Coronavirus hospitalizations break another record in Utah as case spike wears on – Salt Lake Tribune

Heres what you need to know:A coronavirus warning sign at a Republican campaign rally in Belgrade, Mont., last month.Credit...Tommy Martino/Associated Press

The spread of the coronavirus in the United States in recent weeks has been worse than it seems, not because of how it has been spreading but where.

The virus has been pummeling some of the least populous states in the country, but the relatively low numbers can be deceptive. The surges in rural areas have been just as severe as the spikes in densely populated cities in the Sun Belt over the summer.

North Dakota, South Dakota and Montana, for example, have announced the countrys highest number of cases on a per capita basis. Already, the North Dakota and South Dakota numbers exceed the per capita figures seen at the peak of summer surges in the Sun Belt.

Other states with large rural areas including Wyoming, Idaho, West Virginia, Nebraska, Iowa, Utah, Alaska and Oklahoma have recently recorded more cases in a seven-day stretch than in any other week of the pandemic.

We, as North Dakotans, find ourselves in the middle of a regional Covid storm, Gov. Doug Burgum said Wednesday.

But population can skew perspective.

Wessington Springs, S.D., or Shelby, Mont., are unlikely to produce the same alarming imagery amid a pandemic as New York City or Houston, where mobile morgues and packed E.R. hallways became icons of suffering.

In the last seven days, Florida had the highest number of virus-related deaths in the nation, 764. But the state has more than 21 million residents.

North Dakota had only 78 deaths but it has a population of 762,000.

Governor Burgum warned of additional adversity and perhaps deadlier outcomes after months of watching from afar as other places faced large outbreaks.

And, he said, were doing this at a time when perhaps our citizens and parents and many are fatigued at the stress of managing this for so long.

It is hardly just the countrys less populated regions that have health experts worried. Numbers are up across the country, and around the world.

I dont know why anybody would think its not so bad, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and an expert on contagious diseases. We went to a low of around 35,000 cases per day late in the summer. Now were up to over 50,000, with those numbers climbing every day. Nationally, its going back up, and Im really worried that were seeing a big increase.

But the pattern appears to be shifting.

In the more populous states where case increases are being seen, including Wisconsin and Illinois, the worst numbers are not coming from the largest population centers.

In Wisconsin, rural counties in the states northeast, as well as midsize metropolitan areas like Oshkosh, Appleton and Sheboygan, are reporting the most discouraging data. In Illinois, cases are rising around Chicago, but the per capita figures are much worse around the far-smaller cities of Rockford and Decatur, as well as in rural counties in the states south.

The weekly number of new coronavirus cases in Europe is now at its highest point since the start of the pandemic, a top World Health Organization official said on Thursday, urging governments to impose tighter, targeted controls on social gatherings.

The number of confirmed cases in Europe rose by a million to seven million in just 10 days, Hans Kluge, the WH.O.s director for Europe, told reporters, and the number of daily deaths had passed the level of 1,000 for the first time in months. (An earlier version of this item stated incorrectly the last time daily deaths in Europe had passed 1,000; it was earlier this year, not ever.)

His warning came as Britain announced tightened restrictions on several areas, including London, where people from different households will be barred from meeting indoors starting after midnight on Friday. People will also be discouraged from using public transportation.

The new measures will also apply to the city of York, in northern England, as well as to parts of central and southeastern England.

Many European countries are adopting stricter controls, which Dr. Kluge called absolutely necessary, as increased caseloads are raising fears of another surge as winter approaches.

On Wednesday, President Emmanuel Macron of France announced that, starting on Saturday, the authorities would impose a curfew from 9 p.m. to 6 a.m. in the Paris region and around eight other major cities. The curfews will run for at least four weeks.

The measure is part of a renewed state of emergency that allows the national government to restrict public gatherings and movement countrywide. It was first declared in the spring but had ended in July.

We need this and if we dont want to take harsher measures in 15 days, or three weeks, or one month, we have to do it and comply with it, Mr. Macron said.

In Germany, Chancellor Angela Merkel and state governors have also agreed to nationwide restrictions on social gatherings and domestic travel, in response to a rise in infections.

I am convinced that what we do and what we dont do in these coming days and weeks will be decisive in how we get through this pandemic, Ms. Merkel at a news conference on Wednesday.

Nick Saban, the University of Alabamas coach and one of the most powerful figures in college sports, said Wednesday that he had tested positive for the coronavirus.

Sabans announcement came as for the second time this week the Southeastern Conference postponed a game because of the coronavirus, unnerving fans and players less than a month into the season that sustains an economic and cultural juggernaut throughout the South.

During a news conference conducted over Zoom, Saban, seemingly alone and wearing a face mask around his neck, said he had been very surprised to learn he was infected. He was tested as part of Alabamas daily screening of its football program.

I personally think I did a really good job of trying to manage my personal space, Saban said. And that would be what Ive informed our players to try to do, because you have to respect this disease.

Saban said in a statement that he was asymptomatic and staying at his home in Tuscaloosa. Alabamas athletic director, Greg Byrne, also tested positive, the university said.

Both immediately left the facility and went to their homes to self-isolate after receiving that information, Dr. Jimmy Robinson, Alabamas team doctor, and Jeff Allen, the football teams head athletic trainer, said in a statement. At this point in time, the positive tests are limited to those two individuals. All individuals who are considered high-risk contacts have been notified and will follow quarantine guidelines.

Saban, Alabamas coach since 2007, has won five national championships at Alabama and one at Louisiana State. He said that Steve Sarkisian, the offensive coordinator, would oversee game preparations at the football complex while he worked from home.

The second-ranked team is scheduled to play No. 3 Georgia on Saturday.

But the Southeastern Conference said Wednesday that Saturdays game between No. 10 Florida and Louisiana State, the reigning national champion, would not be played until at least Dec. 12, a week before the conference title game.

The postponement came two days after Floridas coach, Dan Mullen, described the football program as a model of safety during the pandemic and a day after the team paused football activities because of an increase in positive tests for the virus.

Floridas game against L.S.U., which was to be played in Gainesville, Fla., is the 29th Football Bowl Subdivision game since last August to be upended because of the pandemic.

The Big 12 Conference announced on Sunday that Baylor and Oklahoma State would not play this weekend because of an outbreak at Baylor. And on Monday, the conference postponed a game between Missouri and Vanderbilt after Vanderbilt concluded that once injuries, opt-outs and virus-related concerns were considered, it would not have enough scholarship players available to compete on Saturday.

Dr. Anthony S. Fauci, the nations leading infectious disease expert, took issue on Wednesday with President Trumps repeated claims that 100 million doses of coronavirus vaccine would be ready by the end of the year.

For a vaccine that is proven safe and effective, its not going to be 100 million doses, Dr. Fauci said in an interview streamed live with the CBS Evening News anchor and managing editor Norah ODonnell.

Dr. Fauci agreed that there may be millions of vaccine doses ready by January from the six companies now developing them in partnership with the federal government, but he stressed that they must each be vetted before they would be made available to the public. Right now, there are several vaccine candidates whose safety and effectiveness should be known by November or December, Dr. Fauci said.

He said he expected that there would be widespread distribution of a vaccine by the end of April. The federal governments goal is 700 million doses, he said.

Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, has had an increasingly contentious relationship with Mr. Trump as the pandemic has spread. During the interview with Ms. ODonnell, he made no secret of his concerns about Mr. Trumps continued campaign events, which tend to include many maskless participants.

When you have congregate settings and people are close to each other, and you dont have everyone wearing a mask, that is a risky situation, Dr. Fauci said. Even a partially open space, such as an airplane hanger, is not safe, according to Dr. Fauci.

He said he was pleased by Mr. Trumps recovery from the virus, but cautioned that others in the presidents position age 74 and overweight should not assume they would also do as well.

Such thinking, Dr. Fauci said, would be like watching someone drive 95 miles an hour without crashing and thinking, So, I can go ahead and speed and not get into an accident.

There are a lot of people his age and weight that did not do as well as the president did, Dr. Fauci said.

After receiving a heavy infusion of monoclonal antibodies to treat his bout of Covid-19, President Trump declared that he is immune to the virus that causes it and talked privately about wearing a Superman T-shirt under his dress shirt when he left the hospital.

Even as the president has exulted in his supposed imperviousness to the coronavirus that is resurging across parts of the country, he has delighted in portraying former Vice President Joseph R. Biden Jr. as vulnerable and cloistered, wearing masks every time you see him.

But if the president is in fact now immune to the virus, he may not remain so, scientists warn. His treatment may have prevented his body from making the antibodies necessary for long-term protection.

The experimental monoclonal antibodies Mr. Trump received were produced by the drug company Regeneron and will wane in a matter of weeks, as the synthetic molecules are known to do. Unless they are replenished, Mr. Trump may be left more susceptible to the virus than most patients who had Covid-19 and recovered, several experts warned.

Moreover, the steroid treatment the president received early in the course of his illness suppresses the bodys natural immune response, including its propensity to make antibodies of its own.

He may be not protected the second time around, especially because he didnt develop his own antibodies, said Akiko Iwasaki, an immunologist at Yale University.

Most people who are infected with the coronavirus produce antibodies that should protect them from a second infection. Its unclear how long this immunity lasts. Research into other coronaviruses suggests that it may be up to a year, experts have said.

As New York State continues to fight the apparent resurgence of the coronavirus in several hot spots, Gov. Andrew M. Cuomo threatened at one point on Wednesday to withhold state funds from local governments that do not successfully enforce shutdowns on schools and restrictions on gathering.

During a morning call with reporters, Mr. Cuomo specifically mentioned New York City and Orange and Rockland counties in the northern suburbs, including the town of Ramapo and village of Spring Valley, all of which have areas with the highest positivity rates in the state. Mr. Cuomo said he was frustrated by reports of continued gathering in those areas, including at schools and houses of worship, despite restrictions imposed by the state last week.

Hopefully that will motivate them, the governor said of local governments.

The governor did not provide details on what sources of funding could be withheld, or how much money could be denied to local governments, though he said the state could impound all funds. His office later said no withholding of funds was imminent, characterizing Mr. Cuomos comments as a warning. (Later in the day, he issued an executive order authorizing such moves.)

Still, a spokesman for Mayor Bill de Blasio of New York City criticized the governors comments, suggesting that such tactics were counterproductive.

What drives NYCs COVID response and enforcement is the threat of a second wave, not threats of federal or state funding cuts, the spokesman, Bill Neidhardt, said on Twitter.

The Rockland County executive, Ed Day, said in a statement that he generally supported the governors restrictions and that the county had taken steps to enforce them. But he singled out both Ramapo and Spring Valley, saying that those localities, which have a majority of the countys cases, flat out refuse to enforce the governors executive orders.

Mr. Cuomo also said that the state could withhold funds from both public and private schools that had already violated state orders, including those in red zones, or areas with the most severe restrictions, that had not closed as required. The schools would be notified in letters beginning on Wednesday, he said.

Statewide, the daily rate of positive test results was 1.1 percent, Mr. Cuomo said. But in the red zones, the positivity rate was at 6.29 percent, up from 4.13 the day before.

And hospitalizations in the state increased to 938, up 15 from the day prior, the governor said. The state has seen a sustained increase in hospitalizations over the last 10 days.

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And what were seeing well go over the indicators in a little bit but were seeing, thankfully, is some leveling off, certainly in the city. Overall, some leveling off in the communities that have been most affected. So far, the overall picture is steady and that is good news. We need to see more progress obviously in the zones of greatest concern. We need to keep an eye on other neighborhoods, surrounding areas. Make sure that the situation is contained. But what were seeing overall, in terms of the city indicators, suggests that we are making some progress. And Ive said, this is a decisive week, truly decisive. We have to stop a second wave from hitting New York City. And we have the power to do it. Its really important to wear that mask regularly. If you go to work. If you go to a store, if you are any place with people you dont live with, wear that mask. It makes a huge difference its the simplest tool. Its made such a difference for the city. Especially with colder weather coming on, more indoor activity, that people cannot let the guard down need to keep that mask as a central part of our strategy. That plus social distancing plus testing will be the key to stopping this threat of a second wave and moving us forward.

In a news conference earlier on Wednesday, Mr. de Blasio said that the citys seven-day average positivity rate was at 1.46 percent. He also sounded an upbeat note on positivity rates in the red zones.

Leveling off is the right phrase, Mr. de Blasio said, without specifying positivity rates in the zones.

At his briefing, Mr. Cuomo also criticized a Sept. 25 birthday party on Long Island that left 37 people infected and 270 in quarantine. Steve Bellone, Suffolk Countys executive, said in a statement that there were 81 guests in attendance, well over the 50 currently permitted under state rules.

In an interview on Wednesday, Mr. Bellone said that there had been multiple complaints about health rule violations at the inn before the party. The owners of the inn, which has closed temporarily, will be fined $12,000, officials said Wednesday.

Decisions about whether to reopen schools in the United States this fall were driven more by politics and teachers unions than by scientific evidence about the risk of coronavirus infection, according to research by political scientists at Boston College and the University of North Texas.

Their working paper, which draws on a database of school reopening plans for more than 10,000 of the nations roughly 13,000 school districts, has not been peer reviewed. But its findings are in line with those of previous research on what has driven decisions about school reopenings during the pandemic.

The authors, Michael T. Hartney and Leslie K. Finger, evaluated the influence of different factors on a districts decision. They found that a school systems size and the share of the vote won there by Donald J. Trump in 2016 were by far the strongest predictors of whether schools opened in person far more so than the average daily rate of new coronavirus cases in the county where a district was located.

Independent public health experts argued that school districts should make decisions about reopening based on local data about the transmission of the virus, as well as schools ability to put in place safety measures like social distancing and adequate ventilation. But the decisions quickly took on a political bent, the authors said.

President Trumps demands that schools reopen and his insistence that the worst of the pandemic was behind the country were embraced by his followers, who pushed for schools to reopen, while hardening the conviction of some educators and parents that teaching in person was unsafe.

Senior White House officials put pressure this summer on the Centers for Disease Control and Prevention to play down the risks of sending children back to the classroom, frustrating public health experts.

At the same time, as caseloads began to climb again in some parts of the country, teachers unions increasingly sought to protect their members by opposing in-person instruction. As a result, most large districts started the year remotely.

There may not be a Democratic or Republican way to clean the streets, the papers authors wrote, but, according to our findings, there are two distinctly partisan approaches to reopening Americas schools.

More than seven months into the coronavirus pandemic, the rules and regulations that govern daily life in the United States continue to vary widely, forcing people to interpret a checkerboard map of mask requirements, restaurant occupancy restrictions and travel guidelines.

What a person can and cannot do go to a nightclub, throw a Halloween party, get a nose piercing largely depends on where that person lives.

Many residents of Florida are free to work out at indoor gyms, eat inside at restaurants and mingle in crowded bars. But a resident of Los Angeles County, Calif., can do none of those things.

Right now we really have 50 different experiments going on, said L. Scott Benson, a professor at the University of Utahs Division of Public Health.

Throughout the pandemic, discordant protocols across state lines have frustrated governors and public health officials trying to contain the spread of the coronavirus.

In March, Gov. Andy Beshear of Kentucky lamented that residents could hop the border into neighboring Tennessee and eat at indoor restaurants. Those types of variations continue today, and even exist within individual states.

Theyre realizing that, well, if bars across the river are open, you can always go over to the bar over there, said Robert D. Duval, a professor in West Virginia Universitys Department of Health Policy, Management and Leadership. He added that people have to understand that such behavior prolongs the need for the rules in the first place.

On Tuesday, Gov. Gary Herbert of Utah unveiled new rules that apply on a county-by-county basis depending on the rates of virus transmission. Under the restrictions, a resident of Wasatch County could attend a social gathering of 10 people or fewer, while a person in neighboring Duchesne County could attend a gathering with as many as 50 people.

Mr. Benson and other public health experts said a one-size-fits-all coronavirus response would be impractical. People in rural areas require different rules than those in dense, urban populations, they say.

With cases surging in Wisconsin, Gov. Tony Evers issued an order last week that would limit indoor dining at most bars and restaurants to 25 percent capacity. But that order was blocked on Wednesday by a county circuit judge over concerns that it disproportionately affected smaller businesses that would be unable to operate profitably under such tight restrictions.

This is a dangerous decision that leaves our state without a statewide effort to contain this virus, said Britt Cudaback, a representative for Mr. Evers. We will be challenging the decision, and in the meantime, we need Wisconsinites to stay home and help us prevent the spread of Covid-19.

This week, two high-profile, late-stage clinical trials Johnson & Johnsons test of a coronavirus vaccine and Eli Lillys study of a Covid-19 drug were put on pause because of possible safety concerns. Just a month earlier, AstraZenecas vaccine trial was paused after two volunteers became seriously ill.

Clinical trials experts said these delays were comforting, in a way: They show that the researchers were following proper safety procedures. But for now, details about the nature of the volunteers illnesses are scant. And although pauses of vaccine trials are not unusual, some experts said that pausing treatment trials like that of Eli Lillys antibody drug is rarer, and perhaps more worrisome.

That trial was testing the treatment on hospitalized patients a group that was already sick, and in which declines in health would not be surprising. So for a trial like that one to be paused, the safety concerns must have been significant, they said.

Ive done 50-plus monitoring committees, and its quite a rare thing to do, said Tim Friede, a biostatistician at University Medical Center Gottingen in Germany, referring to his role as a safety monitor for drug trials.

For now, the companies behind the trials arent saying much. In a statement in September, AstraZeneca said it had paused its trial to investigate a single event of an unexplained illness. But two vaccinated volunteers reportedly developed the same condition, an inflammation of the spinal cord called transverse myelitis.

Johnson & Johnson said that it was pausing its vaccine trial because of an unexplained illness. Eli Lillys trial of the antibody treatment was paused because of a so far undisclosed health difference between the group that received the drug and the group that received a placebo.

When people volunteer for a late-stage trial, known as Phase 3, they randomly get a treatment or a placebo, and neither they nor their doctor knows which one they received. In the weeks that follow, theyre carefully monitored. People in a vaccine trial may get a checkup each month and record any symptoms they experience in a journal. People who get a drug while theyre hospitalized may be given blood tests and medical exams.

Barron Trump, the presidents youngest son, tested positive for the coronavirus at one point, Melania Trump, the first lady, revealed on Wednesday, adding that he has since tested negative.

The White House had previously said that Barron Trump, 14, had tested negative for the virus. But Mrs. Trump said in a statement Wednesday that my fear came true when he was tested again and it came up positive.

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

Utah shattered its previous record for coronavirus hospitalizations Friday and one of the states largest hospitals said it was forced to set up extra beds because the intensive care unit was full.

University of Utah Hospital was bringing in doctors and nurses for overtime shifts Friday to staff new beds after its ICU reached more than 100% capacity, said hospital spokeswoman Suzanne Winchester.

The hospital in March set up a regular unit to have the monitoring capability of an ICU, said Dr. Russell Vinik, chief medical operations officer.

But we dont have staffing for that ICU," he said. "That is made by doctors, nurses, therapists working extra shifts and extra time.

The hospital normally has room for 111 ICU patients, Vinik said. With the makeshift ICU, there is room for 134 patients but with 115 patients admitted as of Friday, there was room for only 19 more, he said. The hospital had been adding three or four ICU patients each week but with 1,496 new cases Friday, Utah saw its weekly rate of new cases reach unprecedented levels this week, and that means even more new ICU patients are likely on the way.

That makes us that much more concerned in preparing for whats ahead of us for the next month or more, Vinik said. We have dedicated staff and everybodys pitching in, but we cant keep doing this for months and months. We need the publics help to do what they can do.

The spike in cases is unsustainable, Gov. Gary Herbert agreed in a statement released with the daily coronavirus report. Utahns must wear a mask around others, socially distance, and limit social gathering sizes. Unless we do these things, we can expect to see more sobering days like today."

Salt Lake City Mayor Erin Mendenhall called this a deciding moment.

The actions we take in the days ahead will determine whether or not our systems are able to handle our healthcare needs, Mendenhall said. We have to do everything we can.

Herbert said four more counties are expected to be declared high transmission areas next week, a designation that brings heightened restrictions, such as longer-term mask requirements and limits on social gatherings. Six counties were already in that category as of this week.

The 15 moderate transmission counties already were under mask requirements and 10-person limits on gatherings as part of what state officials are calling a two-week circuit breaker intended to reduce infection rates during a weeks-long spike that has made Utahs outbreak one of the worst in the nation. The 15 moderate counties are Box Elder, Carbon, Davis, Grand, Iron, Millard, Morgan, San Juan, Sanpete, Sevier, Summit, Tooele, Uintah, Washington and Weber.

Its unclear which four of those counties are on track for tighter restrictions; nine of them now have per-capita rates of new cases that exceed the states threshold for high" transmission levels, but another criterion the percentage of tests that come back positive is not reported daily at the county level.

The six counties now under the states highest restrictions are Salt Lake, Utah, Wasatch, Cache, Juab and Garfield. A seventh, Piute County, had both the states worst number of new infections per capita and percentage of tests with positive results, but it remained in the low transmission category because its small population made its data relatively unstable, said Utah Department of Health spokesman Tom Hudachko. It is considered under review but the virus has become so pervasive there that the countys schools were forced to shut down because so many employees were on quarantine.

Utahs new guidelines are more strict than they were, but they remain more lax than other, national models.

For example, the White House Coronavirus Task Force guidelines assign the highest-risk red zone label to any county with more than 101 weekly cases per 100,000 people less than Utahs high transmission two-week infection rate of 325. Under the White House metrics, 23 of Utahs 29 counties would have the most stringent rules. The same White House guidelines place any county reporting more than 10% of its tests as positive in the highest-risk category a lower bar than Utahs threshold of 13%.

Meanwhile, public health teams at Harvard and Brown universities developed metrics that define transmission risks at their highest level when a population confirms an average of 25 daily cases per 100,000 people during one week, or 350 new cases in two weeks. Thats slightly higher than Utahs two-week case threshold but the model also calls for more aggressive restrictions at that level, advising: Stay-at-home orders necessary. If that were to be implemented here, 13 of Utahs counties would be under lockdown.

And the numbers are only getting worse. For the past week, the Utah Department of Health has tallied 1,224 new positive test results a day, on average, continuing a streak of new record highs.

Utahs death toll from the coronavirus stood at 537 on Friday, with eight fatalities reported since Thursday:

Hospitalizations rose sharply Friday, with 290 Utah patients actively getting care, the state reported, far exceeding the previous high of 259. The weekly average also hit a record high at 256.

In total, 4,559 patients have been hospitalized in Utah for COVID-19, up 48 from Friday. For the past two weeks, the state has reported 643 new hospitalizations, by far the most of any 14-day stretch.

Utahs ICUs were 75% occupied as of Friday, above the states threshold to move counties to high restrictions under some circumstances, according to the states guidelines.

The rate of new cases per capita remained higher in Utah County than in any other local health district, but with a record-breaking 696 new cases, Salt Lake County was approaching similar infection rates. Herriman reported the most cases per capita in the past week, followed by Draper and the eastern neighborhoods of West Valley City.

Wasatch and Tooele counties and the Central and Southeast Utah health districts also reported record new cases for the past week.

Statewide, the positivity rate remains in the 13% to 14% range that state officials say indicates there are far more people sick than those getting tested. On Friday, it was at 13.9%.

There were 9,307 new test results reported on Friday, above the weeklong average of about 8,000 new tests per day.

Stephan Schmitz (Folio Art)

By Charles PillerOct. 14, 2020 , 6:15 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

This story was also supported by the Science Fund for Investigative Reporting. Please help Science pursue ambitious journalism projects.

On the morning of 13July, more than 20 COVID-19 experts from across the U.S. government assembled in a conference room at the Department of Health and Human Services, steps from the Capitol. The group conferred on how best to gather key data on available beds and supplies of medicine and protective gear from thousands of hospitals. Around the table, masks concealed their expressions, but with COVID-19 cases surging out of control in some parts of the country, their grave mood was unmistakable, say two people who were in the room.

Irum Zaidi, a top aide to White House Coronavirus Task Force Coordinator Deborah Birx, chaired the meeting. Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Preventions (CDCs) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birxs demand that hospitals report 100% of their COVID-19 data every day.

According to two officials in the meeting, one CDC staffer left and immediately began to sob, saying, I refuse to do this. I cannot work with people like this. It is so toxic. That person soon resigned from the pandemic data team, sources say.

Other CDC staffers considered the decision arbitrary and destructive. Anyone who knows the data supply chain in the U.S. knows [getting all the data daily] is impossible during a pandemic, says one high-level expert at CDC. And they considered Birxs imperative unnecessary because staffers with decades of experience could confidently estimate missing numbers from partial data.

Why are they not listening to us? a CDC official at the meeting recalls thinking. Several CDC staffers predicted the new data system would fail, with ominous implications. Birx has been on a monthslong rampage against our data, one texted to a colleague shortly afterward. Good f---ing luck getting the hospitals to clean up their data and update daily.

When Birx, a physician with a background in HIV/AIDS research, was named coordinator of the task force in February, she was widely praised as a tough, indefatigable manager and a voice of data-driven reason. But some of her actions have undermined the effectiveness of the worlds preeminent public health agency, according to a Science investigation. Interviews with nine current CDC employees, several of them senior agency leaders, and 20 former agency leaders and public health expertsas well as a review of more than 100 official emails, memos, and other documentssuggest Birxs hospital data takeover fits a pattern in which she opposed CDC guidance, sometimes promoting President Donald Trumps policies or views against scientific consensus.

As coordinator of the White House Coronavirus Task Force, Deborah Birx, shown at a March news conference, has played a central role in the Trump administrations response to the pandemic.

The agencys loss of control over hospital data is emblematic of its decline in nine short months. Since the pandemic began, CDC has foundered (see sidebar, below). It has committed unforced errors, such as shipping out faulty coronavirus tests, and has been squelched or ignored amid continual political interference.

CDC employees with whomSciencespokewho requested anonymity because they fear retaliationalong with other public health leaders, say Birxs actions, abetted by a chaotic White House command structure and weak leadership from CDC Director Robert Redfield, have contributed to what amounts to an existential crisis for the agency. And her disrespect for CDC has sent morale plummeting, senior officials say. During a May task force meeting,The Washington Postreported, Birx said: There is nothing from the CDC that I can trust.

CDC scientists and others say Birxs record echoes her approach as head of the Presidents Emergency Plan for AIDS Relief (PEPFAR) since 2014. Although that program is widely praised, people who worked on it for years say her draconian management and unrealistic data demands damaged morale and disrupted fieldwork and patient services.

Through the office of Vice President Mike Pence, who heads the task force, Birx declined to be interviewed or to respond to written questions, including whether the White House pressured her to use TeleTrackings system. (TeleTrackings majority owner, real estate developer Michael Zamagias, has donated to Republican candidates and has ties to Trump businesses through colleagues, according to an NPR report.)

Redfield also declined to be interviewed or to respond to written questions. In a statement, he said: I will do everything in my power to support [CDC scientists] as I maintain my commitment to lead this agency grounded in data, science, and public service.

Birxs admirers, including Emory University epidemiologist Carlos del Rio, credit her with sometimes pushing back against antiscientific White House policies.And Anthony Fauci, respected head of the National Institute of Allergy and Infectious Diseasesand fellow task force member, has consistently praised Birx as someone who picks her battles to exert positive influence in the long run. He has suggested her recent trips to advise state health leaders have helped reduce COVID-19 cases.

Birx is in a horribly difficult position, saysNancy Cox, former director of CDCs influenza division and now an affiliated retiree of the agency. She wants to stay in the good graces of the president and the rest of the administration while trying to do the right thing with respect to public health. Do I view her as a good scientist who gets things done? Yes.

But Birxs lack of background in respiratory disease outbreaks has left her with blind spots, as has her management style, Cox says. Do I view her as someone who is willing to railroad people into doing what she has decided is the right thing to do? Yes. Does she listen real well? Not necessarily. One result was the debacle with the hospital data.

The interviews and documents obtained byScienceshow Birx replaced a functional, if imperfect, CDC data systemwell understood by hospitals and state health departmentswith an error-ridden and unreliable filter on hospital needs that sometimes displays nonsensical data, such as negative numbers of beds. Such problems could hamper effective distribution of federal resources during an anticipated fall and winter spike in COVID-19 and flu cases, CDC officials say.

This is the surreal part of it: They are attempting to replicate something we built over 15years. And they are failing, says a high-level CDC official with personal knowledge of the system. Either Birx isnt looking at the data, or shes looking awaybecause its an absolute disaster.

When Trump installed Birx to coordinate the task force on 27February, she was widely regarded as a strong choice, even by the presidents critics. Public health scientists hoped her data driven discipline, political adroitness, long-standing ties to Redfield, and military bearingshe spent 28years in the Armycould insulate the pandemic response and CDC against some of Trumps damaging impulses. Her new role gave her the ability to exert substantial authority over CDC (see organizational chart, below).

At that point, the agency was already struggling. Among other mistakes, CDC had botched the rollout of its initial COVID-19 tests in early February. And the Trump administration had attacked or muzzled agency leaders for speaking basic truths and repeatedly forced CDC to soften its scientific advice.

Birx appeared to have the experience to bolster the agency. She had worked as a fellow in cellular immunology under Fauci and later became lab deputy to Redfield at the Walter Reed Army Institute of Research (WRAIR), where he directed AIDS vaccine research. The pair co-authored numerous scientific papers during the late 1980s and early 90s. When Redfield was investigated for possible misconduct after presenting overly rosy data on a vaccine therapy approach to AIDS treatment at a 1992 Amsterdam conference, Birx defended him to Army investigators. (The investigation found errors but cleared Redfield of misconduct charges.)

A working organization chart obtained by Science shows Deborah Birxs central roles in the federal COVID-19 response. She coordinates the White House Coronavirus Task Force (WHCTF) and co-chairs two of its three divisions: the unified coordination group, which manages the response from the Department of Health and Human Services (HHS) and the Department of Defense (DOD); and Operation Warp Speed, which develops vaccines in cooperation with several agencies. Domestic manufacturing coordinates production of personal protective gear and other needs. The physician advisory group has only an advisory role. Listed individuals co-chair the groups. (This chart was issued on 31 July.)

V. Altounian/Science

Soon after, Redfield retired from the military to co-found the Institute of Human Virology at the University of Maryland. Birx assumed his job at WRAIR, then rose to direct the U.S. Military HIV Research Program. She next moved to CDC, directing its global AIDS project for 9years. In 2014, then-President Barack Obama appointed her as global AIDS ambassador and head of the Department of States PEPFAR. That project has been seen by many people as an exemplary foreign aid program. It is credited with saving millions of lives in the developing world since its founding in 2003 and sharply lowering HIV infection rates among girls and young women, among other achievements.

Birx set out to strengthen PEPFAR data systems and move funds to where they could save the most lives, those familiar with the program say. PEPFAR had a mandate of doing more with the same budget, says del Rio, who chairs PEPFARs Scientific Advisory Board. Birx succeeded by squeezing out inefficiencies, and being very data driven, and by cutting drug costs, he says.

Sten Vermund, dean of the Yale School of Public Health, led PEPFAR programs in Africa under Birx and her predecessor, Eric Goosby. Vermund praises Birxs industry and science and notes that his Mozambique program got more funding under her leadership. Birx also deftly shepherded PEPFAR into the Trump era with no budget cuts, and her plan to refocus PEPFAR made sense, says Amanda Glassman, executive vice president of the Center for Global Development, a Washington, D.C. and London-based research group.

But Glassman and Vermund also agree that Birx made constant, burdensome, urgent demands for data on HIV/AIDS cases, treatments, and other factors. Vermund says those demands sometimes disrupted services for patients. He describes some of Birxs data demands as almost whimsical and their purposes opaque, calling her leadership style authoritarian.

That description is backed by a blistering audit of PEPFARs work in four African countries, issued in February by the Department of States inspector general (IG). Most of the PEPFAR staff auditors interviewed in 2019 said their input was ignored and that program heads, led by Birx, set unachievable benchmarks.

One PEPFAR staffer told auditors that a target for the number of people on antiretroviral therapy in one country was actually greater than the number of people living with HIV. Some staff described PEPFAR management as autocratic or dictatorial. One said high-level technical staff adopted an approach of just obey and move on. Working in fear and a space where nothing is negotiable.

Programs that missed data quotas could have their funding cut off, a situation a third staffer described as a recipe for cooking data. The data targets put a lot of pressure on the [local] partners, a fourth staffer told the IG investigators. Sometimes, you are not even sure that the numbers are true. Especially when you go to the field and look at the [patient] registers. You cannot verify that they are real patients. A CDC PEPFAR manager toldSciencethat Countries need the money, so program staff manipulated performance data.

Vermund says his program never falsified data, but we knew for a fact that others did not necessarily tell the truth, [using] exaggerations to make themselves look better. He says some programs double-counted patients who entered treatment, dropped out, and then returned. Perverse incentives were created based on the data-driven outcomes. Despite the pressure, the audit showed, Birxs data targets were often missed.

Amid the constant distraction of data demands, services to patients sometimes suffered, one staffer told the IG. That problem occurred in many PEPFAR nations, the CDC manager says.

In response to the IG report, Birx promised some reforms and clearer, transparent dialogue. She said local PEPFAR teams would set their own targets, although funding would be adjusted to the presented level of ambition. Before those actions were fully in place, Trump appointed her to coordinate the Coronavirus Task Force.

Del Rio isnt surprised that some PEPFAR staff members were unhappy. Shes a no-bullshit kind of person, he says. Shes not running a Montessori school.

And Glassman notes that many women who attain powerful jobs face extra criticism or get tagged as authoritarian, whereas men with comparable leadership styles are simply accepted. Is [Birx] getting pounded partially because shes a woman? she asks.

But Glassman concedes that despite good intentions, Birxs style was a disaster at PEPFAR. And tying data targets to funding without independent verification does invite misreporting, she says. Her desireto get those resultsand show them to the world, I think, just overcame everything, Glassman says.

Now, some CDC staffers say, Birx is applying the PEPFAR playbook to the new pandemic, and the dismantling of CDCs COVID-19 hospital data system is a consequence.

Agency insiders concede that CDCs National Healthcare Safety Network (NHSN)the system used for 15years to gather crucial data from hospitalswas far from perfect. The network, which collects data from about 37,000 hospitals and other health care facilities, has been underfunded for years. All the same, five times weekly, NHSN reliably produced actionable COVID-19 data such as available hospital beds, intensive care occupancy, and ventilators used, according to CDC sources and internal reports obtained byScience. CDC staffers used long-tested statistical algorithms to impute missing data.

When NHSN was shut down for hospital COVID-19 data in July, more than 100 public health and patient advocacy groups, along with scientific and medical societies (including AAAS, which publishesScience), warned that the switch could degrade crucial data reporting. Attorneys general for 21 states and the District of Columbia echoed their concerns. (The system still collects COVID-19 data from nursing homes and on issues such as on health careassociated infections and resistance to antimicrobial therapies such as remdesivir, which has helped some severely ill COVID-19 patients and was given to Trump.)

But del Rio says Birx viewed NHSN in a similar light as the data system she inherited at PEPFAR in 2014woefully inadequate. Birx was exasperated, del Rio said, that NHSN could not provide daily, comprehensive data, for example on supplies of remdesivir, to guide the governments efforts.

Either Birx isnt looking at the data, or shes looking awaybecause its an absolute disaster.

In a spring meeting, Birx seemed fixated on applying the lessons of HIV/AIDS in a small African nation to COVID-19 in the United States, says a CDC official who was present. Birx was able to get data from every hospital on every case in Malawi, the official says. She couldnt understand why that wasnt happening in the United States with COVID-19. Birx didnt seem to see the difference between a slow-moving HIV outbreak and a raging respiratory pandemic. [CDC Principal Deputy Director] Anne Schuchat had to say, Debbi, this is not HIV. Birx got unhappy with that.

Birx insisted every hospital update 100% of its data every day, including detailed patient demographics. She added new data categories, such as patient age and supplies of remdesivir. CDC officials told her 100% daily compliance was virtually impossible, but said NHSN statisticians could accurately extrapolate from partial data, providing results in near real time, one agency official says.

Another CDC official charged with responding to Birxs demands calls her fixation and fetishization of those daily count numbers deeply frustrating. Birxs top assistants accused CDC employees who pushed back of being callous about COVID-19 deaths. The process assumed the tone of a military command structure, the CDC official says: Obey without question. Echoing PEPFAR employees, the official adds that it seemed designed to make you feel like you are failing every day.

Birx doesnt really understand data, says James Curran, public health dean at Emory University, who led CDCs HIV/AIDS unit for 15years before Birxs time at the agency. I dont think shes asking the right questions. It doesnt mean that the CDC is always right. But you should have a partnership with people.

Instead, say CDC sources with direct knowledge of the events, Birxs team made a take it or leave it demand: Immediately collect case data by age, or NHSN would be replaced.

When the switch to TeleTracking was announced, Redfield applauded it as a way to streamline reporting. He also tweeted that the decision was made at working levels in CDC and didnt rise to his level. Many people in CDC saw his comments as a betrayal.

Birxs imperative of 100% of hospital data every day has proved elusive. The Department of Health and Human Services (HHS) data hub for hospital capacity, including inpatient beds occupied overall and by COVID-19 patients, now draws on data collected by TeleTracking, a for-profit company with nearly 400 employees, and on data submitted by state health departments and hospital associations. As with NHSN, nearly all data are collected manually rather than automatically from electronic patient records. Some hospital associations and health departments combine data from hospitals into spreadsheets and send them by fax or email to HHS. TeleTracking also offers a web interface for hospitals or their contractors to enter data.

The underlying data tables are updated daily but run 3 to 4days behindless efficient than NHSN before it ceased operating. CDC officials and public health experts blame several factors for those problems: Hospitals arent used to TeleTrackings system and the additional data points (such as age) added work. Also, TeleTracking has long-standing relationships with fewer hospitals than NHSN; such relationships can speed troubleshooting.

In a 7October written reply to questions, an HHS spokesperson acknowledged the time lag but called it a good practice to provide the most complete dataset because hospitals might not be able to respond on weekends, for example. But the department plans to reduce that lag, the spokesperson wrote.

At a 6October press briefing, Birx said 98% of hospitals were reporting at least weekly and 86% daily. In its reply toScience, HHS pegged the daily number at 95%. To achieve that, the bar for compliance was set very low, as a single data item during the prior week. A23September CDC report, obtained byScience, shows that as of that date only about 24% of hospitals reported all requested data, including protective equipment supplies in hand. In five states or territories, not a single hospital provided complete data.

HHS said the 23September analysis was filled with inaccuracies, misunderstandings, and errors, without providing details, and questioned its authenticity.

The Centers for Disease Control and Preventions director, Robert Redfield, shown at its headquarters in Atlanta, has been criticized for failing to robustly defend the agency against accusations of political interference.

ButSciencealso obtained a report prepared by CDC data experts for use by the agency and Birxs team dated 19May, back when TeleTracking and NHSN were both offered as options for data submission. NHSN showed 3% to 6% missing data for such items as COVID-19 inpatient bed occupancy and ventilator use. TeleTracking showed 36% to 57% missing data. Those numbers were mostly unchanged, with significant improvement in only one category, in the 23September update, after NHSN was no longer used for hospital reporting.

Like NHSN, the TeleTracking system estimates missing data, but the company and HHS declined to release any details for independent analysis. CDC staffers say TeleTracking has other problems; for example, many hospitals share ID numbers in its system, making it difficult to differentiate between each ones needs. CDC critiques obtained bySciencealso show TeleTracking has consistently reported nonsensical numbers. For example, the system showed negative numbers of occupied hospital beds and more than 15,000 beds for a single California hospital. In nearly 1500 cases, it showed more beds filled than total beds at a hospital.

TeleTracking referred questions to HHS, which said it plans to boost automation to reduce errors. For now, the HHS spokesperson wrote: HHS made a conscious decision to take a different approach on data collection. Rather than reject incorrect data outright, HHS allows it to flow into our system and then attempts to manually fix detected errors. A CDC data expert calls that an admission of faulty data practices.

In a 25September memo from Birx to HHS Secretary Alex Azar, obtained byScience, Birx made a major concession to reality: She gave up on elements of the daily 100% compliance rule that had motivated the switch to TeleTracking. For example, Birx instead asked that inventories of supplies, such as personal protective equipment, be provided weekly because more frequent reporting had proved infeasible.

During the 6October press briefing, Birx said the moves ensure that we are not adding additional burden for hospitals. The key is valid and timely data, she said.

But in that same briefing, Birx and Centers for Medicare & Medicaid Services Administrator Seema Verma announced a new and stringent requirement reminiscent of PEPFAR: Funding will be tied to reporting compliance. Hospitals will be disqualified from Medicare and Medicaid reimbursements if they fail to submit required data after being warned of lapses. Thememo from Birx to Azar, marked not releasable to the public,shows Birx pushed for the change.

The move is sledgehammer enforcement that could needlessly divert time and money from patient care, Federation of American Hospitals President and CEO Charles Chip Kahn said in a statement after the announcement.

As at PEPFAR, CDC officials say this requirement could create perverse incentives to supply false data. Medicare funding is a survival issue for hospitals, so many are likely to submit the requested numbers regardless of whether they are accurate, say three high-level CDC officials with personal knowledge of agency data systems.

HHS cited safeguards against such fraud, including assistance from state health departments, and systematic logic and error checking. The departments IG also identifies fraud aggressively, the spokesperson wrote.

However, the potential long-term impact keeps CDC staffers up at night, one says. I worry, is this going to damage the whole process of how public health data are collected down the road?

CDC officials say Birx acquired her outsize influence over the agency in part because of how power was allocated in the federal pandemic response. An organizational chart obtained byScience, marked for official use only, shows Birx coordinates the task force and co-chairs two key bodies: the unified coordination group, which manages the response from HHS and therefore CDC; and Operation Warp Speed, the vaccine development effort. A physician advisory group, comprising Fauci, Redfield, National Institutes of Health Director Francis Collins, and othersis off to the side(see organizational chart, above). Senior CDC people say those advisers have been reduced to window dressing, with little ability to mediate in the deteriorating relationship between Birx and CDC.

She calls into question the science of the agency.

The hospital data system is perhaps the most calamitous flashpoint in that relationship. But CDC officials say that, in other instances, Birx flouted science and undermined the agency to placate the president. For example, she responded with silence to Trumps suggestion that ingesting disinfectants might cure COVID-19. And according to the nonpartisan FactCheck.org, in March she understated the pandemics spread by misleadingly portraying states with few cases as almost 40% of the country, although those states make up only about 7% of the population.

Dr. Birx, what the hell are you doing? What happened to you? Your HIV colleagues are ashamed, tweeted Yale epidemiologist and AIDS expert Gregg Gonsalves in response.

And she pressured CDC to tone down its guidance on school openings, according toThe New York Times; itpublishedan email she wrote asking Redfield to take a more permissive approach.

Several CDC leaders say Birxs distrust and rejection of input from CDC data experts has created enormous animosity. She calls into question the science of the agency, says a current senior CDC official. Were not perfect but in the midst of a crisis, to indicate that one of your chief arms for responding to a very severe pandemic cant be believed has been disastrous.

Birxs supporters say she has done as well as anyone can working for Trump. She can navigate science and politics, del Rio says. I dont think anybody can navigate science and Trump. And Birx has resisted some of the presidents outrageous claims, even persuading Pence to sometimes wear a mask. In August, she described the pandemic to CNN as extraordinarily widespread, losing some favor with Trump.

Even critics within CDC give Birx qualified credit. Her consistent push for testing has gotten crosswise with the White House, says a top CDC official, who adds: At her core, shes a scientist.

But that official and others also see Birx as a cautionary tale of how an ostensibly well-meaning expert can cause great harm by working in the style of the Trump administration. Bullying and threatening is a last resort for our usual way of operating, whereas thats the modus operandi for this administration and the White House task force, the official says. We need people who think like we do. Ive heard that stated in multiple instances by Birxs top assistants, the official adds. Its not scientific.

Many executives and midcareer professionals who represent the future of the agency plan to leave if Trump wins reelection, several sources say. Its another reason that has public health authorities wondering whether CDC has already passed a tipping point, from which it will struggle to recover no matter who is elected.

The implications of a discredited CDC for the COVID-19 pandemic are grave, says Thomas Frieden, who led the agency under Obama. If the public doesnt trust government guidance to take vaccines when available, he says, the pandemic could rage indefinitely. Breaking that trust could cost our economyand American lives.

Senior career executives at another beleaguered agency, the Food and Drug Administration, recently called for preservation of their scientific independence in aUSA Todayeditorial. At CDC, leaders below Redfield are talking privately about whether to take a similar public stand against the destruction of their agency by the Trump administration. One says: The longer we dont speak out, the harder it will be to regain our credibility.

When imagining cutting edge innovation, many Americans may picture scientists creating the COVID-19 vaccine or engineers at Tesla designing a first-of-its-kind electric truck. Many, however, would not imagine the drone delivery system in Rwanda that delivers blood and essential medical items to regions inaccessible by road, or Indian train cars converted into makeshift COVID-19 medical facilities. These frugal innovations are fundamentally different from most innovations developed in the U.S. as they aim to do more with less in resource-constrained contexts faced by many low- and middle-income countries.

The current pandemic has highlighted the necessity of applying similar innovations in the developed world. For example, the U.S. initially struggled to support communities in acquiring enough masks, personal protective equipment, and ventilators. A recent Nature Medicine article identifies frugal innovations used to address these challenges like 3D-printed ventilator multipliers that could provide urgent therapy for up to seven patients per ventilator machine, do-it-yourself cloth masks, and training community health workers for local contact tracing and COVID-19 testing.

These developments suggest a need for a reimagining of our approach to innovation. For example, drones are highly regulated and have restrictions to acquiring suitable flight permits. Furthermore, organizations like the Food and Drug Administration, although critical to population safety, can be slow in approving medications and medical devices. Even pro-competition antitrust laws that are important to ensuring competitive markets may prevent information sharing and collaboration between companies when rapid responses are needed.

These regulations are changing in the face of the pandemic. The Federal Aviation Administration (FAA) has allowed for drone use in select response efforts. The Centers for Medicare and Medicaid Services (CMS) is now allowing telehealth visits to be reimbursed during the duration of the pandemic. Even the Department of Health and Human Services has stated it will limit enforcement of strict patient privacy laws like HIPAA to ensure care access is not prevented.

Although these changes are not permanent, it is unlikely that the regulatory environment will return to pre-pandemic conditions, presenting opportunities to exploit. For instance, Simprints built a fingerprint-based tool to track the spread and treatment of neglected diseases. Without accurate information, it is hard to actively address communicable diseases. There are many marginalized populations in the U.S. who face similar challenges and only access the health system once they are already extremely sick.

These innovations extend beyond just the field of healthcare. In Kenyas education technology space, M-Shule provides education access to students through text messaging. Using an AI algorithm, the company personalizes education for even poor and remote students, better preparing them to be successful during national examinations. Such creative solutions that promote social distancing may be even more important in the COVID-19 era.

Since innovations like these are being tested in settings much harsher than that of the U.S., they may find success domestically as well. Even the most advanced U.S. industries sometimes rely on a less-is-more approach. NASA and Lockheed Martin found that simply leaving off the white paint from early iterations of the space shuttles external fuel tank saved nearly 600 pounds of weight. Similarly, in the aftermath of 9/11, the FAA recognized that reinforcing cockpit doors and adding a door locking protocol were effective security measures to prevent repeat tragedies. Innovation can be simple.

Despite the vague nature of frugal innovations, it is possible to recognize some common themes. First, innovators should aim to build adaptable and flexible technologies that can be used in scarce contexts. M-Pesa, for instance, is a mobile-money transfer system that opened access to financial services for a significant portion of Kenyas poor and rural populations. This tool has simplified banking services and reduced the need to visit a physical bank branch. Second, innovations dont have to be sophisticated to be useful. Basic cloth masks are often sufficient to reduce viral spread instead of producing additional medical grade PPE. Lastly, innovators should consider the repurposing of current tools for new contexts, such as the hundreds of U.S. distilleries that have shifted to making hand sanitizer during the pandemic.

The benefits of frugal innovations in developed countries can extend beyond the resource constraints of the pandemic. These innovations are often cheaper than current alternatives and increase accessibility to populations usually excluded from traditional service offerings. This reimagined innovation can further segment industry marketplaces and create new economic opportunities for companies to pursue, such as expanding telehealth access. Furthermore, these solutions allow for reform of current financially constraining protocols, such as using 3D-printed ventilator multipliers to make better use of the expensive equipment. Although COVID-19 has challenged us in many ways, this pandemic is an opportunity to reimagine innovation going forward to address the current and future problems facing our nation.

Patient groups on social media are fighting COVID-19 misinformation. Jub Rubjob/Getty Images hide caption

Patient groups on social media are fighting COVID-19 misinformation.

For decades, people struggling with illnesses of all kinds have sought help in online support groups, and during 2020, such groups have been in high demand for COVID-19 patients, who often must recover in isolation.

But the fear and uncertainty regarding the coronavirus have made online groups targets for the spread of false information. And to help fellow patients, some of these groups are making a mission of stamping out misinformation.

Shortly after Matthew Long-Middleton got sick on March 12, he joined a COVID-19 support group run by an organization called Body Politic on the messaging platform Slack.

"I had no idea where this road leads, and so I was looking for support and other theories and some places where people were going through a similar thing, including the uncertainty, and also the thing of like, we have to figure this out for ourselves," says Long-Middleton, 36, an avid cyclist who lives in Kansas City, Missouri. His illness started with chest discomfort, then muscle weakness, high fever, loss of appetite and digestive problems.

But with the support came misinformation. Group members reported taking massive amounts of vitamins including Vitamin D which can be harmful in excess or trying other home remedies not backed by science.

Experts warn that such false or unverified information spread on online support groups can not only mislead patients, but also potentially undermine trust in science and medicine in general.

"Even if we're not actively seeking information, we encounter these kinds of messages on social media, and because of this repeated exposure, there's more likelihood that it's going to seep into our thinking and perhaps even change the way that we view certain issues, even if there's no real merit or credibility," says Elizabeth Glowacki, a health communication researcher at Northeastern University.

In an effort to help fellow COVID-19 sufferers, some patients, like Vanessa Cruz, spend most of their days fact checking their online support groups.

"It's really become like a second family to me and being able to help everybody is a positive thing that comes out of all this negativity we're experiencing right now," Cruz says.

Cruz, a 43-year-old mother of two, moderates the Facebook COVID-19 support group "have it/had it" from her home in the Chicago suburbs. She's also a "long-hauler," and has been dealing with COVID-19 symptoms, including fatigue, fever and confusion since March.

The worldwide group has more than 30,000 members and has recently been buzzing with reports from India about treating COVID-19 with a common tapeworm medication (it's not FDA-approved and there's little evidence it works) as well as speculation about President Trump's recent diagnosis.

Other troubling posts include people pushing hydroxychloroquine, which has not been proven to be effective in treating COVID-19, and sharing the viral video "America's Frontline Doctors" which promotes other unproven treatments and spreads conspiracy theories.

Cruz says supporting fellow patients can be a tricky balance of getting the facts right, but also giving people who are scared the chance to be heard.

"It's like you really don't know what to question, what to ask for, how to reach for help," Cruz says. "Instead of doing that, they just, they write up their story, basically, and they share it with everybody."

To keep the group evidence-based, it has built up a 17-person fact checking team, which includes two nurses and a biologist, that reviews every post that goes up.

However, many online COVID-19 groups don't have the resources or strategy to address misinformation.

Mel Montano, a 32-year-old writing instructor who lives in New York and has also felt sick since March, says she left a large Facebook support group because she was frustrated by the conspiracy theories that filled its posts.

"All of these conflicting theories completely took away from the focal point of it," Montano explains. "It was a mess. It was [like] being on one of those conspiracy theory pages or channels, and it was just not for me."

Montano is now a moderator of the Body Politic group on Slack.

Facebook and Twitter have made changes in their approaches toward COVID-19 misinformation, including additional fact checking, removing posts that contain falsehoods and removing users or groups that spread them.

However, critics say more changes are needed.

Fadi Quran, campaign director of Avaaz, a human rights group that focuses on disinformation campaigns, says Facebook needs to revise the way it prioritizes content.

"Facebook's algorithm prefers misinformation, prefers the sensational stuff that's going to get clicks and likes and make people angry," Quran says. "And so the misinformation actors, because of Facebook, will always have the upper hand."

A study by Avaaz showed that misinformation and disinformation had been viewed on Facebook four times as often as information from official health groups, like the World Health Organization.

Facebook did not respond to inquiries for this story.

COVID-19 patient Matthew Long-Middleton thinks the problem goes deeper than getting the data right. He says a lot of bad information is spread because patients so badly want to find ways to feel better.

After nearly six months of symptoms, Long-Middleton says he's returned to better health in the past month, though he continues to check in on fellow support group members who are still struggling.

He never tried risky treatments discussed in the group himself, but he understands why someone might.

"You want to find hope, but you don't want the hope to lead you down a path that hurts you," he says.

This story came from a reporting partnership between NPR, Kaiser Health News and KCUR.

Government health workers hand out Ayurvedic medicine to people who are getting tested for COVID-19 in Gurugram, a city in northern India, in May.

By Priyanka PullaOct. 15, 2020 , 6:55 AM

Reporting for this story was supported by a journalism grant from the Thakur Family Foundation, which has not exercised any editorial control over the contents of this report.

The Indian health ministryhas begun to recommend traditional remediesto tackle the countrys COVID-19 outbreak, dismaying many Indian doctors and scientists. On 6 October, health minister Harsh Vardhan released recommendations for preventing COVID-19 and treating mild cases based on Ayurveda, Indias millenniaold system of herbal medicine, triggering sharp criticism from the Indian Medical Association (IMA), a group of more than one-quarter of a million modern medicine practitioners.

In a press release, IMAdemanded Vardhan produce evidenceof the treatments efficacy; if hes unable to do so, the associationwrote, Vardhan is inflicting a fraud on the nation and gullible patients by calling placebos as drugs.Recommending any drug without evidence for a deadly disease that has claimed more than 100,000 Indian lives is a dangerous trend, adds C. S. Pramesh, a thoracic surgeon and the director of Mumbais Tata Memorial Centre. The government has no shortage of studies to point to, but Pramesh and others dismiss them as unconvincing.

The Indian governments push for Ayurveda is in line with the ruling Bharatiya Janata Partys mission to revive traditional medicine. Since 2014, when the Hindu nationalist party was elected to power, it has upgraded a government department for alternative medicine to the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), and more than tripled its annual budgetto almost $290 million.

Developed by the AYUSH ministry, the COVID-19 advisory includes treatments such as clarified butter applied inside the nostrils; a hot concoction of pepper, ginger, and other herbs; and a patented formulation called Ayush-64. The latter, a mixture of four herbs, was developed in the 1980s for malaria by the Central Council for Research in Ayurvedic Sciences (CCRAS), now a body under the AYUSH ministry.

Although last weeks protocol only recommends the remedies for mild disease, it says moderately and severely ill patients can make an informed choice about using Ayurveda as well, and refers readers to another Ayurvedaguideline documentthat prescribes similar herbal interventions for people with severe manifestations of COVID-19 such as respiratory distress and pneumonia.During a recent press conference, the AYUSH ministrys secretary, Vaidya Rajesh Kotecha, claimed the remedies were supported by dozens of in vitro, animal, and human studies, listedin a report onthe ministrys website.

But almost all the human studies are small and uncontrolled, critics say. These are con trials and faked studies, says Cyriac Abby Philips, a hepatologist at Keralas Ernakulam Medical Centre.

For example, in one of the studies the AYUSH ministry cites as support for Ayush-64,published in theJournal of Ayurveda and Integrative Medicine, the investigators gave the drug to 38 patients with flu symptoms.There was no control arm, and some of the patients on Ayush-64 also received paracetamol and other modern drugs, making it impossible to tease out the effects of each.

In another study, published in 1982, investigators gave 29 malaria patients Ayush-64, while 30 received modern antimalarials, including chloroquine. The investigators noted that whereas all the patients on modern drugs were cured, only 72% on Ayush-64 responded. Nothing about the study supports Ayush-64s efficacy in malaria, Philips says.

And in any case, clinical studies for malaria and other diseases cannot be extrapolated to COVID-19, says Gagandeep Kang, a microbiologist at Christian Medical College, Vellore, who helped develop and test Indias first rotavirus vaccine. All diseases are not the same, she says.

N. Srikanth, an Ayurvedic practitioner and a deputy director general at CCRAS, tellsScienceInsiderthat trials of Ayurvedic therapies for COVID-19 are underway.And on 9 October, an association of government Ayurvedic scientists said IMAs claim that Ayurvedic drugs were no better than placebos was rigorously condemnable. They pointed out that some modern medical practitioners continue to use drugs such as hydroxychloroquine for COVID-19, even though there is little evidence for their efficacy. (Indias health ministryrecommended hydroxychloroquineboth as treatment and prevention for the pandemic coronavirus in March, based on a few small and inconclusive clinical trials, a decision it didnt roll back after subsequent larger studies failed to bear out their advice.)

Pramesh dismisses that argument as whataboutery. Any system of medicine, whether modern or alternative, must back up claims of efficacy with well-conducted trials, he says. And I have seen very little actual data that shows the medicines being recommended by the AYUSH ministry to be useful.

News Release

Tuesday, October 13, 2020

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, today launched a study designed to determine whether certain approved therapies or investigational drugs in late-stage clinical development show promise against COVID-19 and merit advancement into larger clinical trials. The ACTIV-5 Big EffectTrial, which will enroll adult volunteers hospitalized with COVID-19 at as many as 40 U.S sites, is being conducted in collaboration with the NIHs public-private partnership Accelerating COVID-19 Therapeutic Innovations and Vaccines (ACTIV) program.

The ACTIV-5/BET study aims to streamline the pathway to finding urgently needed COVID-19 treatments by repurposing either licensed or late-stage-development medicines and testing them in a way that identifies the most promising agents for larger clinical studies in the most expedient way possible, said NIH Director Francis S. Collins, M.D., Ph.D.

The Phase 2 adaptive, randomized, double-blind, placebo-controlled trial will compare different investigational therapies to a common control arm to determine which experimental treatments have relatively large effects. Approximately 100 hospitalized volunteers will be assigned to each study arm with each of the study sites testing no more than three investigational treatments at once.

The goal here is to identify as quickly as possible the experimental therapeutics that demonstrate the most clinical promise as COVID-19 treatments and move them into larger-scale testing, said NIAID Director Anthony S. Fauci, M.D. This study design is both an efficient way of finding those promising treatments and eliminating those that are not.

The trial will test risankizumab, a monoclonal antibody developed by Boehringer Ingelheim (Ridgefield, Connecticut) and AbbVie (North Chicago, Illinois), in conjunction with the antiviral drug remdesivir, compared to a placebo plus remdesivir. The ACTIV-5/BET trial will also test the investigational monoclonal antibody lenzilumab, developed by Humanigen (Burlingame, California), with remdesivir, compared to placebo and remdesivir. Remdesivir has demonstrated clinical benefit for patients with severe COVID-19 requiring supplemental oxygen and is considered standard of care for hospitalized COVID-19 patients.

Monoclonal antibodies are laboratory-made versions of proteins naturally produced by the immune system in response to invading viruses or other pathogens. Risankizumab was approved in the United States in 2019 for the treatment of severe plaque psoriasis. Lenzilumab is currently being tested separately in a phase 3 COVID-19 study and in a phase 1b/2 study as sequenced therapy with CAR-T treatments.

In the ACTIV-5/BET study, volunteers assigned to receive risankizumab will be administered a single intravenous dose on day one of the study. Study participants assigned to receive lenzilumab will be given a 600 mg intravenous infusion every eight hours for a total of three doses.

The primary purpose of the ACTIV-5/BET study is to evaluate the clinical efficacy of the different investigational therapeutics relative to the control arm in hospitalized adults based on the volunteers clinical status at day eight. The studys secondary point of evaluation is to evaluate the clinical efficacy of the different investigational therapeutics as assessed by the amount of time it takes for each volunteer to recover from COVID-19.

Study volunteers will be assessed daily by clinical staff while hospitalized. Once discharged, the volunteers will have study visits on days 15, 22 and 29 on an outpatient basis, with some of these visits potentially conducted by phone if there are infection control concerns or other restrictions. All volunteers will undergo a series of SARS-CoV-2 tests, including testing of serum and plasma samples and oropharyngeal swabs on day one of the study prior to receiving an investigational therapy and again on days three, five, eight and 11, while hospitalized. These tests will be performed again on days 15 and 29 whether the study volunteer remains hospitalized or returns for clinical follow up as an outpatient.

Study staff will be monitoring volunteers for adverse events, and an independent data safety monitoring board will oversee the trial and conduct periodic reviews throughout its duration.

For more information about the ACTIV-5/BET trial, please visit ClinicalTrials.gov using the identifier NCT04583969.

NIAID conducts and supports researchat NIH, throughout the United States, and worldwideto study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIHTurning Discovery Into Health

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Last week The Exchange dug into recent data concerning the amount of venture capital raised by female founders. As a refresher, the numbers were not good.

In Q3 2020, PitchBook data reported that US-based female founders raised $434 million across 136 rounds. That dollar amount was off from $841 million in Q2 2020, for context. The numbers were a dramatic turnaround from where 2019 left the industry.

The Exchange explores startups, markets and money. Read it every morning on Extra Crunch, or get The Exchange newsletter every Saturday.

The sharp decline in available capital is slowing the pace at which women are founding new companies in the COVID-19 era. There are other factors at play, new data from the Female Founders Alliance (FFA) indicates, but the funding drought is not helping.

Overall, the pace at which women are indicating that they intend to found a company, according to a group of women that the FFA is tracking longitudinally, is slipping.

FFA, a community of women founders and a startup accelerator working to achieve greater gender diversity in technology, built a sample of 150 women from tech hubs with high likelihood of having entrepreneurial aspirations, according to its dataset. It asked them about their entrepreneurial goals both before COVID-19 arrived, and again this September.

The changes in responses from before the pandemic and today are striking. Lets examine the data in light of what we learned last week concerning capital available for female founders and see what we can find out.

FRISCO, Texas (CBSDFW.COM) A Texan is working to find a possible cure for COVID-19 thats not so unusual. The fact that the researcher is 14-years-old and is now being recognized nationally, well thats a little different.

Anika Chebrolu, a student at Independence High School in Frisco, recently won the 3M Young Scientist Challenge and $25,000.

I developed this molecule that can bind to a certain protein on the SARS COVID-2 virus, Chebrolu explained. This protein by binding to it it will stop the function of the protein I started with a database of over 682 million compounds.

The 14-year-old was only in middle school when she entered the contest months ago and originally planned her project to involve the seasonal flu. She later changed it to COVID-19 and says she was driven by the scope of the pandemic and the people who were suffering.

We just always have this constant fear whos going to be affect by the coronavirus, Chebrolu said.

She describes herself as a typical teenager who plans to pursue a career as a medical researcher when she gets out of school.

My grandpa when I was younger he always used to push me toward science. He was actually a chemistry professor and he used to always tell me learn the periodic table of elements, she said. Over time I just grew to love it.

Right now, shes balancing her search for a COVID cure in between classical Indian dance training and practicing her skills as an artist.

I describe myself as a person who aspires to be a lot of things, Chebrolu said.

SEC commissioner Greg Sankey said Friday that conference schools can face a cumulative penalty of $1 million as the league continues to enforce COVID-19 sideline protocols and hold head coaches accountable for wearing masks during games.

While Sankey acknowledged that some teams have done well in complying with sideline protocols during games, he compared the overall response to a report card marked "Needs improvement." Multiple SEC schools have already violated the mask-wearing rule and will lose money from their conference revenue distribution, sources told ESPN.

The first offense is $100,000, followed by $200,000, $300,000 and $400,000 for a fourth violation. Sankey said he has focused on "head coaching compliance," but declined to say which schools have already been fined and how much.

"My premise is, our head football coaches are leaders, the most visible people in their programs," he said. "They set the tone. They have that responsibility in this environment."

Sankey said his conversations about this have been with the athletic directors -- not the coaches -- because the campus athletic departments accepted the responsibility for enacting the protocols. Sankey said he is in his third week of "writing memos" to remind each athletic director of the importance of enforcing the protocols.

"First week was, 'After Week 1, there seems to be some misunderstanding, here's a memo of clarification,'" Sankey said. "'Make sure this is widely circulated and everyone understands their responsibility for wearing masks.' The second week was less friendly, with the clarification that accountability can include fines, removal from the sidelines or suspensions. We will impose financial assessments to athletics departments, withholding from conference revenues."

The SEC office has a handful of employees who comb through the broadcast videos each week to monitor the sideline protocols.

"When the coach is on camera, is the mask on? Yes or no? Pretty objective standard," said Sankey, who typically stays in his conference office on Saturdays to watch games, and has reported five negative tests to do that. "Is there any social distancing involved, which to a certain extent can mitigate not wearing a mask, but the mask-wearing expectation is clear.

"In circumstances where the majority of time the head coach is not wearing the mask," he said, "that's where accountability will be applied."

In addition to focusing on the sidelines during televised games, the SEC office has also been paying attention to camera angles showing fans -- some of which can be deceiving, Sankey said, because they often don't show the entire stadium.

Still, he conceded some images of fans in close groups have raised concerns.

"The second week we had some student sections that were just too close together, third week the same," Sankey said. "Each of those weeks we tried to figure out how to provide reminders, clarifications, and one of the questions is, 'Should we be more aggressive from the conference office?' Conference offices don't regulate fan attendance, typically. That's why we, right up front, said it's campus decision-making, local decision-making, state decision-making. Here are some expectations. The question is, what do we have to do to make sure each of our programs is fully engaged in managing those expectations properly? That question comes from the scenes on TV that raise concerns, and rightly so."

It has been a turbulent week for the SEC, as two games -- Vanderbilt vs. Missouri and LSU vs. Florida -- were postponed because of coronavirus outbreaks. Alabama coach Nick Saban and athletic director Greg Byrne announced Wednesday that they had tested positive for the coronavirus.

"There's a lot that goes on in this world right now, so I think I'm through the point of being surprised," he said when asked specifically about Saban. "I had a hurricane last week in the middle of a pandemic. This week I had two games that are postponed. So there's a lot of news that merits reaction, so the answer is no, other than it's 2020."