NYC Is Opening Its Own Coronavirus Testing Lab – The New York Times

State health officials published new data this week that showed the states coronavirus positivity rate was higher in the spring than originally disclosed, even as public officials cited the data to justify business reopenings during the pandemic.

The Department of State Health Services announced a new method Monday for calculating the positivity rate, or the proportion of positive tests, and conceded that the previous method obscured the extent of viral transmission by combining old and new cases. The new formula relies on the date a coronavirus test was administered, rather than the date it was reported to health officials and verified as a case.

As Texas prepared for the first phase of reopening in late April, Gov. Greg Abbott repeatedly pointed to the states positivity rate, even as the number of new cases and deaths continued to rise. Announcing his initial reopening order April 27, Abbott declared that the "COVID-19 infection rate has been on the decline over the past 17 days."

The following week, the governor downplayed a new single-day record in new COVID-19 cases by again pointing to the positivity rate.

Despite concentrating on areas where we think there may be a high level or number of people who could test positive, the fact remains that more than 95% of the people who were tested test negative," Abbott said during a May 5 news conference.

State data at the time placed the seven-day average positivity rate at 5.84%, near the 5% benchmark recommended by the World Health Organization before governments ease restrictions. The actual rate, however, was higher. According to the new method employed by DSHS, Texas seven-day average positivity rate was actually 8.4%, near the 10% threshold Abbott had called a warning flag indicating a high level of community spread.

After the reopening of bars, restaurants, stores and child care centers throughout May, Texas saw a surge in cases beginning in June. The states reported seven-day average positivity rate under the old method jumped from 4.27% at its lowest point in late May to 17.4% at its peak in mid-July. After revising the data, the states new chart shows that the positivity rate jumped from 5.81% in May to a peak of 21% in early July.

On June 26, Abbott ordered bars to close again and mandated that Texans wear face masks in public spaces. The states official positivity rate that day was 13.7%; the new data shows it was actually 18.5%.

Abbotts office did not respond to multiple requests for comment.

DSHSs technology has struggled to keep up with the volume of tests reported to the agency, resulting in large backlogs that distort the data. In August, DSHS reported some 350,000 new test results that had been bottlenecked because the state could not process enough tests per day before a system upgrade Aug. 1, resulting in an artificially inflated spike. On Sunday, officials reported that another 205,000 test results had accumulated as far back as March and belatedly added another 21,336 positive cases.

Public health experts say discrepancies in key metrics, such as the positivity rate, made it difficult for officials to make informed policy decisions.

If you calculate it the old way the incorrect way what happens is when the pandemic is growing, because of the lag, the positivity rate will be less than the reality, said Rajesh Nandy, associate professor of biostatistics and epidemiology at the University of North Texas Health Science Center at Fort Worth. That causes a problem because when we realize there might be another surge, its already too late. And thats what happened in June.

Nandy added that the positivity rate in June was grossly underestimated.

You have to understand the data and the particular limitations surrounding it, said Angela Clendenin, instructional assistant professor of epidemiology and biostatistics at the Texas A&M School of Public Health. We are dealing with a disease that we knew nothing about.

Catherine Troisi, an infectious disease epidemiologist at UT Health School of Public Health in Houston, said the states new method of calculating the positivity rate will give a more accurate picture of how active the virus remains in Texas communities. But, she said, thats dependent on ensuring the state is testing the right people those experiencing symptoms and people who have come into contact with them.

People who should be tested are not coming, Troisi said.

Texas consistently logged more than 60,000 tests per day in July, according to state data, but that has dropped off to around 40,000 to 50,000 per day in September. As students return to schools and universities, which can become new hot spots for the virus, accurate testing is imperative, she said.

Disclosure: The University of North Texas Health Science Center, Texas A&M University and UTHealth have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

High school parties force some Northeast schools in the U.S. to delay the return to classes.

Several K-12 school districts in the U.S. Northeast have delayed the start of in-person classes in recent days after high school students attended large parties, leading to concern about increased spread of the virus.

After several weeks of partying college students complicating their schools reopening plans, high school students are now creating the same disruptions, underscoring the yawning gap between policy and enforcement and the limitations of any school to control the behavior of young people.

Lincoln-Sudbury Regional High School in Sudbury, Mass., just west of Boston, delayed opening classrooms by two weeks, to Sept. 29, after the police broke up a party involving 50 to 60 students from the school on Saturday, local officials said.

The Board of Health said the police had reported that the students were not wearing masks or practicing social distancing, and that many had either fled when the police arrived or given false names to officers.

Although there were no known cases of the virus among students at the party, the board said that without complete information about who had attended, the risk to the school community cannot be adequately assessed.

In nearby Dedham, Mass., the school district also delayed in-person instruction after an uptick of cases in the town, which local health officials attributed to two recent gatherings of young people, including a party attended by high school students.

In Pelham, N.Y., high school students partying during and after the Labor Day weekend led the school district to postpone the start of in-person learning for all students and to require that high school students either be tested before coming to school or quarantine for 14 days.

The superintendent, Cheryl H. Champ, wrote in a letter to families that more than 100 teenagers appeared to have attended the parties and that video showed students engaging in risky behavior, failing to practice physical distancing, and not wearing masks or face coverings.

Also in New York, Carle Place Union Free School District on Long Island delayed bringing students back to school after end-of-summer parties led to positive cases.

As we are learning the hard way, the actions of a few can impact the many, the superintendent, Christine A. Finn, wrote to families.

Trump defends his indoor rally, but some aides are concerned.

President Trump and his campaign are defending his right to rally indoors after they held one on Sunday in Nevada. But some aides have privately called the move a game of political Russian roulette amid growing concern that such gatherings could prolong the pandemic.

Im on a stage, and its very far away, Mr. Trump said in an interview with The Las Vegas Review-Journal on Monday, after thousands of his supporters gathered on Sunday night inside a manufacturing plant in a Las Vegas suburb, flouting a state directive limiting indoor gatherings to fewer than 50 people.

The president did not address health concerns about the rally attendees, a vast majority of whom did not wear masks or practice any social distancing. When it came to his own safety, he said, Im not at all concerned.

The decision to hold a rally indoors, officials said, was something of a last resort for a campaign that had tried to procure five different outdoor locations. A Trump campaign official said they all faced pressure from state officials not to host the rally. The plant where the rally was ultimately held, Xtreme Manufacturing, has been fined $3,000 by the city of Henderson, Nev., the local news media reported.

Upcoming rallies in Wisconsin and Minnesota are planned for outdoor airport hangars, the kind of gathering the president recently resumed scheduling with little fanfare but which still violates state guidelines limiting gatherings to fewer than 50 people. But some states, including North Carolina, where Mr. Trump held an outdoor rally in Winston-Salem last week, have a First Amendment exemption permitting crowds to gather in the name of freedom of speech.

Tim Murtaugh, a Trump campaign spokesman, defended the decision to carry on with an indoor rally.

No one bats an eye at people gambling in casinos or tens of thousands of people protesting shoulder to shoulder, he said. People should be able to gather peacefully under the First Amendment to hear from the president of the United States.

But the decision to forge ahead created a wave of internal backlash, including from a top Trump adviser who said the campaign was taking a cavalier approach to the pandemic that could backfire politically. The adviser requested anonymity so as not to anger Mr. Trump.

More than 100 people, a majority of them not wearing masks, packed into a hotel ballroom in Arizona for an event on Monday.

A sweeping initiative to test and screen all 700,000 students and 75,000 employees in the Los Angeles public schools for the virus has started, with five cases detected last week among more than 5,400 children and adults tested, the districts superintendent said.

All were among adults who work for the district. Up to 20,000 more employees are to be tested this week, said Austin Beutner, the superintendent, whose Los Angeles Unified School District is the nations second largest, behind New York Citys.

Some 700 small children in district-provided child care were also tested, Mr. Beutner said, but none were infected.

With the exception of certain special-needs students, who recently received the go-ahead to return to classrooms for very limited instruction, classes at Los Angeles Unified have been remote.

The $150 million program, announced last month amid national alarm over inadequacies in testing, is expected to be among the largest and most comprehensive school-based initiatives in the nation by the time Los Angeles classrooms fully reopen, which will depend on positivity rates.

Last weeks tests, conducted on Thursday and Friday, were among principals, custodians and others working in sanitized school buildings, as well as children in the districts child care program.

The next round will be for all employees, whether or not theyre at a school site, and then well roll into testing students, Mr. Beutner said.

The positivity rate about 0.1 percent of tests conducted was far lower than the 3.4 percent overall rate in Los Angeles County, said Mr. Beutner, who said that was to be expected. Los Angeles Unifieds tests are being administered regardless of symptoms, whereas the more than 11,000 tests conducted each day in the county have tended to be among people who have sought testing because of symptoms or fear of exposure.

In other education news:

Twenty-three fraternity and sorority houses and seven other homes at Michigan State University were ordered to quarantine by the county health department. If they dont comply with the orders, which require that residents distance themselves and wear masks within the homes and return calls and text messages from officials within two business hours, they could face up to six months in prison, a fine of $200 or both.

Some low-income K-12 students had depended on visits by dental hygienists to school gyms and nurses offices for their dental care, but with many schools closed, oral health care providers are concerned that children could have a mouthful of cavities without their parents knowing.

With universities largely putting the onus on students not to spread the virus, students are using platforms like Twitter and Reddit to argue against their schools pandemic policies. When James Madison University in Virginia hosted an outdoor movie night, a student posted a photo of the events crowded lawn in a Twitter thread highlighting the schools failure in handling this pandemic.

A federal judge strikes down virus safety measures that had been put in place by Pennsylvanias governor.

A federal judge in Pennsylvania ruled on Monday that several restrictions ordered by Gov. Tom Wolf to combat the pandemic in the state were unconstitutional. The decision struck down stay-at-home orders and the closure of non-life-sustaining businesses, directives that were issued in March and have since been suspended.

The judge also declared that a current order limiting the size of gatherings no more than 25 people indoors and 250 outdoors violated the right of assembly enshrined in the First Amendment.

A spokeswoman for Mr. Wolf, a Democrat, said the administration was seeking a stay of the decision and an appeal. William Shaw Stickman IV, the judge who ruled on the case, was nominated to the bench by President Trump in 2019.

Mr. Trump, at an event in Arizona, celebrated the decision, calling it a great ruling.

As in other states, many Republican politicians in Pennsylvania have been steadfastly opposed to their states pandemic mitigation strategy, with some in Pennsylvania urging the governors impeachment. In July, the State Supreme Court rejected a suit filed by Republican legislators seeking to end Mr. Wolfs emergency authority.

Some of the most vocal opponents of the governor, including Representative Mike Kelly, a Republican whose district is in western Pennsylvania, were among the plaintiffs in the suit that was decided on Monday.

The court believes that defendants undertook their actions in a well-intentioned effort to protect Pennsylvanians from the virus, Judge Stickman wrote. However, good intentions toward laudable ends are not alone enough to uphold governmental action against a constitutional challenge. Indeed, the greatest threats to our system of constitutional liberties may arise when the ends are laudable, and the intent is good especially in a time of emergency.

In a statement, the governors spokeswoman said that the actions taken by the administration were mirrored by governors across the country and saved, and continue to save, lives in the absence of federal action.

A senior Chinese health official said a coronavirus vaccine could be available to the public in China as early as November, the state news media reported on Tuesday.

Dr. Wu Guizhen, the chief expert for biosafety at the Chinese Center for Disease Control and Prevention, told the state broadcaster CCTV that ordinary people in China could be given the vaccine in November or December. Current progress has been very smooth for vaccine candidates in the final stage of clinical trials, she said.

China now has five vaccine candidates in late-stage clinical trials, including one being developed in collaboration with other countries, Dr. Wu said. Two production factories have been approved for manufacturing, and a third is in the approval process, she said. China, the worlds largest vaccine producer, has put the prospect of a Covid-19 vaccine at the center of a diplomatic charm offensive.

China has already approved at least two experimental vaccines under an emergency use program, which began this summer with soldiers and employees of state-owned companies and has quietly expanded to include health care and aviation workers.

Dr. Wu, who said she was still doing well after receiving one of the experimental vaccines in April, said she expected them to remain effective for one to three years.

Dr. Wus estimate that a vaccine could be ready in November is not far off from predictions made by President Trump. His administration has told state officials to be ready to start distributing one as soon as late October. That would be just before the U.S. presidential election, and the timing raised concerns that a vaccine could be rushed for political reasons. A group of drug companies racing to develop a vaccine has pledged not to release anything that does not meet efficacy and safety standards.

A vaccine approved by Russia in August was met with skepticism from experts who warned against rushing normal procedures, and Russian and Chinese vaccines have been criticized over their designs. Health officials have warned against thinking of a vaccine as a silver bullet, saying that even if one is approved before the end of the year, it will take time to produce and distribute and will not mean an immediate end to pandemic restrictions.

The French cities of Marseille and Bordeaux significantly tightened restrictions on public gatherings on Monday after officials pointed to a concerning surge of cases in the cities and surrounding areas.

The two cities were among several areas where the French government, amid a nationwide rise in cases, has identified a worrying spread of the virus, including among older people.

Officials in both cities imposed a new ban on gatherings of more than 10 people in public places like parks, riverbanks and beaches and canceled school outings and student parties. Visits to retirement homes will also be more restricted.

In Marseille, a city on the Mediterranean coast, officials banned the selling and consumption of alcohol after 8 p.m. And in Bordeaux, in the countrys southwest region, the authorities banned bars from having standing customers or playing music on the street, and made it illegal to drink alcohol in public areas.

The limit for large outdoor gatherings in Gironde, the area that encompasses Bordeaux, had been 5,000 the same as the limit for the rest of the country. Now public gatherings are limited to 1,000 people, and events like carnivals and antiques sales will be banned, local officials said in a news conference on Monday.

Fabienne Buccio, the prefect for the Nouvelle-Aquitaine region, which includes Bordeaux, said at the news conference that venues that usually organized dancing parties like weddings would no longer be allowed to do so.

The idea is not to no longer get married, but to postpone big festivities tied to weddings, Ms. Buccio said, adding that public transportation would be bolstered during rush hours to avoid overcrowding in buses and trains.

In other developments around the world:

The Australian state of Victoria, the center of the countrys outbreak, on Tuesday reported no new coronavirus deaths for the first time in more than two months. The states capital, Melbourne, remains in lockdown, but restrictions have been loosened in the rest of the state as cases continue to fall.

New Zealand on Tuesday reported zero new cases of community transmission as it begins to loosen restrictions that were imposed after an outbreak last month in Auckland, its largest city.

Hong Kong on Tuesday reported zero new cases of community transmission for the first time since a third wave of infections began in early July. Bars, nightclubs, karaoke parlors, theme parks and swimming pools will be allowed to reopen starting Friday, officials said. Carrie Lam, Hong Kongs chief executive, also praised a two-week mass testing program that ended on Monday but drew fewer participants than the government had hoped. Almost 1.8 million people, or about a quarter of the population, signed up for the testing, which uncovered 32 cases, or about two per 100,000 people tested.

The United States relaxed its travel advisory for China and Hong Kong on Monday, warning Americans to reconsider travel but not outright advising against it, as the State Department had previously done because of the virus. In its updated guidance, the department said China and Hong Kong had resumed most business operations.

In Jordan, schools will be closed for in-person classes, restaurants will be open only for delivery and takeout, public markets will shut down and houses of worship will suspend prayers for two weeks starting Thursday in an attempt to curb the spread of the virus, the countrys state-run news agency said on Monday.

Silvio Berlusconi, the former Italian prime minister, left a Milan hospital on Monday, nearly two weeks after he was admitted for pneumonia caused by Covid-19. In a short speech, he warned Italians not to underestimate the gravity of the virus. Cases have been growing in Italy in recent weeks, and Mr. Berlusconi most likely contracted the virus while vacationing on the island of Sardinia, which became a viral hot spot in August.

Starting Monday, Britain has lowered the limit on the number of people allowed to meet to six from 30. The country recorded 3,330 new infections on Sunday, the third consecutive day of new case counts surpassing 3,000, a level not seen in Britain since May.

Antarctica, the only continent free of the coronavirus, is preparing for an influx of researchers in the coming months as a change of season makes studies on the icy South Pole more feasible. The first researchers, from the United States, arrived on Monday after quarantining in New Zealand.

A health official in Australia said on Monday that she was under police protection because of death threats amid rising opposition to her pandemic policies. Dr. Jeannette Young, the chief health officer of Queensland, had been criticized over a requirement that travelers from other parts of Australia quarantine for two weeks, especially after a woman in quarantine was not allowed to attend her fathers funeral.

The top communications official at the powerful cabinet department in charge of combating the virus accused career government scientists on Sunday of sedition in their handling of the pandemic and warned that left-wing hit squads were preparing for armed insurrection after the election.

Michael Caputo, 58, the assistant secretary of public affairs at the Department of Health and Human Services, said without evidence that the Centers for Disease Control and Prevention was harboring a resistance unit determined to undermine President Trump. He also suggested that he personally could be in danger.

You understand that theyre going to have to kill me, and unfortunately, I think thats where this is going, Mr. Caputo, a Trump loyalist installed by the White House in April, told followers in a video he hosted live on his personal Facebook page.

In a statement, the department said Mr. Caputo was a critical, integral part of the presidents coronavirus response, leading on public messaging.

Mr. Caputo delivered his broadside against scientists, the news media and Democrats after a spate of news reports over the weekend that detailed his teams systematic interference in the C.D.C.s official reports on the pandemic. Former and current C.D.C. officials described to Politico, The New York Times and other outlets how Mr. Caputo and a top aide routinely demanded the agency revise, delay and even scuttle the C.D.C.s core public health updates, called Morbidity and Mortality Weekly Reports, which they believed undercut Mr. Trumps message that the pandemic was under control.

Those reports have traditionally been so shielded from political interference that political appointees see them only just before they are published.

Mr. Caputo on Sunday complained on Facebook that he was under siege by the news media and said that his physical health was in question and his mental health has definitely failed.

In his Facebook video, Mr. Caputo ran through a series of conspiracy theories, culminating in a prediction that Mr. Trump will win re-election, but his Democratic opponent, Joseph R. Biden Jr., will refuse to concede.

And when Donald Trump refuses to stand down at the inauguration, the shooting will begin, he said. He added: If you carry guns, buy ammunition, ladies and gentlemen, because its going to be hard to get.

Wisconsin is facing its highest level of new daily cases during the pandemic, averaging more than 1,000 new cases a day in the last week, with college towns driving the troubling surge.

On Sunday, the state reported a new daily record of 1,582 cases and a 20 percent positivity rate. Most of the cases have been among people between the ages of 20 and 29, a health department spokeswoman said.

Wisconsin has reported more than 1,700 cases linked to college campuses, according to a New York Times database, with over 1,000 of those at the University of Wisconsin-Madison, the schools flagship campus. La Crosse County, home to University of Wisconsin-La Crosse, had one of the highest per capita case counts in the state over the last seven days, while some large counties like Milwaukee, Waukesha and Racine have not seen a major uptick in cases and remain below the state average.

On Sunday afternoon, the chancellor at University of Wisconsin-La Crosse announced shelter in place restrictions for all residence halls on campus. And in Madison, the faculty senate voted on Monday afternoon to shorten spring break to a three-day weekend.

Wisconsin was not hit as hard as some other states early on in the pandemic, but it has not made it through unscathed. Just over 1,200 people have died of the coronavirus, with some of the highest daily death reports coming in late May.

In other news around the United States:

Instead of its usual two-and-a-half-mile journey through Manhattan, the 94th Macys Thanksgiving Day Parade will be confined to the Herald Square area and broadcast for viewers to watch, the company announced on Monday. This years event is basically the end portion of our traditional march, said Orlando Veras, a Macys spokesman.

South Carolinas lieutenant governor, Pamela Evette, said Monday that she had tested positive, but has had only mild symptoms. She was last in close contact with Gov. Henry McMaster on Sept. 6, a spokesman said, adding that Mr. McMaster received a negative test result on Sunday.

Treasury Secretary Steven Mnuchin said on Monday that he was prepared to negotiate with Speaker Nancy Pelosi with no conditions on an economic stimulus plan, as talks between the White House and Democrats on such a package remained stalled. Speaking to CNBC, Mr. Mnuchin said that while he believed a robust recovery was underway, parts of the economy, particularly small businesses, needed more help. But Ms. Pelosi accused Republicans of merely pretending to want to provide additional aid, saying a plan they brought up in the Senate last week was relief in name only.

As wildfires tore through huge areas of Oregon this week, prison inmates were hurried away from the encroaching flames not to freedom but to an overcrowded state prison, where they slept shoulder to shoulder in cots, and in some cases on the floor. Food was in short supply, showers and toilets few, and fights broke out between gang members.

They were safe from one catastrophe, but delivered to another: the coronavirus pandemic, which has spread at an alarming rate in Americas prisons.

From what we know about Covid-19, how quickly it can spread and how lethal it can be, we have to prepare for the worst, said Bobbin Singh, the executive director of the Oregon Justice Resource Center, a prisoner advocacy organization.

Twin crises of the pandemic and a devastating wildfire season have taken a significant toll in prisons along the West Coast. Virus outbreaks have spread through cellblocks Oregons state prison system has had 1,600 infections over the past three months and poor ventilation systems have whipped in smoke from the fires.

Kristina Boswell, a prisoner in Oregon who was moved overnight on Friday, described a chaotic evacuation in an audio recording her lawyer shared with The Times.

She said prisoners were bound together with zip-ties and loaded into buses in the middle of the night, without their medications or water. When they arrived, she said, there was a shortage of mattresses and no chance of social distancing.

Were all in dorm settings, said Ms. Boswell, who was among more than 1,300 female prisoners moved to Deer Ridge Correctional Facility in Madras, Ore. Everyone is crammed in.

An arthritis drug that suppresses the immune system may slightly improve recovery times in severely ill Covid-19 patients, the drugs makers announced on Monday.

The drug, baricitinib, was tested in a large clinical trial sponsored by the National Institute of Allergy and Infectious Diseases. More than 1,000 hospitalized patients were randomly assigned to receive either the arthritis drug plus remdesivir, an antiviral shown to modestly speed recovery, or remdesivir plus a placebo.

Those taking the two-drug combination recovered on average one day sooner than those taking remdesivir alone, said Eli Lilly and Incyte, the makers of baricitinib. But the companies provided no data.

The N.I.A.I.D. confirmed that the Eli Lilly announcement is accurate but would not comment further, as government researchers analyze the trial results and prepare a paper for publication.

Their priority is assuring scientific rigor in how the data are disclosed, said Dr. Daniel Skovronsky, the chief scientific officer of Eli Lilly. Ours is that when we have potentially material information, we get it out to our shareholders.

Baricitinib is used in an attempt to quell the so-called cytokine storm, an overreaction of the immune system occurring in some severely ill Covid-19 patients. In a cytokine storm, the immune system itself may cause illness and death.

Citing the drugs benefit, Eli Lilly said it would ask the Food and Drug Administration for emergency use authorization, allowing it to sell baricitinib at a 40-milligram dose before the company formally submits an application for marketing.

The news poses a problem for doctors and hospitals. While the baricitinib trial was underway, researchers in Britain reported that a cheap generic steroid, dexamethasone, can improve recovery and reduce the death rate in Covid-19 patients. That drug also works to tamp down the immune systems overreaction.

The studies arent entirely comparable, however. Doctors and patients knew who was getting the drug in the British study, but not in the American trial, and the study populations differed. The death rate among patients in Britain was also four times that of patients in the United States.

Ukrainian government video from the scene showed hundreds of men and boys waiting along a highway in Belarus to try to enter Ukraine. Some have set up tents, apparently after having waited overnight.

Border guards in helmets and body armor policed a row of barricades blocking them from coming into the country. Ukraine has been closed to foreigners since August.

The pilgrims have been given food and water, the Ukrainian border service said.

Avraham Shapira, an Israeli pilgrim who is at the border with his children, told CNN that he'd booked a direct flight from Tel Aviv to Kiev four weeks ago, because he heard the border would be closed.

When he got to the airport, he said, the flight was canceled and he booked new tickets to Kiev via London. In London, his next flight was canceled too, but he was able to book a ticket to Belarus.

He praised the Belarus government for providing "all the services" needed by the pilgrims crossing the border, saying the Belarusians have offered to provide buses to bring the pilgrims directly to Uman, stay two days and return to Belarus.

Shapira added the group would not "see any citizen of Ukraine. It's not a danger for anybody. I come to pray for the world, I don't come to pray only for me."

"Our country is ready to take responsibility on all these functions and, of course, organize the process as safely as possible, for instance it will not affect the situation with the Covid disease rate," said President Alexander Lukashenko's press secretary Natalia Eismont said in a statement.

Members of conservative right-wing and Christian groups take part in an anti-government rally in Seoul on Aug. 15. Ed Jones/AFP via Getty Images hide caption

Members of conservative right-wing and Christian groups take part in an anti-government rally in Seoul on Aug. 15.

A decade ago, building cleaner Noh Il-soon was in the market for a new church. She had previously moved within Seoul, and when she did, she looked for a local congregation to join.

A missionary introduced her to a Presbyterian church called Sarang Jeil, Korean for "love comes first." Noh says she was immediately captivated by the sermons of the charismatic pastor, Jun Kwang-hoon.

"If my previous way of knowing Jesus, during 50 years in other churches, was like licking the outside of a watermelon," she says, "then knowing Jesus through our pastor was like splitting open the watermelon and tasting the sweet and juicy fruit inside."

The church had become increasingly visible and influential among fundamentalist Christian groups in South Korea, but its fortunes recently soured.

Authorities say the church has become the main cluster in a new wave of COVID-19 infections that has threatened to reverse the country's early success in controlling the virus. In addition, Jun, the charismatic pastor, is now in jail, accused of illegal election campaigning and libeling South Korean President Moon Jae-in by calling him a North Korean spy.

Sarang Jeil Church pastor Jun Kwang-hun speaks outside a detention center in Uiwang, South Korea, in April. Jun tested positive for the coronavirus last month, two days after he took part in an anti-government rally in Seoul. Ko Jun-beom/Newsis via AP hide caption

Sarang Jeil Church pastor Jun Kwang-hun speaks outside a detention center in Uiwang, South Korea, in April. Jun tested positive for the coronavirus last month, two days after he took part in an anti-government rally in Seoul.

Authorities have linked more than 1,100 cases of infection including Jun and 60-year-old Noh, who is now a deaconess to the Sarang Jeil Church. The numbers are second only to those linked to the Shincheonji Church of Jesus, a nationwide organization whose 5,200 cases were at the center of South Korea's first wave of infections in February.

Seoul city authorities say the Sarang Jeil Church failed to provide complete membership lists, prompting police to raid its headquarters. Some members refused to get tested. Some questioned the accuracy of the tests, and others fled quarantine after testing positive.

The clash between the church and the government over disease control has become the latest flashpoint in a wider conflict between a right-wing coalition, including fundamentalist churches, and the liberal administration of President Moon.

"Christian fundamentalism has been the mainstream of South Korea's Christianity, which has been very political since its early days," observes Kim Jin-ho, a pastor and researcher at the Christian Institute for the 3rd Era, a Seoul-based religious research institute.

That fundamentalism includes a tradition of charismatic preachers like Jun Kwang-hoon, who trace their roots back to Protestant American missionaries who worked in Korea more than a century ago.

"A political holy movement"

Before the pandemic hit, Jun and his followers were a common sight at weekend anti-government marches in downtown Seoul. Conservative demonstrators, including evangelical Christians and military veterans, waved Korean and American flags and held banners praising President Trump and decrying North Korean leader Kim Jong Un.

Jun also led prayer rallies on the streets, with crowds of followers dancing in a state of religious ecstasy and speaking in tongues.

"They are not there for money or benefits," Noh says proudly. "When they are there, the Holy Spirit inside them dances."

Jun built up his following among older, lower-income South Koreans like Noh in the late 1990s, Kim says. Many of them had moved from the countryside to the cities beginning in the 1970s. Then, some two decades ago, as other Protestant churches began to target affluent urban professionals, Jun's following strengthened amid an increasing sense of alienation among the less privileged.

"These people took the ostracization they experienced amid the changes South Korean Protestantism went through in the late '90, and turned it into a political holy movement led by Jun Kwang-hoon," Kim says.

Noh, dressed plainly, carrying bags of journals about her religious life and wearing a face mask as she speaks with NPR in a residential neighborhood near the Sarang Jeil Church, says she's not terribly concerned about her material well-being.

"Our pastor tells us, 'Don't bet everything on 100 years of good life here on this Earth'," she explains. "Instead, invest in the heaven up there."

Many pastors of small churches in South Korea subsist on donations from members, Kim says, which they're unable to collect now because the government has required them to move religious services online during the pandemic.

This situation "creates an economic burden on the churches, which makes the churches strongly resist the government's recommendations," Kim says.

"Undermining the credibility of all of Korea's churches"

Authorities accuse Jun and his followers of attending a banned anti-government rally last month, to which more than 500 COVID-19 cases have been linked. Jun was among those who tested positive for the virus after the rally.

Jun and his followers in turn accuse the government of intentionally infecting church members with the coronavirus and faking COVID-19 test results to frame them as the epicenter of the current wave of infections. As of Tuesday, South Korea had nearly 24,000 cases; it had almost 15,000 on Aug. 12, when the first church member tested positive.

In a speech last month, President Moon said the church should apologize to the public instead of spreading conspiracy theories.

"The lack of common sense among a very small group," he said, "is undermining the credibility of all of Korea's churches."

Noh, who has recovered from her COVID-19 infection, insists that Sarang Jeil Church members have cooperated with the government's disease control efforts, including by telling members to stay home and get tested.

She also insists that her patriotism is a natural result of her religious convictions and that by holding street prayer rallies and demonstrations, she and her church are just trying to prevent Moon, who has worked to improve relations with North Korea, from taking the country down the wrong path.

"The gospel cannot coexist with communism," Noh says. "We're still in conflict with North Korea, and there are remnants of North Korean sympathizer, leftist forces in this country."

She believes that South Korea was meant to embody the vision of Syngman Rhee, a U.S.-educated Christian who became the South's first president in 1948. He envisioned South Korea "standing on the four pillars of liberal democracy, free market economy, the alliance with the U.S., and a Christian state," she says.

South Korea has no officially designated religion.

Noh is bitter that South Korean media coverage of the Sarang Jeil Church, including Christian media coverage, has been overwhelmingly critical, while ignoring, she says, the suffering of church members.

Noh also complains that after she tested positive for the coronavirus, she felt that Seoul city and public health officials "treated me like a ball of germs, not a citizen of the country. I was so angry."

NPR's Se Eun Gong contributed to this story from Seoul.

The week America lost the fight against the new coronavirus, the nations premier health agency promised local officials it had the virus under control.

It was the third week in February. Senior leaders at the Centers for Disease Control and Prevention repeatedly brushed off calls to take COVID-19 more seriously.

They dismissed concerns from Minnesota to Hawaii that their plan to contain the outbreak by screening overseas travelers was riddled with inconsistencies.

They punted questions from state officials worried that returning travelers could spread the coronavirus when they showed no symptoms.

For days, they refused to test a California woman because she had not traveled overseas. When she tested positive, the CDC downplayed the fact that the patient who became known as Patient Zero proved the virus was spreading within the USA.

At the beginning of the coronavirus outbreak, CDC Director Robert Redfield insisted the national threat was low.Pool, Getty Images

Instead, CDC Director Robert Redfield went on national television and repeated seven times that the threat to the nation remained low.

The American public needs to go on with their normal lives, he said.

As the virus raced across America, state and local authorities sought help from the CDC, the $7billion federal agency established to lead the nation through pandemics.

Instead of answers, many received slow, confusing and conflicting information or no response at all a USA TODAY investigationfound. Reporters reviewed 42,000 pages of emails and memos obtained from health departments and interviewed more than 100 community leaders and public health experts, including current and former CDC officials.

Theagency has received widespread scrutiny for yielding topolitical pressure from the White House. These interviews and records provide the most extensive look yet at how the CDC, paralyzed by bureaucracy, failed to consistently perform its most basic job: giving public health authorities the guidance needed to save American lives during a pandemic.

Communities were left to make life-or-death decisions about testing, personal protection and reopening.

Health officials flooded the CDC with hundreds of phone calls and emails. Many questions went unanswered. In other cases, the agency response amounted to you decide.

In Nevada, the states top infectious disease scientist called the CDC begging for a list of travelers coming from China. A flustered agency representative hung up on her.

In Kentucky, a CDC official recommended that visitors continue to be allowed into nursing homes because they might not get another chance to visit family members. In an email,he wrote, Let people choose.

Authorities in at least 13 states questioned CDC guidance that contradicted either scientific evidenceor information put out by the CDC itself, records show. At times, rank-and-file CDC representatives, aware of their own leaderships lagging response,told state health departments to consider adopting guidance from academic studies or other states.

In more than two dozen news briefings, congressional hearings and other public statements from January to April, the CDC downplayed the potential harm from the virus.

In the most extreme cases, the CDC undermined health officials advocatinga more aggressive approach to controlthe spread.

The agency went so far as to edit a government science journal in late March to remove a Washington state epidemiologists call fortesting throughout senior assisted-living facilities. I would be careful promoting widespread testing, the CDC editor noted, according to drafts obtained by USA TODAY.

The CDC declined to make senior leaders available forinterviews and did not answer detailed questions about USA TODAYs findings.In a statement emailed by CDC spokesman Tom Skinner,the agency said it has executed its mission to protect Americans and worked to support state and local health departments with accurate information.

CDC has based decisions on known science and data available and has been clear that, as more became known about the virus, guidance and recommendations would evolve and change, the statement said.

The pandemic has presented unprecedented challenges, and many health officials told USA TODAY they were grateful for the CDCs help. CDC has been an incredible partner to us,said Dr. Kathy Lofy, the health officer in Washington state.

The White Househandicapped the agency from the start. Last week, journalist Bob Woodward disclosed that President Donald Trump told him in early February that his administration knew the virus was spreading through the air and killing people at a higher rate than the flu, but Trump publicly minimized the risks.

Former CDC officers who held senior leadership roles under Republican and Democratic presidents told USA TODAY the agency that once commanded global respect collapsed when communities needed it most.

They are incapable of responding to the emergency, said Dr. Pierre Rollin, former deputy chief of a CDC branch on viral pathogens and one of the worlds most renowned infectious disease experts.

Nearly 200,000 have died of COVID-19in the USA, and more than 6.6 million have been infected. The CDC suspects 10 times more Americans have caught the virus, but official counts remain skewed by its inability to fix chronic testing issues.

Without a national plan to guide them,authorities lost months debating whether to require face masks and when best to reopen businesses and schools.

Last month, the CDC reversed critical testing guidance for people exposed, saying those without symptoms did not need to be tested. Health officials and even the staunchest CDC champions lambasted the move. Some states are choosing to ignore it.

The CDCs own scientific advisersfear the agencys multiplefailures since February have destroyed the publics confidence, which will be crucial to successfully roll out a vaccine.

The leadership role of the CDC didnt hold firm,Dr. Brent Pawlecki, the chief healthofficer at Goodyear, told agency leaders in July as a panel of independent scientists reviewed the agencys early response. It has created a lot of confusion and unfortunately a lot of distrust.

Cynthiana, Kentucky, a community of 6,400 residents without a four-lane road, took the CDCs advice to continue life as normal.

No one paid much attention when the tenor with the best voice in thechurch choir called in sick after Sunday practice. Then, alto Julia Donohues migraine turned into a fever. The 28-year-old Walmart cake decorator, who liked to bake brownies for her church family, was airlifted to intensive care as her oxygen levels plunged.

Donohues positive test for COVID-19 was the first confirmed case in the state. Kentucky joined more than 20 states reporting their earliest brushes with coronavirus during the first week of March.

Show captionHide captionJulia Donohue, 28, a cake decorator from Cynthiana, Ky., was the first in her state to test positive for COVID-19. The rural town, which has...Julia Donohue, 28, a cake decorator from Cynthiana, Ky., was the first in her state to test positive for COVID-19. The rural town, which has a population of about 6,000, saw an early outbreak of the virus.Jack Gruber, USA TODAY

As Kentuckys case count ballooned, so did the fallout from the CDCs missteps.

The areas highest elected official, Harrison County Judge Alex Barnett, spent the next two weeks on a lunch tour to support businesses, visiting restaurants with his family. He snapped pictures posing with meals and posted them to Facebook to show people it was safe.

From the CDCs news briefings, the new coronavirus related to the viral family that causes the common cold sounded like a concern mostly for Americas distant big cities.

In public statements, leaders from Connersville, Indiana;Hudson, New York; andWinston-Salem, North Carolina, all repeated the CDCs low risk talking points.

The Kentucky hospital where Donohue first went to the ER had received no urgent warnings about community spread. More than 50 hospital workers did not wear masks or other protective gear, already in short supply, when they came into close contact with her.

I dont think people understood, Crystal Miller, health director for four counties in the area, told USA TODAY. We didnt know.

For the two weeks from when Donohue fell ill until the governor shut down the state, Barnett said he did not realize how much the small city of Cynthiana was at risk.

I am no expert in health when it comes down to it. I am a farmer, Barnett told USA TODAY. I am an expert on growing cattle and tobacco. I rely on the CDC for guidance.

Harrison County Judge Alex Barnett, center, recites the Pledge of Allegiance before a virtual meeting of court magistrates in Cynthiana, Ky. Joining him are Treasurer Melody McClure and 7th District Magistrate Dwayne Florence.Jack Gruber, USA TODAY

Within weeks, the confirmed case count in the county, pop. 19,000, climbed to 11. An outbreak engulfed a nursing home.

Miller sent constant updates around the state about her areas cases, tracking new information first on sticky notes, then a spreadsheet. She worked 15-hour days, responding to text messages from colleagues until 2 a.m.

In email exchanges, Kentucky officials questioned nonsensical directives from the CDC, such as to tell doctoroffices when testing for coronavirus to make sure the air does not mix with other air.

This is next to impossible for provider practices to accomplish, Andrea Flinchum in Kentuckys Health Department told the CDC in an email March 10.

Later that month, Flinchum asked CDC headquarters for advice on when and how to reuse respirators.A local representative shared several studies, but more than a week went by without official word from the agency. Waiting patiently to see this, Flinchum wrote.

In another email exchange,Dr. Kevin Spicer, a federal CDC medical officer stationed in Kentucky, acknowledged that he had been waiting two weeks for the agency to update its guidance on when and how to release people with COVID-19 from hospitals and isolation.

Lacking anything official, Spicer shared a link to a Washington state document outlining more up-to-date practices. It was not consistent with current CDC guidance, he noted.

Long-term care facilities, especially vulnerable, became another point of confusion during the first wave of Kentuckys outbreak in March. Matthew Penn, director of the CDCs public health law program, told a lawyer in the states Health Department not to ban nursing home visitors outright.

Persuasion by education strategy may work best, he wrote in an email. Let people choose.

Two days later, Gov.Andy Beshear banned nonessential visits at nursing homes. That week, the Centers for Medicare and Medicaid Services, which regulates the facilities, advised nursing homes nationwide to do the same.

More than 2,600 nursing home residents have tested positive in Kentucky since March. At least 530 have died, according to CMS data. Across the country, more than 53,000 residents have died.

Dr. Muhammad Babar, a geriatrician at the University of Louisville advising the state on coronavirus care at long-term care facilities, told USA TODAY that following the CDC lawyers advice would have resulted in a disaster.

In its statement to USA TODAY, the CDC noted that the agencysent approximately 1,300 public health experts to conduct more than 2,000 investigations in states to combat the pandemic. The agency said its guidance was tailored around keeping communities informed of the evolving science and changes to guidance through routine, direct and transparent engagements.

Kentuckys first recognized victim, Donohue, recovered but still suffers from migraines and shortness of breath.

Another singer in her choir died after being infected with COVID-19. For that, Donohue carries guilt that she might have unwittingly spread disease.

I thought I didnt have to worry about a killer virus, she told USA TODAY.

The CDC was created 75 years ago to fight malaria. Americans pay billionsfor its protection against outbreaks of disease and chronic conditions.

Headquartered in Atlanta, removed from the direct line of politics, the federal agency employs thousands of public health experts, many embedded in local health departments. Though it's not primarily a regulatory agency, its science guides national medical practice.

When the novel coronavirus surfaced last winter, the CDC spent weeks repeating assurances that the risk to Americans was low. Many local authorities, however, realized a crisis was coming and they were unprepared.

I just cant see how this outbreak will be contained, theNebraska state epidemiologist wrote Jan. 23.I think this is going to be a big pandemic.

In Kansas, the health director wrote to his staff Feb. 19:Are we behind the power curve on planning?

The CDC missed the early spread of the new coronavirus, blinded by its own decision to limit screening for the virus after its initial testing kit failed. That was one of the agencys most consequential scientific errors.

In California, Solano County public health officer Dr. Bela Matyas, working alongside CDC experts, had seen how people without symptomscould spread the disease in February, at an early quarantine site at Travis Air Force Base.

Bela Matyas is health officer for Solano County, Calif., which treated the first confirmed case of community spread of the coronavirus.Martin E. Klimek for USA TODAY

He said it was clear the agencys travel screenings focused on obvious symptoms such as fever were not going to work.

By definition, it was going to be a failure, Matyas told USA TODAY.

The agencys own director of global migration and quarantine knew it, too. Dr. Martin Cetron called the airport temperature screening a poorly designed control and detection strategy in internal emails later in the spring, resisting White House pressure to revive the program.

Health authorities trying to protect their communities pushed the CDC to loosen itsrestrictions on early testing.

The CDC controlled the nations first tests for COVID-19. Supplies were limited, and the agency designed restrictive testing guidelines. Fever and respiratoryillness werenot enough. The person had to have traveled to China or had contact with someone with a confirmed case.

Public health experts, including former CDC officials,accused the agency of creating guidelines on crucial measures such as testing based on supply shortages, not science.

We were told you dont need to be tested unless you have symptoms. Thats stupid and its always been stupid, Jim Curran, an epidemiologist at Emory University who led the CDCs research into HIV for 15 years, told USA TODAY. Policy shouldnt be based on scarcity.

One hospital in Seattle, the site of the first major U.S. outbreak, used paper and some spare space at the nurses station to track changes to the CDC testing guidance that often came unannounced and without clarifications, emergency room physician Sachita Shah told USA TODAY.

They taped paper after paper onto a computer monitor. The CDC told the hospital to test patients only if they had symptoms and had traveled to China; then Japan and South Korea; then Iran and Italy.

By the time the agency broadened the criteria to those without travel histories, the hospital had turned away several patients who needed testing.

CDC was too slow, Shah said. They should have been on top of this.

At the center of the first major U.S. outbreak of the coronavirus, Seattle, Dr. Sachita Shah said her hospital struggled to keep up with changing CDC testing guidance.Karen Ducey for USA TODAY

The case in Northern California, known as Patient Zero,exposed how wrong the CDC had been to test so narrowly.

Doctors at UC Davis Medical Centerpleaded for days to test the woman on a ventilator. She suffered from an unexplained respiratory disease yet had not recently traveled. The CDCs testing process did not allow for the possibility that the virus was spreading in the community.

We werent even able to test for it, CEO Dr. David Lubarsky said. It was a failed algorithm.

The CDC said in its statement provided to USA TODAY that the early testing protocol was based on the epidemiology of the disease at the time. CDC senior officer Dr. Nancy Messonnier said in Februarythat the agency greenlighted testing for the patient when it became aware of the case. Clinicians and a health official involved said they lost days pushing for access.

Patient Zero ultimately ledthe agency to rewrite its testing guidance. By then, more than 200 workers at two hospitals that treated her had risked exposure.

So many staff members had to be quarantined that one of the hospitals temporarily shut down its intensive care unit.

The CDCs leadership went on to fail Latino, Black and Native American communities and low-income neighborhoods. Experts said minority populations often were excluded from the policymaking process. They are more than twice as likely to be infected as non-Hispanic whites and nearly five times as likely to be hospitalized.

We were not prepared despite everything we know about public health disparities, K. Vish Viswanath, a health communication professor at Harvard and an independent scientist on the CDCs advisory board, told the agency during a panel review in July. That to me is inexcusable.

Donald Flores, a maintenance worker at the hospital that treated Patient Zero, developed symptoms in quarantine but was never tested. Heworries every workday that he is not protected.

Somebody, Flores said, doesnt give a damn.

The breakdown in the agencys communication with communities contributed to the failure of the Trump administrations signature defense against the pandemic: restrictions on travel from hot spots in China and later around the world.

Authorities expected the CDC to provide basic information names, contact information and arrival time so they could track travelers. Time and again, the CDC failed to do so.

In early February, Nevadastate epidemiologist Melissa Peek-Bullock learned from the local news about an airplane carrying three people who had been traveling in China,which was about to land in Las Vegas. The travelers posed a threat to U.S. cities, based on the CDCs criteria.

When Peek-Bullock called the agency seeking the passengers names and contact information, she was met with hostility, according to interviews and documents from the state Health Department.

At the Los Angeles airport, where the flight had been temporarily redirected, officials with the CDCs quarantine and mitigation division told her they were unaware of the requirements drawn up bytheir own colleagues.

In a call to the CDCs emergency hotline, Peek-Bullock said, she spoke with a representative who refused to identify the passengers, saying they were free to move along their way.

Increasingly desperate, she explained her fear that they could place all of Las Vegas at risk. Then the CDC representative hung up on her, Peek-Bullock said.

Its hard to imagine that would happen, she told USA TODAY. Truly, you just want to get the information that you need to do the right thing.

Afterward, the head of Nevadas Health Department, Richard Whitley, wrote to Redfield,the CDC director, to complain: The lack of communication in this circumstance created frustration and confusion for all those involved.

Senior CDC official Dr. JosMontero responded that the agency was trying to educate all of its divisions on the latest guidelines and requirements to share traveler information. He wrotethat the CDC regrets that Nevada Department of Health and Human Services had difficulty initially obtaining this information.

The shortcomings exposed by a pandemic had been years in the making.

President Trump on Wednesday rejected the professional scientific conclusions of his own government about the prospects for a widely available coronavirus vaccine and the effectiveness of masks in curbing the spread of the virus as the death toll in the United States from the disease neared 200,000.

In a remarkable display even for him, Mr. Trump publicly slapped down Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, as the president promised that a vaccine could be available in weeks and go immediately to the general public while diminishing the usefulness of wearing masks despite evidence to the contrary.

The presidents comments put him at odds with the C.D.C., the worlds premier public health agency, over the course of a pandemic that he keeps insisting is rounding the corner to an end. Mr. Trump lashed out just hours after Dr. Redfield told a Senate committee that a vaccine would not be widely available until the middle of next year.

I think he made a mistake when he said that, Mr. Trump told reporters. Its just incorrect information. A vaccine would go to the general public immediately, the president insisted, and under no circumstance will it be as late as the doctor said.

Mr. Trump also said Dr. Redfield made a mistake when he told senators that masks were so vital in fighting the disease caused by the coronavirus, Covid-19, that they might be even more important than a vaccine. The mask is not as important as the vaccine, Mr. Trump said.

The president has repeatedly claimed that a vaccine could be available before Election Day on Nov. 3, a timeline that most health experts say is unrealistic, prompting concerns that the Food and Drug Administration might give emergency authorization to a vaccine before it has been fully vetted for safety and effectiveness. Nine pharmaceutical companies have pledged to stand with science and to not push through any product that didnt stand up to scientific scrutiny.

Earlier on Wednesday, Joseph R. Biden Jr., the Democratic presidential nominee, accused the president of trying to rush out a vaccine for electoral gain.

Let me be clear: I trust vaccines, Mr. Biden said. I trust scientists. But I dont trust Donald Trump, and at this moment, the American people cant either.

Michael R. Caputo, the embattled top spokesman of the cabinet department overseeing the U.S. coronavirus response, will take a leave of absence to focus on his health and the well-being of his family, the Department of Health and Human Services announced Wednesday.

Mr. Caputos science adviser, Dr. Paul Alexander, will be leaving the department.

The announcement came after a bizarre and inflammatory outburst on Facebook on Sept. 13 and disclosures that Mr. Caputo and his team had tried to water down official reports of the Centers for Disease Control and Prevention about the pandemic.

Mr. Caputo, a longtime Trump loyalist and the health departments assistant secretary of public affairs, apologized for his Facebook presentation to his staff and to Alex M. Azar II, the departments leader, after his comments became public.

Since he was installed at the department in April by the White House, Mr. Caputo, a former Trump campaign aide, has aggressively worked to develop a media strategy for dealing with the pandemic. But critics, including some in the administration, complained that he was promoting the presidents political interests over public health.

His Facebook talk, which was shared with The New York Times, was filled with ominous predictions of left-wing hit squads plotting armed insurrection after the election and attacks on C.D.C. scientists, who he said had formed a resistance unit determined to undercut Mr. Trumps chances of re-election. He accused the scientists of rotten science and said they havent gotten out of their sweatpants except to plot against the president at coffee shops.

In his appearance in front of a Senate health panel on Wednesday, Dr. Robert R. Redfield, the director of the C.D.C., said Mr. Caputos remarks about government scientists committing sedition were false accusations offensive to career officials at his agency.

C.D.C. is made up of thousands of dedicated men and women, highly competent, Dr. Redfield said. It is the premier public health agency in the world.

Mr. Caputo and a colleague pushed the C.D.C. to delay and edit apolitical . health bulletins, called Morbidity and Mortality Weekly Reports, in an effort to paint the administrations pandemic response in a more positive light.

South Africa will reopen its borders to most countries on Oct. 1, President Cyril Ramaphosa said Wednesday, as the country prepares to ease other restrictions with its virus situation continuing to improve.

We have withstood the coronavirus storm, the president said in a national address.

It is time to move to what will become our new normal for as long as the coronavirus is with us.

Business and leisure travelers entering South Africa, which closed to international passengers in March, will need to present a negative coronavirus test from within 72 hours of their departure or stay in quarantine at their own expense. Anyone showing symptoms will be quarantined until proved to be negative. Mr. Ramaphosa said the government would publish a list of countries with high infection rates that may be subject to travel restrictions.

South Africa will also drop to its lowest alert level starting at midnight this Sunday, allowing for indoor gatherings of up to 250 people and outdoor gatherings of up to 500, with gyms, theaters and other venues limited to 50 percent of their capacity. The nightly curfew will also be reduced to between midnight and 4 a.m. Restrictions on sporting events will remain in place, and masks will still be required in public.

By any measure, we are still in the midst of a deadly epidemic, Mr. Ramaphosa said. Our greatest challenge now and our most important task is to ensure that we do not experience a new surge in infections.

South Africa, the epicenter of the outbreak in Africa and a major tourist destination, went into a strict nationwide lockdown in March that included an unpopular ban on cigarette and alcohol sales. In his speech on Wednesday, Mr. Ramaphosa noted the scourge of violence against women and children during lockdown as well as widespread allegations of corruption related to pandemic relief efforts.

South Africa has had more than 653,000 cases and 15,705 deaths, according to a New York Times database. But the countrys health minister, Dr. Zweli Mkhize, estimated this week that more than a fifth of the population, or 12 million people, had probably been infected.

In other developments around the world:

India reported 97,894 new coronavirus infections on Thursday, its highest one-day increase. The country has the worlds second-highest number of cases after the United States, according to a New York Times database.

New Zealand has entered its first recession in a decade, economic data showed Thursday. Officials said the economy shrank 12.2 percent in the second quarter, the countrys biggest fall on record, amid a nationwide lockdown this spring. On Thursday, the country reported zero community cases for the third consecutive day.

A small group of wealthy nations has bought more than half of the expected supply of the most promising coronavirus vaccines, the British charity group Oxfam said Thursday. Supply deals have been announced for 5.3 billion doses of five vaccines in the last stage of clinical trials. More than 2.7 billion doses, or 51 percent, have been bought by countries including Australia, Britain, Israel, Japan, Switzerland and the United States as well as the European Union, which together represent about 13 percent of the worlds population. Even if all five vaccines are approved, their combined production capacity of six billion doses is enough for only about three billion people since each person is likely to need two doses. That means that nearly two-thirds of the worlds population would not have a vaccine until at least 2022, Oxfam said.

A health official from Madrids regional government warned that the capital was preparing to impose selective lockdowns in districts where the number of cases has recently risen significantly. The minister, Antonio Zapatero, said that the region urgently needed to flatten the curve, before the arrival of colder weather that could help spread the virus faster.

Gen. Eduardo Pazuello on Wednesday became the third health minister in Brazil during the pandemic, The Associated Press reported, after nearly four months holding the position on an interim basis and almost 120,000 deaths from the virus there during that time. General Pazuello, a logistics expert with no prior health experience before taking a deputy position in May, follows two predecessors who departed after disagreements with President Jair Bolsonaro regarding ways to combat the virus.

Six months after locking down the country to curb the spread of the virus, Nepal is starting to welcome back trekkers and mountaineers. The decision is aimed at reviving the countrys ailing economy, which is heavily dependent on mountain tourism. Trekkers visiting Nepal will be required to produce documentation showing that they tested negative before flying in, and to quarantine before traveling to tourist destinations.

A day after covering a large White House event during which many attendees did not wear masks, Israeli reporters returning home on Wednesday were sent into quarantine.

In a statement, a spokesman for Israels Ministry of Health said the journalists who were flying with Prime Minister Benjamin Netanyahu of Israel were directed to go into quarantine and would be the subjects of an epidemiological investigation.

The reporters, who attended Tuesdays signing ceremony on the South Lawn for agreements to normalize relations between Israel and the United Arab Emirates and Bahrain, followed strict health protocols. An Israeli government official said the decision to quarantine them did not result from any specific notice of cases at the White House.

But Health Ministry officials watching the ceremony back in Israel which featured hundreds of attendees, many of them maskless, sitting and mingling in close quarters believed it to be obviously unsafe and were pissed, according to an Israeli government official.

One Israeli reporter who attended the event posted a video on Twitter showing Secretary of State Mike Pompeo speaking just inches away from Israels Mossad chief, Yossi Cohen. Neither man wore a mask.

A day after the ceremony, a Trump administration official tested at the White House was confirmed positive for the coronavirus. The official, who was not publicly identified, was not present for the ceremony, and the authorities began tracing the persons contacts to try to stop any further spread.

The number of cases in Israel, when adjusted for population, has risen to among the highest in the world. The government has mandated a second, nationwide lockdown to begin Friday afternoon, hours before the eve of the Jewish New Year holiday, and to last at least three weeks, extending to the last day of Yom Kippur and the festival Sukkot. The Jerusalem Great Synagogue, the venerable institution where Israeli prime ministers and presidents have prayed, announced on its website on Wednesday that it would remain closed over the Jewish high holidays for the first time in its more than half-century of history.

Connecticut officials on Wednesday took what they called the extraordinary step of closing a nursing home and moving its residents elsewhere after an outbreak that resulted in around 30 cases and four deaths and might have spread to a hospital.

The shutdown came just after the state made the rare move of installing an outside manager at the home, the Three Rivers Nursing Home in Norwich, to address various deficiencies.

The manager recommended the closing after quickly concluding that the problems could not be fixed by Sept. 30 as required by the state, said Deidre S. Gifford, Connecticuts acting health commissioner.

In a statement, the homes operator, JACC Healthcare Center of Norwich, said it supported the move.

Of the homes 53 remaining residents, 17 who have tested positive will be transferred to a home in East Hartford to isolate, officials said; 29 will be moved to other homes near Norwich. The rest are waiting for their test results and under observation for possible infection.

The state began investigating the home last month after 13 residents and two staff members tested positive. By Wednesday, at least 21 residents and six staff members had tested positive.

Investigators found, among other things, inadequate staffing; a failure to keep residents who had tested positive for the virus away from those who had not; and a lack of personal protective equipment.

Investigators also determined that workers at the nursing home had sent several virus patients to Backus Hospital in Norwich for emergency care without telling the hospital in writing that there was an outbreak at Three Rivers. Several hospital employees have tested positive for the virus, and the state is now investigating the outbreak there.

As in many states, the virus has ravaged Connecticuts long-term care homes. Nearly three out of every four of the 3,280 virus-related deaths that the state had recorded as of Wednesday were linked to such homes, according to data compiled by The New York Times.

In neighboring New York, officials this week eased restrictions on visitation guidelines previously set at nursing homes. Under the new rules, homes that have been virus-free for 14 days can allow visitors, half of the previous 28-day requirement.

The Big Ten Conference said Wednesday that it would try to play football as soon as the weekend of Oct. 23, potentially salvaging the seasons of some of the most renowned and lucrative teams in college sports and reversing a decision from just over a month ago not to compete because of the pandemic.

The move will probably appease some prominent coaches, parents, players, fans and even President Trump, but it is also likely to provoke new accusations that the league is prioritizing profits and entertainment over health and safety.

In a statement on Wednesday morning, the league said players, coaches, trainers and others on the field would undergo daily testing for the virus, and that any player who tested positive would be barred from games for at least 21 days.

Leagues that have already returned to play, like the Atlantic Coast Conference and the Big 12, have been forced to postpone a handful of games or bench players because of positive tests or exposure to the virus. Stadiums are operating with fewer spectators in the stands or none at all.

Complicating matters is the association between football and social gatherings like tailgate parties. Health officials near some Big Ten campuses, including Michigan State and Wisconsin, have begun cracking down on students for partying, threatening harsh penalties and putting fraternities and sororities under quarantine. In Ingham County, home to Michigan State University, local health officials ordered residents of nearly two dozen Greek houses, as well as several other group houses, to quarantine for 14 days after the university reported 160 new cases.

While we know many students are doing the right thing, we are still seeing far too many social gatherings in the off-campus community, where individuals are in close contact without face coverings, Mayor Aaron Stephens of East Lansing said on Saturday of the order.

At the University of Wisconsin-Madison, which is also part of the Big Ten and had a sharp uptick in cases last week, local health officials ordered all Greek organizations with one or more cases among their live-in members to quarantine. Several states, including Kansas, Colorado and Michigan, have tracked coronavirus clusters to fraternities and sororities.

And at SUNY Oswego in New York State, which has recorded 70 new cases since Saturday, officials warned students that any parties hosted by fraternity or sorority members, even if not technically sponsored by their Greek organizations, would still lead to severe individual and organizational penalties.

In recent days, the University of Iowa, Iowa State University, Ohio State University and the University of Wisconsin-Madison have canceled spring break, when students often travel to places like Florida and spend a week partying.

In other education news:

The University of Georgia said on Wednesday that it would not be able to host on-campus voting at a student center this fall over concerns about long lines and insufficient indoor air space for social distancing. It said it would provide a shuttle to other voting sites, and that other sites could be made available for in-person voting with the states approval. Critics noted that the universitys football team has not canceled its Oct. 3 season opener, but the university said the game would be held in an outdoor stadium with substantially reduced capacity. In its weekly coronavirus report on Wednesday, the university said a total of 421 positive tests had been reported from Sept. 7 to 13, most of them students, a decline of more than 70 percent from the previous week.

The University of Michigan is seeking a court order to end a strike by graduate students demanding more protection from the virus. In its court filings, the university accused the union, which went on strike Sept. 8, of interfering in the universitys mission to educate students by unlawfully withholding their labor.

All students at the University of Colorado Boulder, which has an enrollment of about 35,000, were advised to quarantine for two weeks by the countys health department on Tuesday after a surge of cases tied to the university. The county health director said that mandatory restrictions would be imposed if the positivity rate remained high.

The University of Arizona, with about 45,000 students, also asked students living on or near campus to quarantine this week and next, with the exception of attending classes, after a major spike in cases. And Grand Valley State Universitys 21,000 students in Allendale, Mich., were also ordered to stay in place for two weeks by the county health department.

President Trump urged Republicans on Wednesday to go for the much higher numbers in stalled negotiations over another economic recovery package, undercutting his partys push for a bare-bones plan that omits another round of stimulus checks for Americans struggling to weather the pandemic-induced recession.

The comments on Twitter were the latest instance in which Mr. Trump has undermined the Republican position in high-stakes negotiations, muddling the partys message along with lawmakers chances of reaching a politically palatable solution.

Democrats are pressing for at least $2.2 trillion in stimulus spending, a sum that White House negotiators and Republican leaders have said is far too high. Senate Republicans tried last week to push through a substantially scaled-back package that would provide only about $300 billion in new spending and did not include the $1,200 stimulus payments but it did not reach the 60-vote threshold and Democrats called the bill inadequate.

In his tweet, the president falsely asserted that it was Democrats who had opposed the stimulus checks which have been a part of every aid plan they have proposed, including the $3.4 trillion measure they pushed through the House in May.

Top Democrats, who are under mounting pressure from centrist lawmakers to act on another relief plan before the November elections, seized on Mr. Trumps comments to try to pressure Republicans to bow to their demands for more spending. Speaker Nancy Pelosi of California and Senator Chuck Schumer, Democrat of New York and the minority leader, said they look forward to hearing from the presidents negotiators that they will finally meet us halfway.

The coronavirus is out of control and is the No. 1 global security threat in our world today, the United Nations secretary general, Antnio Guterres, said Wednesday at a news conference outlining his messages for this years General Assembly session. The session, which began this week, will largely be held via virtual meetings because of the pandemic.

Mr. Guterres called for greater cooperation to develop and distribute an affordable vaccine and criticized what he called deadly misinformation that could dissuade people from getting vaccinated.

Mr. Guterres also said he would press the organizations 193 member states to help ensure that nations heed his plea for a worldwide cease-fire in all armed conflicts, which he called for six months ago to help combat the pandemic.

The United Nations has been unable to orchestrate a coordinated global response to the scourge and its pleas for billions of dollars in emergency aid for the neediest countries have so far only engendered what Mark Lowcock, the organizations top relief official, has called a tepid response.

On Tuesday, the new president of the General Assembly, Volkan Bozkir, a veteran Turkish diplomat, announced he would convene a special session of the body during the first week of November devoted to addressing the pandemic.

LATEST IN SCIENCE ROUNDUP

Federal officials outlined details on Wednesday of their preparations to administer a future coronavirus vaccine to Americans, saying that they would begin distribution within 24 hours of any approval or emergency authorization, and that their goal is for no American to pay a single dime out of their own pocket.

The officials, who are part of the governments Operation Warp Speed the multiagency effort to quickly make a coronavirus vaccine available to Americans also said the timing of a vaccine was still unclear.

Were dealing in a world of great uncertainty, said Paul Mango, the deputy chief of staff for policy at the Department of Health and Human Services. We dont know the timing of when well have a vaccine. We dont know the quantities. We dont know the efficacy of those vaccines.

The officials said they were planning for initial distribution of a vaccine perhaps on an emergency basis, and to a limited group of high-priority people such as health care workers in the final three months of this year and into next year. The Defense Department is providing logistical support to plan how the vaccines will be shipped and stored as well as how to keep track of who has gotten the vaccine and whether they have been given one or two doses.

In other science news:

A single infusion of an experimental drug has markedly reduced blood levels of the coronavirus in newly infected patients and lowered the chances that they will need hospitalization, the drugs maker, Eli Lilly, announced on Wednesday. The drug is a monoclonal antibody, a man-made copy of an antibody produced by a patient who recovered from Covid-19.

Russias vaccine, which has been approved by the government but not yet been fully tested for safety and efficacy, won a new customer on Wednesday in India, according to a Russian financial company backing the vaccine. The Indian company, Dr. Reddys Laboratories, agreed first to cooperate on clinical trials and, if they are successful, to buy 100 million doses, the Russian Direct Investment Fund said in a joint statement with the company.

Just hours before New York Citys 1.1 million students logged on for virtual school orientation on Wednesday morning, the Department of Education announced a last-minute change to how children will learn when classes officially start on Monday.

The city announced earlier in the summer that all schools would be required to provide at least some live instruction to all students on every day they were learning at home. Principals and teachers have been warning for weeks that there were simply not enough teachers to educate students in-person and online; different teachers have to instruct each cohort. The city finally acknowledged the enormous staffing crunch, which the principals union estimated could be as large as 10,000 educators, with Tuesday nights announcement.

For students in the hybrid education model, which involves physically attending school one to three days per week and learning remotely the rest of the time, the new rule will no longer require schools to provide daily live instruction when those students are remote. The roughly 40 percent of students who have chosen to learn remotely full time will still get live instruction each day. Students can switch to full remote learning at any time.

When the students in the hybrid model do not receive live instruction, they might instead watch a prerecorded video of a lesson, or complete assignments on their own time. The city also said that if schools have enough staff to provide daily live instruction on days when hybrid students are at home, they should do so.

The citys mayor has argued that reopening schools for in-person instruction is crucial for the citys hundreds of thousands of vulnerable children who were largely failed by remote learning. But the scarcity of both in-person instruction and live teaching has frustrated many parents.

On Wednesday, Mayor Bill de Blasio said that the city would add more teachers throughout the fall to provide live instruction.

Elsewhere in the New York area:

After months of complaints about testing delays, New York City officials are set to announce on Thursday that they have opened a lab in Manhattan that should significantly cut down on wait times as the city prepares for its most ambitious period of reopenings, with public school classes and indoor dining scheduled to begin this month. The new facility will prioritize New York City residents, meaning turnaround times within 24-48 hours, officials said.

Mr. de Blasio on Wednesday announced that he is furloughing his own staff at City Hall, himself included. The policy will affect 495 mayoral staff members, who will have to take an unpaid, weeklong furlough at some point between October and March 2021. The mayor intends to work during his furlough without pay, his spokesman said. The furloughs would yield $860,000 in anticipated savings.

Mr. de Blasio also said on Wednesday that New York City would close off additional streets to vehicle traffic to allow restaurants to serve customers outdoors and would also extend the street closings from weekends to weekdays. The move is meant to try to help restaurant owners offset some of their huge losses during the pandemic. Indoor dining is set to resume in the city on Sept. 30, but restaurants will be allowed to serve at only 25 percent capacity.

Reporting was contributed by Peter Baker, Alan Blinder, Luke Broadwater, Emily Cochrane, Michael Corkery, Michael Crowley, Melissa Eddy, Rick Gladstone, David Halbfinger, Anemona Hartocollis, Mike Ives, Isabel Kershner, Andrew E. Kramer, Gina Kolata, Sapna Maheshwari, Patricia Mazzei, Raphael Minder, Benjamin Mueller, Richard C. Paddock, Linda Qiu, Gretchen Reynolds, Dana Rubinstein, Ed Shanahan, Eliza Shapiro, Bhadra Shrama, Sheryl Gay Stolberg, Glenn Thrush, Marc Tracy, Noah Weiland and Sameer Yasir.

Without masks and a vaccine, we could reach Herd Immunity from COVID-19, but deaths would skyrocket. We break down the science of it. USA TODAY

The United States plans to begin distributing coronavirus vaccine within 24 hours of one being approved, federal officials said Wednesday.

Its an audacious goal in an already franticly paced COVID-19 vaccine development and distribution program being overseen by the White House's aptly-named Operation Warp Speed.

The goal is that 24 hours after a licenseor an Emergency Use Authorization is issued "we have vaccine moving to administration sites," Lt. Gen. Paul A. Ostrowski, Operation Warp Speed deputy chief of supply, production and distribution, said on a media call Wednesday morning.

The initial rollout could begin as early as late this year or January.

The announcement came as the Centers for Disease Control and Prevention issued a 56-page playbook outlining details of how the vaccine will be distributed to medical providers nationally.

The vaccine initially willbe in short supply and will go to the most vulnerable, CDC director Dr. Robert Redfield testified to the Senate appropriations subcommittee on Labor, Health and Human Services, Education and Related Agencies later on Wednesday.

If youre asking me,When is it going to be available to the American public so we can begin to take advantage of vaccines to get back to our regular life? I think were probably looking at late second quarter, third quarter 2021, he said.

The vaccine will be available to any American who wants it regardless of ability to pay, assured officials. The vaccine itself, as well as the syringes and other equipment, will be distributed by and paid for by the U.S. government, the officials said.

An administration fee, basically a fee for giving the shot, can be charged by doctors offices, clinics and pharmacies but will either be paid for by private insurance,Medicaid, or federal funding.

There are still details to be worked out with Medicare fee-for-service providers. In the worst case, it will cost $3.50 per shot but were working on that, said Paul Mango, deputy chief of staff for policy in the office of the Secretary at the U.S. Department of Health and Human Services.

More: Scientists outraged by White House appointees' meddling with coronavirus information: 'Outright egregious'

More: The sprint to create a COVID-19 vaccine started in January. The finish line awaits.

More: 'Mind-bogglingly complex': Here's what we know about how COVID-19 vaccine will be distributed when it's approved

In a report to Congress and the accompanying "playbook" for states and localities, federal health agencies and the Department of Defense outlined complex plans for the vaccination campaign. It will begin slowly in January or potentially late in 2020 with the presumption that initially vaccine supplies will be limited. Within months, as more vaccine becomes available, the shots will be offered to every American who wants one.

Distribution will be through McKesson, a medical distribution company, working with the Pentagon for logistical and IT support. All shots will be given by civilian health workers, in health departments, clinics, hospitals, doctor's offices and pharmacies.

The campaign is "much larger in scope and complexity than seasonal influenza or other previous outbreak-related vaccination responses," according to the playbook.

Among the highlights:

Most of the candidate vaccines requiretwo doses. Some must be given21 days apart, others 28. The second dose must be from the same vaccine manufacturer. It's anticipated that eventuallyseveral vaccines from different manufacturers will be approved and available.

Health workers, other essential employees, and people in vulnerable groups will be allocated vaccine first. The National Academy of Medicine and the CDC's Advisory Committee on Immunization Practices are creating plans for who will be first in line.

Stateand local health departmentswill need to devise precise plans for receiving and locally distributing vaccines. All but one of the vaccines must be shipped frozen and one, from Pfizer, mustbe shipped at minus 94 degrees.

Each state has one month to submit its distribution plan.

Contributing: Associated Press

Read or Share this story: https://www.usatoday.com/story/news/health/2020/09/16/covid-vaccine-plan-free-americans/5815006002/

Trump: I'm not looking to be dishonest. I don't want people to panic. And we are going to be OK. We're going to be OK, and it is going away. And it's probably going to go away now a lot faster because of the vaccines.

It would go away without the vaccine, George, but it's going to go away a lot faster with it.

Trump: Sure, over a period of time. Sure, with time it goes away.

Stephanopoulos: And many deaths.

Trump: And you'll develop -- you'll develop herd -- like a herd mentality. It's going to be -- it's going to be herd-developed, and that's going to happen. That will all happen.

What that back-and-forth proves is that Trump's understanding of the virus, which has sickened more than 6 million Americans and killed almost 200,000, is still very, very rudimentary.

Let's get the one thing Trump got right in his answer out of the way: Yes, a vaccine would help reduce the number of people getting Covid-19. So when Trump says "it's probably going to go away now a lot faster because of the vaccines," he is, broadly speaking, correct -- if decidedly inarticulate.

Now to the rest of what Trump said.

First off, "herd mentality" is what drives Trump's supporters not to wear masks when gathering in large crowds (or ever). It's not what governs viruses.

It's not clear whether Trump was referring to herd immunity in the context of people getting Covid-19 or people getting the eventual Covid-19 vaccine. (Why wasn't Trump clear about that? Well, there's at least the possibility he doesn't know the difference.)

Which, well, wow.

If Trump was referring to the acquisition of herd immunity via vaccine, his repeated assertions that the virus will disappear quickly is also wrong.

Again, in order to achieve herd immunity, a very big chunk of the population needs to have the antibodies for the virus. That happens either by getting sick and recovering or by getting a vaccine that includes a small amount of antibodies that, ideally, create immunity to Covid-19.

Let's assume, for the sake of argument, that by January 1, 2021, a vaccine has been approved for widespread distribution that has proven effective in large numbers of people. In order to achieve Trump's idea of herd immunity, we need millions of Americans to get the vaccine.

In short: There really is no quick fix here. While a vaccine would undoubtedly increase -- rapidly -- the number of people with Covid-19 antibodies, it would not create herd immunity anytime soon.

It's not at all clear if Trump understands, well, any of this. He's just making promises about vaccines and riffing on "herd mentality" when the human cost of our ongoing fight against the coronavirus just keeps rising. What he doesn't seem to grasp is that none of this is going to just magically disappear -- no matter how many times he says it.

CORRECTION: This story has been updated to remove an unverified calculation about herd immunity and correct what is currently known.

Now, the bad news: In many of those states, testing has also decreased. And the overall number of daily new cases is still way too high as the US faces a trio of major challenges this fall.

On Sunday, 34,450 new cases were reported nationwide, according to data from Johns Hopkins University. That's better than the summer peak in late July, when the US had more than 60,000 new cases a day.

But nationwide, testing is down 10% this past week compared to the previous week, according to data from the Covid Tracking Project.

And of the confirmed cases we do know about, 34,450 is still an enormous number, health experts said Monday.

"We never really got the cases down. Remember, we're talking about 35,000 cases a day. Today, we're likely to hit over 40,000 cases a day," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"Back in April ... we had 22,000 cases a day and thought, 'My God, it can't get any worse.' And what's happening here is we're going to see this kind of up-and-down, up-and-down. But each time it goes up, it goes a little higher. Each time it comes down, it doesn't come down as far."

Nearly 550,000 children in the US have been diagnosed with Covid-19 since the pandemic began, according to the American Academy of Pediatrics and the Children's Hospital Association.

The groups found that children represent nearly 10% of all reported cases in the US.

Epidemiologists say the US must get the virus under control because the US will soon face several challenges simultaneously:

"You're going to have all these patients coming into hospitals and doctors office with symptoms that could be coronavirus, that could be the flu," Gounder said.

"And we're going to have to treat all of them like they have coronavirus. So that's a very dangerous and scary situation to be in."

Academic struggles: While millions of students grapple with online learning, many schools that brought students back to classrooms are suffering with outbreaks.

Athens-Clarke County, Georgia -- home to the University of Georgia -- has seen a "dramatic spike" in cases after maintaining lower case counts and death counts throughout the summer, Mayor Kelly Girtz said.

"Clearly, it's the return to campus of large numbers of students who are not here through the summertime," the mayor said.

Michigan State University students were asked to quarantine after the local health department reported 342 new cases among people affiliated with the university since August 24, East Lansing Mayor Aaron Stephens said.

While heath experts stress that a Covid-19 vaccine might not be publicly available until 2021, there are promising signs among several of the vaccines currently in Phase 3 trials.

Pfizer CEO Albert Bourla told CBS' "Face the Nation" that there was a "quite good chance" researchers will know by the end of October whether its experimental vaccine works.

"Then, of course, it is (the) regulator's job to issue (a) license or not," Bourla said.

"I think we should strive to have as more diverse population as possible," Bourla told CBS, stressing the importance of having a diverse group of volunteers given the heightened impact Covid-19 has had on communities of color.

"Right now we are not bad. Actually, we have a population that globally only 60% are Caucasians, 40%, approximately, minorities."

Moderna, which is also in Phase 3 testing for its vaccine, said its minority enrollment has also improved. About 59% of the participants are White, 22% are Hispanic, 11% are Black, 5% are Asian, and 3% are from other populations.

The world's largest vaccine manufacturer said if a Covid-19 vaccine requires two doses, it might be 2024 before everyone could get inoculated.

And that means production on a mammoth scale.

"I know the world wants to be optimistic on it... [but] I have not heard of anyone coming even close to that [level] right now," Poonawalla said. "It's going to take four to five years until everyone gets the vaccine on this planet."

Dr. William Schaffner, an infectious diseases professor at Vanderbilt University Medical Center, said he expects the timeline in the US to be faster.

"I suspect we'll have more vaccine for the United States before we have it for the entire world," Schaffner said.

Several vaccine makers in the United States have given their volunteers two doses during at least one phase of their clinical trials.

But "some vaccines under development right now require only one dose," Schaffner said. "So I think that timeline could be accelerated -- surely here at home, and even around the world."

Pfizer's coronavirus vaccine could be distributed to Americans before the end of the year if found to be safe and effective,CEOAlbert Bourla said Sunday.

The drugmaker should have key data from its late-stage trial for the Food and Drug Administration by the end of October,Bourla said during an interview on CBS'"Face the Nation." If the FDA approves the vaccine, the company is prepared to distribute "hundreds of thousands of doses," he said.

Because of the pandemic, U.S. health officials and drugmakers have been accelerating the development of vaccine candidates by investing in multiple stages of research even though doing so could be for naught if the vaccine ends up not being effective or safe.

The U.S. pharmaceutical giant has been working alongside German drugmaker BioNTech. In July,the U.S. government announced it would pay the companies $1.95 billion to produce and deliver 100 million doses of their vaccine if it proves safe and effective.The deal was signed as part of Operation Warp Speed, the Trump administration's effort to accelerate development and production of vaccines and treatments to fight the coronavirus.

Bourla said Sunday that the company has already invested $1.5 billion for the development of the potential vaccine. He said if the vaccine failed to work it would be financially "painful" for the company.

"At the end of the day, it's only money. But that will not break the company, although it's going to be painful,'" he said.

Pfizer's experimental vaccine contains genetic material called messenger RNA, or mRNA,which scientists hope provokes the immune system to fight the virus.

Pfizer is one of three companies currently in late-stage testing for a vaccine. The other two are Moderna andAstraZeneca, which announced Saturday it would resume its trial after temporarily pausing it for safety reasons.

On Saturday, Pfizer submitted a proposal to the FDA to expand the late-stage trial to include up to 44,000 participants, a significant increase from its previous target of 30,000.

The developments come as infectious disease experts and scientists in recent weeks have said they have concerns that President Donald Trump is pressuring the FDA to approve a vaccine before it's been adequately tested. FDA Commissioner Stephen Hahn, insisting he wasn't being pressured by Trump to fast-track a vaccine,told The Financial Timeslast month the agency is prepared to bypass the full federal approval process in order to make a Covid-19 vaccine available as soon as possible.

On Sept. 8, nine drug companies, including Pfizer, released a letter pledging that they would prioritize safety and uphold " the integrity of the scientific process" in their efforts to develop coronavirus vaccines.

Even if a vaccine is approved to be distributed before the end of the year, it will likely be in short supply. The vaccine will likely require two doses at varying intervals, and states still face logisticalchallenges such as setting up distribution sites and acquiring enough needles, syringes and bottles needed for immunizations.

Earlier this month, the National Academies of Sciences, Engineering, and Medicine released a draft proposal for distributing a vaccine in the U.S. if and when one is approved for public use. The report was requested by the National Institutes of Health and the Centers for Disease Control and Prevention.

The vaccine would be distributed in four phases, with health-care workers, the elderly and people with underlying health conditions getting vaccinated first, according to the group. Essential workers, teachers and people in homeless shelters as well as people in prisons would be next on the list, followed by children and young adults.