its standards unmistakable to drugmakers and reassure jittery Americans that the agency would not cut corners when assessing a vaccines safety and effectiveness.
Within days of submitting the guidelines to the White House, F.D.A. scientists, fearing they would never be made public, decided to include them in the briefing materials for an outside group of vaccine experts scheduled to meet on Oct. 22. They slipped a version into the appendix of the committees briefing materials, with a new title.
Executives from Johnson & Johnson and Merck, each with vaccine candidates, called for the guidelines release. Dr. Albert Bourla, Pfizers top executive, wrote on Twitter that he had faith in the F.D.A.s ability to set standards.
The same morning, the materials were quietly posted online. The White House was given about an hours notice, according to a senior administration official. Later that day, the White House abruptly cleared the guidelines, which were then posted to the F.D.A. website.
Despite an uptick of coronavirus cases in New Jersey, Connecticut and Pennsylvania, New York officials said on Tuesday that travelers from those three neighboring states would not be required to quarantine, though each state meets the qualifications for the restriction.
The announcement came with no small amount of confusion: A senior adviser to the governor confirmed that Pennsylvania would be added to the quarantine list, and Mr. Cuomo later indicated in a news conference that New Jersey and Connecticut would not be required to quarantine, but he did not initially mention Pennsylvania.
But the governor later clarified in a statement that enforcement from Pennsylvania would also be too difficult to maintain, considering the vast number of people who cross the states northern border into New York and its eastern border into New Jersey.
That rationale was also articulated by Mr. Cuomo in reference to Connecticut and New Jersey, two neighbors to New York that have worked together for months to try to coordinate a response to the coronavirus crisis.
There is no practical way to quarantine New York from New Jersey and Connecticut, Mr. Cuomo, a third-term Democrat, said in a morning news conference. There are just too many interchanges, there are too many interconnections, there are too many people that live in one place and work in the other.
Adding to the confusion, Beth Garvey, special counsel to Mr. Cuomo, said during the morning news conference that New Jersey and Connecticut were both being added to the list on Tuesday, despite Mr. Cuomo earlier suggesting they would not be. In a brief aside after Ms. Garveys remarks, the governor said Pennsylvania, we have the same basic issue.
None of the states were on a quarantine list released on Tuesday afternoon by the governors office.
Still, Mr. Cuomo said that all nonessential travel among New York and the three states should be avoided and promised he would issue more guidance on that point on Wednesday.
New York did add two states to its list on Tuesday: Maryland and Arizona. All told, 40 states and territories are now on the travel advisory list, which Mr. Cuomo referred to as really a bizarre outcome considering that New York once faced one of the worst outbreaks in the country.
On Monday, more than 64,200 new cases and at least 517 new deaths were reported in the United States. Over the past week, there have been an average of 59,269 cases per day, an increase of 34 percent from the average two weeks earlier, and fears are growing in New York about a potential second wave. Two weeks ago, Mr. Cuomo closed nonessential businesses in parts of Queens and Brooklyn where positivity rates had spiked.
Since late June, New York, New Jersey and Connecticut have worked in concert to create a list of states from which travelers to the region are subject to a two-week quarantine.
Essential workers have been exempt from the quarantine since it began in June. Other workers who cross state lines have technically been subject to the advisory, but officials have also said that the quarantine is only required by those who spend at least 24 hours in a state on the list which would exclude most commuters.
The quarantine was intended to apply to any person arriving from an area with a positivity rate higher than 10 per 100,000 residents over a 7-day rolling average or an area with a 10 percent or higher positivity rate over a 7-day rolling average.
New Jersey has a population of about 8.88 million people, and so anything over an average of about 888 new cases puts the state above that threshold. According to a New York Times database, New Jersey has seen an average of 1,016 cases per day in the past week, an increase of 54 percent from the average two weeks earlier.
For Connecticut, the threshold is around 356, and its daily average in the past week was at 378 cases per day.
Though New York has seen a significant increase in cases in parts of New York City and its suburbs, its overall positivity rate has remained lower than its neighbors. On Tuesday, Mr. Cuomo said the daily rate was 1.32 percent statewide, and 2.91 percent in the so-called red zones, areas where he recently imposed severe restrictions as virus hot spots sprang up across the state. Hospitalizations in the state increased by eight, to 942.
In New York City, Mayor Bill de Blasio said Tuesday that the citywide seven-day average positivity rate was at 1.58 percent.
An earlier version of this item incorrectly described when more than 64,200 new cases and at least 517 new deaths were reported in the U.S. It was Monday, not Tuesday.
President Trump and other politicians have repeatedly warned that lockdowns and similar measures could cause at least as much distress as they prevent, in particular by increasing the risk of overdoses and suicides because of economic hardship. But the evidence for that claim is sparse; on Monday, a study posted on Medrxiv, a prepublication site, found that in Massachusetts, the suicide rate during the states lengthy stay-at-home advisory last spring remained steady, neither increasing nor decreasing.
The analysis is being submitted to a journal; it has not yet undergone peer review.
This narrative that longer stay-at-home policies drive suicides doesnt bear out, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Womens Hospital in Boston and the lead author of the study. At least in a state that had a very long stay-at-home advisory, which, for all intents and purposes, was a shutdown. It was a ghost town here.
Dr. Faust led a team of researchers from Harvard and Yale who compared suicide rates from March to May, when the state was largely shut down, with the rates during the same months in 2019, which were in line with previous years. The team adjusted for background trends (U.S. rates have been increasing steadily for many groups since at least 2008) and for the numbers of deaths still under investigation as possible suicides. The rate this spring was unchanged from previous years just under one suicide a month per 100,000 people.
Our data are reassuring that an increase in suicide deaths in Massachusetts during the stay-at-home advisory did not occur, the authors concluded. Moving forward, effective prevention efforts will require comprehensive attention to the full spectrum of mental health services.
At the Andbe Home, a private nursing home in northern Kansas, a single resident tested positive for the coronavirus on Oct. 7. Two weeks later, all 62 residents have become infected, along with at least 12 staff members, and 10 of the residents have died.
That is how hard, and how fast, the virus can hammer the vulnerable in the rural Great Plains and Mountain West, where the pandemic is now raging. States in the region that were little affected in the spring and summer and tended to see the virus as a distant threat now have some of the highest per capita infection rates in the country.
It is with great sadness and concern that I announce that we have a full Covid outbreak in our home, despite the precautions we have been taking since March, Megan Mapes, the administrator of the Andbe Home, wrote Friday on Facebook.
The home has barred all visitors, and residents are isolated in their rooms, Ms. Mapes wrote.
Covid-19 is known to be particularly lethal to adults in their 60s and older who have underlying health conditions, which has put nursing home populations at a higher risk of being infected and dying. In 15 states, the number of residents and workers at nursing homes who have died accounts for at least half of all deaths from Covid-19.
Coming in a small community, such an outbreak inevitably hits home for many people. My grandmother was one of the 10 deaths, Jamie McCreery posted on Facebook. Im shattered and angry, but not at this facility or the workers, who have known the residents and their families for many years.
With a population of just 5,400, Norton County, where the Andbe Home is located, is the hardest-hit county in Kansas right now, relative to its size. The county is grappling with two serious outbreaks in the nursing home and in the Norton Correctional Facility, a state prison where 18 prisoners and three officers have tested positive. Of the 340 cases the county has reported in all, more than 300 have come this month.
The virus spreads readily in congregate living facilities like prisons, group homes and college dorms, and nursing homes have suffered some of the worst outbreaks, because older people with health issues are among the most vulnerable to the disease.
More than 540,000 coronavirus infections and more than 84,000 deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database.
Deaths in the facilities represent about 38 percent of total coronavirus deaths in the country, a slight decline from late June, when nursing homes made up about 43 percent of U.S. deaths. However, the decline may be temporary, experts warn, amid a new surge of cases.
The American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living communities across the country, released a report on Tuesday warning that U.S. nursing homes could be facing another spike.
Danielle Ivory, Mitch Smith and Timothy Williams contributed reporting.
Lucy Tompkins and Jordan Allen
Argentina has become the fifth country in the world to surpass one million confirmed Covid-19 cases.
With a population of around 45 million, Argentina is by far the smallest country on the list, which also includes the United States, India, Brazil and Russia, according to worldwide tracking by The New York Times.
Almost 100,000 of Argentinas cases have been detected in the last seven days, reflecting how infections are soaring in the country, and experts worry that the true total could be far higher. Argentinas reported test positivity rate has hovered around 50 percent for weeks and has reached as high as 75 percent, but the reliability of that data has been questioned recently, with reports that many negative test results were not recorded.
Argentina reported 12,982 new cases and 451 deaths on Monday. In total, 26,716 people have died of the coronavirus in the country, a fatality rate of 2.7 percent, according to the Health Ministry.
Argentina received praise early in the pandemic for imposing a strict quarantine in mid-March. It closed its borders and managed to keep the coronavirus largely under control while other South American countries, including neighboring Brazil, suffered gigantic outbreaks.
Though certain restrictions have since been relaxed, much of Argentina remains under some type of lockdown order.
Once concentrated in the Buenos Aires metropolitan area, the virus has since spread to much of the country, including remote areas with scarce medical resources, even though domestic flights and long-distance buses and trains have largely been grounded.
Argentinas early success in controlling the virus, which was accompanied by a sharp increase in approval ratings for President Alberto Fernndez, led to what some critics call an undue focus on the lockdown as the main strategy to combat the crisis.
What they failed to do in parallel was containment and mitigation of the pandemic, said Adolfo Rubinstein, an epidemiologist who was health minister under the previous president, Mauricio Macri, who was defeated by Mr. Fernndez last year. They needed to go out and detect community cases early, and mitigate the expansion of the pandemic.
U.S. ROUNDUP
With the number of coronavirus infections reaching record levels in New Mexico, Gov. Michelle Lujan Grisham announced new restrictions on Tuesday in the hopes of tamping down the viruss spread.
The governor indicated that the new policies were driven in part by the states health systems being overwhelmed with inpatient coronavirus cases, which has led to 81 percent of all adult hospital beds and 71 percent of intensive care unit beds being filled.
Those policies go into effect Friday, and apply to restaurants and bars, retail stores and other businesses that typically involve close contact between patrons and employees. Any that report four or more positive coronavirus cases over a two-week period will have to close their doors for 14 days. All retail establishments across New Mexico, including grocery stores, will have to close at 10 p.m. each night, and the state will also close state museums and historical sites to visitors.
This last week has been scary, Ms. Lujan Grisham said. Its been unsettling and upsetting to see everybodys hard work and sacrifice undone in only a few short weeks. That is the awful, relentless nature of this virus.
Over the past week, there have been an average of 563 cases per day, an increase of 139 percent from the average two weeks earlier, according to a New York Times database.
New Mexicos positivity rate is 6.5 percent and climbing fast, an indicator of the viruss rapid spread.
According to state contact tracers, restaurants and bars remain a top source of possible exposure to the coronavirus. Those that offer indoor dining will now have to be certified by the state to do so, including consenting to health checks for employees, as well as keeping a record of patrons to assist with contact tracing if needed. Certification will be required after Oct. 30, and indoor dining capacity will be limited to 25 percent of an establishments usual maximum.
In other U.S. news:
In Washington State, colleges and universities will now have to provide quarantine facilities for students if they are exposed to Covid-19 On Tuesday, Gov. Jay Inslee issued more restrictions for higher education campuses as the University of Washington struggles to contain an outbreak among its fraternities and sororities. There have been outbreaks in Whitman County, home of Washington State University, as well.
Officials in North Dakota reported 1,029 new cases on Tuesday, a single-day record and the first time the state has reported more than 1,000 cases in a single day.
A private school in California was ordered to pay $15,000 for ignoring a judges order to stop in-person teaching, in what The Associated Press reported could be the first ruling of its kind in California against a school for violating virus-related health orders. The judgment ended a nearly three-month legal battle between the health authorities and Immanuel Schools, a private Christian school in Californias Central Valley.
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Across the world, the countries that are waging the most successful fights against coronavirus are adopting regional and local measures to protect their populations. And thats why last week, we launched the three local Covid alert levels for England with interventions based on the prevalence of the virus in local areas. Since then weve been undertaking discussions with local leaders in those parts of the country, which are currently bearing the brunt of the second wave of this epidemic. I dont want anybody to think that your actions, our actions, are in vain or the efforts in vain because our collective action across the country has brought the R number well below its natural rate of about 3. As a result, the virus is not spreading as quickly as it did in February and March. Informed by the data that weve just seen, I can announce that Greater Manchester will move to the Very High Alert level. That means that pubs and bars must close unless theyre serving substantial meals. Households cant mix indoors or in most outdoor settings. In some public outdoor spaces, groups must be limited to the Rule of Six. And we strongly advise against travel into and out of the area.
Prime Minister Boris Johnson of Britain announced on Tuesday that Greater Manchester, the countrys second-largest urban area, would be put under the highest level of virus restrictions, shutting many pubs and bars and forbidding indoor socializing by people from different households.
The announcement came despite opposition from the areas mayor, Andy Burnham, who had pushed for greater financial aid for affected residents, and amid a spike in cases around Europe that has reinvigorated the debate over how to balance economic and health concerns.
I know these restrictions are tough on businesses and on individuals, Mr. Johnson said. Not to act would put Manchesters N.H.S. and the lives of many of Manchesters residents at risk.
Mr. Johnson pointed to the areas growing outbreak it has reported more cases over the last seven days than any other place in England, according to a New York Times database. He added that he hoped that local officials would work with the central government to carry out the restrictions, which take effect Friday.
The government will provide some 22 million pounds in aid, which Mr. Burnham argued was woefully insufficient. Talks over relief funds collapsed shortly before the announcement was made, though Mr. Johnson indicated they could be restarted.
At no point today were we offered enough to protect the poorest people in our communities through the punishing reality of the winter to come, Mr. Burnham said.
In London on Tuesday, Heathrow Airport, the countrys largest, began offering rapid tests for 80 ($104) to Hong Kong-bound passengers to meet its entry requirements, in an effort to encourage travel. The service will initially be offered for four weeks, and passengers must book it ahead of time. The tests will be done by private-sector nurses, with results expected within an hour.
Ireland on Monday became the first European country to reimpose a national lockdown, in a dramatic U-turn for the government, which two weeks ago fell short of imposing the highest level of restrictions despite advice from public health experts. The six-week period will begin on Wednesday.
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Federal health officials, public health experts, and drugmakers have said they believe FDA could issue an emergency use authorization (EUA) for a coronavirus vaccine candidate by the end of this year, meaning America could have just a few months to develop a plan to distribute the vaccine nationwide.
A vaccine approval is coming. Get ready to ask these 8 questions.
Currently, state, local, and federal officials are working on such plans, aiming to vaccinate as many Americans as possible against the novel coronavirus, which has infected nearly eight million people in the United States and has been linked to more than 215,000 deaths. But doing so won't be nearly as easy as it might seemmeaning that, even once the United States has a vaccine against the coronavirus, it could still be a while before life in America returns to "normal," experts say. Here's why.
According to the Center for American Progress (CAP), administering two doses of an authorized vaccinewhich is the dosing currently being tested in many late-stage coronavirus vaccine trialswould require the manufacturing and distribution of a total of 660 million doses to vaccinate the entire U.S. population, or at least 462 million doses to vaccinate enough Americans to achieve herd immunity. But manufacturing that many doses of a vaccine may prove difficult, particularly in light of unique challenges posed by the coronavirus pandemic.
For instance, the pandemic has caused disruptions in America's health care supply chain, which has become largely reliant on ingredients, materials, and products made in other countries. Labor and supply shortages throughout the world have resulted in the United States facing shortages of critical medical supplies, from ventilators and personal protective equipment (PPE) to ingredients needed to manufacture some prescription drugs and supplies that could be critical to the storage and distribution of coronavirus vaccines.
According to the Wall Street Journal, pharmaceutical companies are working to build supply chains of both raw materials and factory capacity to manufacture billions of doses of coronavirus vaccinesa task that's no easy feat. According to CAP, one industry executive explained that the undertaking is especially difficult because the pandemic has caused a lack of visibility on all sides of the supply chain.
And even if drugmakers can get the ingredients needed to make the vaccines, they may have a hard time finding the materials they need to store the doses. That's because medical glass has been in short supply since the start of the pandemic, which could prove to be an obstacle for vaccine manufacturers who will need millions of vials for vaccine storage, the Journal reports.
As a result, even though pharmaceutical companies are working to ramp up production as quickly as they can, it's possible that there could be a gap of months between when the first doses of an authorized coronavirus vaccine are released and the point at which a company has manufactured enough doses to vaccinate the entire country, experts say. Neel Jones Shah, global head of air carrier relationships at Flexport, told CAP, "To a T, [manufacturers are] extremely nervous about being able to bring these to market as quickly as people might expect."
Even if companies can manufacture the needed number of doses of a coronavirus vaccine, the effort to distribute a vaccine would require the "largest" vaccination campaign "ever undertaken" in America, needing unprecedented planning and coordination, according to the Washington Post.
The first obstacle the United States could encounter when distributing a new coronavirus vaccine is having the capacity and equipment needed to properly store and ship the vaccine doses, which also could be affected by the country's supply shortages, experts say. And the country could face a particular challenge when it comes to storing and shipping Pfizer's and BioNTech's coronavirus vaccine candidate, which could require a refrigeration temperature of minus 70 degrees Celsius, STAT News reports.
"[V]accine supply chains are exponentially more complex than the PPE supply chain," Shah told CAP. "You can't ruin PPE by leaving it on the tarmac for a couple of days," but "[y]ou will destroy vaccines."
And Joachim KuhnCEO of Va-Q-Tec, a manufacturer that is increasing its production of shipping containers by 50% this yeartold STAT News, "We're seeing increased demand for containers that can store product at low temperatures and longer transport duration."
Supply chain shortages also could affect health care providers' ability to administer the vaccines, the Journal reports, as syringes and needles are in high demand.
Further, officials also must craft and implement a plan detailing who would receive and administer coronavirus vaccinesand determine which Americans, if any, would get priority for receiving a vaccine first.
Last month, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a draft plan for distributing a coronavirus vaccine that prioritizes Americans based on their risk of infection, with health care workers among the first to receive the vaccine. NASEM created the plan at the request of CDC and NIH, and the proposal aims to serve as a guide for more detailed plans on how the United States should prioritize coronavirus vaccinations once a vaccine candidate is approved. For example, NASEM's proposal is intended to serve as a model for the Advisory Committee on Immunization Practices, which is an expert panel responsible for developing vaccination guidance for CDC and local, state, and tribal health authorities.
CDC also called on and has been working with states to craft plans to distribute possible coronavirus vaccines, but federal and state governments haven't yet released official details on those plans. According to the National Governors Association (NGA), CDC in July developed a preliminary coronavirus vaccine distribution plan that expanded on public health infrastructure that was originally developed to distribute a H1N1 vaccine.
Under the plan, manufacturers would deliver coronavirus vaccines to a central distributor that would then send weekly supplies of the vaccine to individual states and territories, the Post reports. The states and territories then would approve requests for vaccine doses from providers and clinics and distribute the doses to their facilities, where providers would administer the inoculation. In addition, NGA said additional supplies of the vaccine would be made available to "select private partners," such as CVS Health and Walgreens, to further "expand access."
But senior Trump administration officials have implied that the federal government could take on a bigger role in distributing the vaccine, saying the effort would be a "joint venture" between CDC and the Department of Defense (DOD), the Post reports. One of the officials said DOD would be responsible for "getting the vaccines to the right place, at the right time, in the right conditions" and supplying needles and syringes, according to the Post.
However the United States ends up distributing a coronavirus vaccine, the effort will be a major undertaking and will require a system to "track the supply, manage the allocation equitably around the country, deal with concerns with the vaccine that arise, track adverse events, and communicate clearly and transparently," Tom Inglesby, director of the Johns Hopkins Center for Health Security, said.
And Bill Foege, a former CDC director and current co-chair of the NASEM panel that released the draft distribution plan, said Americans should expect snafus. "There will be many, many problems with distribution," he told STAT News.
Another factor that could complicate plans to get Americans vaccinated is that the country's initial vaccines against the novel coronavirus may not be totally effectiveand Americans will have to choose between getting one of these initial vaccines or waiting until they know which vaccine is the most effective.
As the New York Times reports, the first round of coronavirus vaccines that become available in the United States "may provide only moderate protection, low enough to make it prudent to keep wearing a mask." And "[b]y next spring or summer, there may be several of these so-so vaccines, without a clear sense of how to choose from among them," according to the Times.
That's because current late-stage trials on coronavirus vaccine candidates are testing the candidates against placebos, instead of against each other. If the experimental vaccines were being tested against each other, researchers would have information which vaccine candidates are more effective than others. But those trials aren't happening at this time, because some U.S. officials thought it would take too long to get such trials off the ground, the Times reports. As such, it will be difficult to know which among the first batch of authorized coronavirus vaccines is most effective, according to the Times.
Further, because the first round of vaccines that become available in the United States may be effective to at least some degree, they could make it difficult for drugmakers working on potentially "superior" vaccines to conduct and complete clinical trials, the Times reports. That's because, instead of participating in a coronavirus vaccine trial or completing a vaccine trial in which they are already enrolled, Americans could choose instead to get an authorized coronavirus vaccine to acquire at least some protection against the virus.
In addition, manufacturers of later coronavirus vaccine candidates may have to prove that their candidates are more effective than the initial batch of authorized vaccines. That could make it tough to gain FDA's approval, as "[t]he difference between two vaccines will be smaller than between a vaccine and a placebo. As a result, these trials may have to be bigger and run longer," and "[t]he steep cost may be more than many of the small start-ups working on innovative vaccines can afford," the Times reports.
"That basically prevents the development of better vaccines," Naor Bar-Zeev, a vaccine expert at the Johns Hopkins University School of Medicine, told the Times.
Overall, Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic, told the Times that officials and scientists will need to be honest and open with Americans about how coronavirus vaccine candidates and what their effectiveness could mean in the future. "As long as you frame something in advance, people do better with it," he said (Spiro/Emanuel, Center for American Progress, 7/28; Twohey, New York Times, 7/16; Sun, Washington Post, 8/3; Sun, Cowan, Reuters, 7/31; Washington Post, 8/14; Fox, CNN, 8/19; Sun, Washington Post, 7/29; Silverman, "Pharmalot," STAT+, 7/30; Chen, Wall Street Journal, 7/30; Murray/Griffin, Bloomberg, 7/25; Loftus, Wall Street Journal, 8/5; Lupkin, NPR, 8/6; Rosenthal, Kaiser Health News, 7/8; Branswell/Silverman, STAT News, 10/9; Zimmer, New York Times, 10/12).
