Broadway theaters and museums that tourists would flock to are still closed. The United States has banned travel from China, Brazil and much of Europe. And Gov. Andrew M. Cuomo has ordered a quarantine for visitors from 31 of the countrys states.
Four months after New York City shut down to combat the coronavirus, its vital tourism industry remains essentially paralyzed even as the city struggles to kick-start its moribund economy.
The enormous challenge the city faces was on vivid display when the Statue of Liberty reopened on Monday. Instead of carrying the usual throngs of visitors from around the world, the first boats to the island that holds the statue ferried more journalists than paying customers.
Times Square, typically gridlocked with visitors, was nearly as lonesome. Its not that happening, said Swathi Roja, who lives in Washington, assessing the so-called Crossroads of the World. Maybe Im not getting the real New York City.
New Yorks abrupt lockdown in March came just before the annual onslaught of tourists as the weather begins to warm. Officials had been expecting more than 67 million visitors in 2020, about one-fifth of them from outside the country.
Now the citys tourism officials have been left wondering how they will ever revive an industry that brought in about $45 billion in annual spending and supported about 300,000 jobs.
Not since the grim days of the 1970s, when crime was rampant, the subway was in disarray and boarded-up storefronts were abundant, has promoting New York to out-of-towners seemed so daunting, said Jonathan M. Tisch, chief executive of Loews Hotels and former chairman of NYC & Company, the citys tourism marketing agency.
There are all kinds of challenges that are going to make our jobs of rebuilding tourism and New York Citys economy even tougher, said Mr. Tisch, who worked the front desk at one of his familys hotels as a college student in the 1970s.
He said the process of rebuilding the citys image as a safe and fun place to visit would take a lot of time and help from the state and city government. Along with rhetorical support from elected officials, hotels and restaurants are seeking tax breaks and rent relief.
We can survive this, Mr. Tisch added.
Mr. Tisch is one of dozens of leaders of tourism-dependent businesses who have been devising plans for the industrys recovery from its longest and steepest slump in memory. The situation is unlike the citys brief shutdown after the 9/11 terrorist attacks in 2001 because Americans felt a patriotic urge then to help the city heal, he said.
Two nights after the attacks, on Sept. 13, shows resumed at all 23 Broadway theaters.
But this time, with confined indoor spaces making it easier for the virus to spread, the theaters plan to remain dark until next year. Without the shows that serve as the citys thumping heart, hundreds of hotels and restaurants in Manhattan are simply trying to survive 2020.
The perception is that if Broadway is closed, New York City is closed, Mr. Tisch said.
In the second week of July, the occupancy rate of New York City hotels was just 37 percent, according to STR, a research firm. That is down from more than 90 percent in recent summers.
We think its too soon to encourage travel and invite folks to come back in, said Fred Dixon, the chief executive of NYC & Company. He said that for the past four months the city had had no tourism to speak of and that he was not even guessing how many visitors it would tally for the year.
So, instead of promoting the city in international capitals and other faraway places as it typically does, the agency is narrowing its focus to New York and its surrounding areas.
This month the city introduced a campaign themed All In NYC that was created by Aruliden, a Manhattan marketing firm, to stir interest among local residents in exploring the city and seeing some of its sights.
The strategy is similar to one being employed by Paris, which is encouraging its own residents to tour the city without the usual hordes. Paris is yours is the theme of that campaign.
But even a scarcity of tourists may not be enough of a lure to get jaded New Yorkers to venture to the citys famous attractions. Local residents were nowhere to be found among the few visitors to the Statue of Liberty on Monday morning.
For now, the city may have to rely on people like Shin Roldan, 31, and her new husband, Keith, 30. The couple, who live within commuting distance in Morristown, N.J., were having a honeymoon of sorts a few months after a pandemic wedding in their backyard, Ms. Roldan said.
Despite the citys continuing ban on indoor dining, they said they were enjoying their stay in a Midtown Manhattan hotel. They had already ridden the tram to Roosevelt Island in the East River and planned to go to the observation deck atop the Empire State Building, which had just reopened.
Updated July 23, 2020
We can take a lot of pictures, just the two of us, with nobody else in the pictures, Mr. Roldan said. Thats always a problem in New York.
The fourth phase of the citys reopening, which started Monday, was a mixed blessing for Brad Hill, whose company operates the concessions on Liberty Island and nearby Ellis Island. It allowed him to bring back more than 100 employees who had been laid off since mid-March. But with so few tourists, being open again was a losing proposition, he said.
Just a few days before, Mr. Cuomo had upended his plans by excluding museums from the list of places that could reopen. That ruled out Ellis Island, whose main attraction is its exhibits on immigration and archives that visitors can search for records of their relatives.
Mr. Hill said he had spent about $60,000 preparing the dining areas and gift shops on the two islands to accept customers in a socially distant manner. Now he was no longer planning to hire more than 150 seasonal workers for the summer.
Mr. Hill said he was having flashbacks to the recovery from past shutdowns of the statue, after 9/11 and Hurricane Sandy in 2012. The only problem with this one is there are no tourists, he said.
Kate Fone and her family, visiting from Haverhill, Mass., saw the statue from a passing tour boat before it reopened. She, her husband and son made a spontaneous trip to take advantage of the low prices and lack of crowds.
They were staying in an Airbnb rental on Fifth Avenue that was a real good deal, she said as she stood outside St. Patricks Cathedral.
Some intrepid travelers made longer treks in defiance of Mr. Cuomos quarantine rules.
Shea Ellis, 33, and Tony Green, 34, drove to New York from Talladega, Ala., a state on Mr. Cuomos list, with his three children. Ms. Ellis, a business manager, said she was undaunted by the spreading virus.
Its all over the country, she said. I havent been worried about it.
Mr. Green, a truck driver, added, You cant just stop your life.
They said they liked the lack of traffic in Manhattan but were disappointed that so much of the city like the 9/11 Memorial Museum, was still closed.
You dont get the real experience, she said.
Abigail Valle made an even longer haul with her nephew, Hazael, and her mother. Taking a break from posing at the base of the Statue of Liberty, she said they had driven 48 hours straight from their home in Azusa, Calif., to see relatives in Brooklyn.
I just wanted to see it in real life, she said of the statue.
After a week in the city, they were heading back on the road Monday night, Ms. Valle said. Next stop: Las Vegas.
Nate Schweber contributed reporting.
Despite the sharp uptick in cases he acknowledged and a US death toll that now exceeds 142,000, Trump declared that "it's all going to work out. And it is working out."
He suggested children do not transmit the coronavirus, though early evidence suggests children can and do. He attributed the recent rise in cases in part to racial justice protests, though early evidence suggests the protests did not cause a spike, and in part to migration from Mexico, though there is no evidence for this either.
Trump also claimed that he has done more for Black Americans than anyone else with the "possible exception" of President Abraham Lincoln. That is transparently ridiculous.
Here is a look at some of Trump's claims and the facts behind them.
Trump suggests Mexico to blame
In assigning blame for the uptick in coronavirus cases, Trump also suggested that Mexico was responsible, even though public health officials haven't publicly made this same accusation.
"Likely also contributing were also sharing a 2,000-mile border with Mexico, as we know very well, and cases are surging in Mexico, unfortunately," Trump said on Wednesday.
Referring to his proposed US-Mexico border wall, Trump added, "It was really meant for a different purpose, but it worked out very well for what we're doing right now and the pandemic."
Facts First: Trump didn't provide any evidence to back up his claims, and the nation's top public health officials aren't blaming Mexico for the US pandemic. Also, cases are spiking in states that don't share a border with Mexico -- like Florida, Louisiana and Idaho -- undercutting Trump's implication that border-crossers are bringing the disease into the US en masse. It's worth noting that the virus first flared in places such as Washington State, New York and New Jersey, thousands of miles away from the Mexican border.
After the briefing, CNN's Chief Medical Correspondent Sanjay Gupta said there isn't medical evidence supporting Trump's assertions. "I don't think there's any data specifically on Mexico," Gupta said. "We actually looked up to see if there was any data on that, and I didn't find any."
There is also a logic problem with Trump's comments. On one hand, he's blaming Mexico for the US spike. But he's also saying that the border barriers have successfully kept out the virus.
Kids transmitting the virus
During Wednesday's briefing, Trump continued to advocate for schools opening in the fall. In support of this he claimed that "a lot of people" say children "don't transmit" coronavirus.
"They don't catch it easily, they don't bring it home easily," Trump added. "And if they do catch it, they get better fast."
According to one recent study from the Korea Centers for Disease Control and Prevention, children between 10 and 19 years old may transmit coronavirus just as much as adults.
"Although the detection rate for contacts of preschool-aged children was lower, young children may show higher attack rates when the school closure ends, contributing to community transmission of Covid-19," the study said.
As a result, even though children appear to be affected less commonly or severely than adults, returning to school still poses certain risks.
Protests and the rise in cases
Trump said there were a "number" of causes for the recent spike in coronavirus cases. He cited some uncontroversial possible contributors, such as Americans returning to bars and increasing their travel.
The first cause he listed, though, was the racial justice protests that swept the country following the police killing of George Floyd in Minneapolis in late May.
"Cases started to rise among young Americans shortly after demonstrations...which presumably triggered a broader relaxation of mitigation nationwide," Trump said.
Obama and Chicago
CNN's Kaitlan Collins noted that in 2016 Trump said that it was President Barack Obama's fault that homicides were up in Chicago. She questioned Trump, "Why was it the President's fault then and not your fault now?"
Trump claimed that Obama "was invited in and he did a poor job. President Obama could've gone into Chicago. He couldn't have solved the problem and he didn't."
Since his early days in office, Trump has suggested sending the National Guard to curb gun violence in Chicago. Chicago's history with the National Guard is tumultuous, most notably during the 1968 Chicago riots and later at the 1968 Democratic National Convention.
Chicago wants a federal presence in the city
After Trump announced plans to send a "surge of federal law enforcement" to Chicago this week after the city experienced more gun violence, he claimed that Chicago will "want us to go in, full blast."
"I think in their own way they want us to go in, full blast. There will be a time when they're going to want us to go in full blast, but right now we are sending extra people to help. We are arresting a lot of people that have been very bad," the President said.
Facts First: This is an overstatement and needs context. The mayor of Chicago, who has a testy relationship with Trump, has cautiously welcomed federal law enforcement into the city to help combat its gun violence, but noted that federal agents were not welcome to "terrorize our residents."
But by Tuesday, Lightfoot cautiously embraced Trump's federal law enforcement to help combat Chicago's gun violence so long as the agents remain focused on gun violence.
Trump and Black Americans
But Trump's response to Biden's assertion was also wrong.
Facts First: While we give Trump lots of latitude to express opinions, this one is simply ridiculous even if he is only comparing himself to previous presidents and excluding other Black heroes. It's absurd to say Lincoln is a "possible" exception; emancipating the slaves was obviously more important for Black Americans than anything Trump has done. President Lyndon B. Johnson signed the 1964 Civil Rights Act and the 1965 Voting Rights Act, monumental bills whose impact dwarfed the impact of any legislation Trump has signed.
CNN's Andrea Kane contributed to this fact check.
TheWest Virginia Department of Health and Human Resources (DHHR) reports as of 10:00 a.m., on July 24,2020, there have been 251,565 total confirmatory laboratoryresults received for COVID-19, with 5,653 total cases and 103 deaths.
In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.
CASESPER COUNTY (Case confirmed by lab test/Probable case):Barbour (28/0), Berkeley (579/19), Boone(67/0), Braxton (8/0), Brooke (42/1), Cabell (243/9), Calhoun (5/0), Clay(17/0), Fayette (111/0), Gilmer (14/0), Grant (37/1), Greenbrier (82/0),Hampshire (55/0), Hancock (80/4), Hardy (49/1), Harrison (152/1), Jackson(153/0), Jefferson (273/5), Kanawha (641/12), Lewis (24/1), Lincoln (38/1),Logan (66/0), Marion (146/4), Marshall (93/1), Mason (38/0), McDowell (13/0),Mercer (79/0), Mineral (87/2), Mingo (77/2), Monongalia (791/15), Monroe(18/1), Morgan (24/1), Nicholas (22/1), Ohio (217/0), Pendleton (25/1),Pleasants (5/1), Pocahontas (39/1), Preston (93/21), Putnam (132/1), Raleigh(118/4), Randolph (199/3), Ritchie (3/0), Roane (12/0), Summers (2/0), Taylor(35/1), Tucker (7/0), Tyler (11/0), Upshur (34/2), Wayne (166/2), Webster(3/0), Wetzel (41/0), Wirt (6/0), Wood (208/11), Wyoming (15/0).
As case surveillance continues at the local health department level, it mayreveal that those tested in a certain county may not be a resident of thatcounty, or even the state as an individual in question may have crossed thestate border to be tested.
Pleasenote that delays may be experienced with the reporting of information from thelocal health department to DHHR.
Please visit thedashboard at www.coronavirus.wv.gov for more detailed information.
The drag is felt acutely in tourist destinations dependent on air travel, like the Canary Islands, hundreds of miles from mainland Spain. Airlines carried 15 million visitors to the archipelago last year, but the flight capacity this month is just 30 percent of what it was a year ago.
Italy has tried to promote national tourism by issuing a so-called holiday bonus, a 150-euro voucher per Italian for lodging, up to 500 per family. Dario Franceschini, the minister of culture and tourism, told Parliament this month that about 400,000 vouchers had been issued, worth 183 million in total. According to Italian news reports, however, only a small fraction of hotels accept them.
Greece, though suffering less from the pandemic than either Italy or Spain, has still seen scant evidence of a rebound in tourism. In the first 12 days of July, passenger traffic at the Athens airport was down 75 percent from a year ago.
Though all of the countries of southern Europe have emerged from lockdown, new outbreaks there and quarantine orders elsewhere have added hurdles. This month, Britain said that people coming from Portugal, among other countries, would be forced to quarantine on arrival, a move that essentially choked off British tourism there.
Outbreaks have also occurred around major tourism hubs like Barcelona, where about three million residents were told on Friday to stay indoors to help contain the coronavirus.
Carlos Garca Pastor, the marketing director of Logitravel Group, a Spanish travel operator that had revenue of about 800 million last year, said that his company expected earnings to drop at least 50 percent this year.
The final result, he said, will really depend on how many new outbreaks there are.
Nearly a month ago, there were 49 cases at the ICE detention center in Farmville, Virginia, which holds adult males. Now, of the 360 immigrants in custody at the center, there are 268 confirmed cases of coronavirus currently under isolation or monitoring, according to agency statistics.
"We're just stuck in here. We can't do anything about it," said a 39-year-old detainee who agreed to share his experience on condition CNN not use his name.
"Some people are worried, sad, because they worry about their families, they worry about being deported," said the detainee, who tested positive for coronavirus in early July.
"A humanitarian crisis is rapidly unfolding at Farmville Detention Center," reads a complaint in the US District Court for the Eastern District of Virginia filed Tuesday by the National Immigration Project, Legal Aid Justice Center and Gibson Dunn.
At Farmville, lawyers attribute the rise in cases to an agency effort to transfer detainees to provide for social distancing.
In early June, 74 detainees were transferred to the Farmville center from facilities in Arizona and Florida and quarantined. They were eventually tested after three detainees had confirmed cases.
Of the 74 detainees transferred, 51 eventually tested positive for coronavirus. Up until then, the center had few to no cases.
Prior to the transfer, the director of the Farmville facility, Jeffrey Crawford, relayed concerns from the center's medical director to ICE about new intakes into the facility, according to a court filing obtained by CNN.
ICE, according to the filing, proposed quarantining any new intakes at another Virginia location for 14 days before transferring them to Farmville. But that wasn't possible for the transfers coming from facilities in Arizona and Florida. Lawyers say that's where the problem began.
"In June, when this started to happen and reports started coming out that people were sick with Covid ... what they originally said is this is just the transfers," said Sirine Shebaya, executive director of the National Immigration Project. "And then eventually they started testing and realized 'oh, it's everywhere.'"
Crawford maintained that "none of the 74 detainees were exposed to the general population" and detailed precautionary measures put in place to stem the spread of the virus, according to the court filing.
But detainees said that despite measures to separate those with confirmed cases, there continued to be intermingling, particularly with the staff members attending those who are separated and then engaging with the general population.
In a statement to CNN, ICE said it's "ramped up its efforts to protect and care for detainees in its custody by providing face masks, procuring additional handwashing stations and most recently, administering comprehensive testing of all detainees."
"The majority of those who tested positive are asymptomatic, but are being closely monitored and receiving appropriate medical care," ICE said, adding that medical checks are done twice daily, including a temperature screening and medication disbursement. "Detainees who have tested negative will be retested and are being held separately from positive detainees"
But that's still done little to quell the concerns of detainees in the facility.
"People are still scared," said Brian Casson, an immigration attorney representing two detainees at the Farmville facility. "The people who don't have results back are worried they're going to get it or have it. I haven't had any clients test negative. I just had one client who tested inconclusive."
ICE said it doesn't deliberately move detainees who have tested positive for coronavirus between its detention facilities, but conceded there "have been some instances where positive cases have been transported by ICE."
The inspector general similarly found issues related to social distancing, stating in the report that "facilities reported concerns with their inability to practice social distancing among detainees, and to isolate or quarantine individuals who may be infected with COVID-19."
Concerns over conditions have prompted a litany of lawsuits nationwide to release detainees and put measures in place to protect those in custody.
Shebaya is involved in three lawsuits relating to Farmville, calling for release of some detainees and challenging conditions at the detention center.
"At this point we're trying to figure out what we can do to make this better for people in the inside," Shebaya said.
By Spencer Custodio | 16 hours ago
While it seems that the number of people hospitalized for Coronavirus in Orange County stabilized this week, there is concern that daily death counts seem to be creeping up, now well into the double digits with 22 people reported as killed by Covid on Thursday.
Orange Health Care Agency officials on Thursday also confirmed that they are increasingly transferring Covid patients from hospitals into skilled nursing facilities.
Editors Note: As Orange Countys only nonprofit & nonpartisan newsroom, Voice of OC brings you the best, most comprehensive local Coronavirus news absolutely free. No ads, no paywalls. We need your help. Please, make a tax-deductible donation today to support your local news.
An unknown number of Orange Countys coronavirus hospital patients have been moved to long term care facilities and skilled nursing facilities as hospitalization numbers ticked up the past couple weeks.
Yes, hospitalized COVID-19 positive patients are being discharged to long term care facilities. The OC Health Care Agency (HCA) does not track individual transfers. However, when a hospitalized COVID-19 positive patient is transferred to a Skilled Nursing Facility (SNF), that patient would be subtracted from the hospitalized count (by the sending hospital) and added to the SNF count via the state daily reporting, HCA staff said in a Thursday email.
A daily situation report from the county Office of Emergency Medical Services on Thursday shows theres been an increase of over 500 virus-positive patients in skilled nursing facility cases since the beginning of the month to 1,837 cases. The report doesnt note which cases are transfers and which ones are virus cases originating from the facilities.
At a Thursday news conference, OC interim health officer Dr. Clayton Chau said he hasnt heard of any surges at the skilled nursing facilities.
In normal times, Chau said, a patient gets into an acute hospital and the next level of care that they need is a skilled nursing facility, then the hospital, as well as the family and their insurance company, will try and find a skilled nursing facility that is appropriate to place people.
As far as I know, I have not heard any surge in skilled nursing facilities, Chau said. Ive not heard staff reporting that weve had an issue yet.
UC Irvine epidemiologist Andrew Noymer said the transfers to nursing facilities could explain why hospitalizations are remaining relatively steady.
So that could explain why all the hospital numbers looked like they plateaued, Noymer said in a Thursday phone interview.
But, Noymer said, the deaths continue to increase.
Theres no shirking the deaths, I mean 22 deaths today, Noymer said. I know the death reporting is clunky but the seven-day average is 2.1 percent per day.
When deaths are reported, they can span a window of up to eight days, the Health Care Agency notes on its website.
So thats the number that Ive been watching and Ive been doing seven-day averages precisely so we dont go crazy over single day jumps because those are just reporting issues, Noymer said.
Meanwhile, the virus has now killed 543 people out of 32,648 confirmed cases, according to the county Health Care Agency.
There are 690 people hospitalized, including 233 in intensive care units.
Over 380,000 tests have been conducted throughout OC, which is home to roughly 3.2 million people.
Dr. Paul Yost, whos an anesthesiologist at St. Josephs Hospital in Orange, said it would be helpful to know how many hospital cases are transferred to skilled nursing facilities so the overall picture of the countys healthcare system can be better understood.
Yost, the CalOptima board chairman, also noted the current system wasnt designed for a pandemic.
Our whole healthcare system is not designed something like this a pandemic that strikes a large percentage of the population, he said. Its designed around providing high quality care around things like heart surgeries but a global pandemic, its not designed for.
Noymer said he cant predict which direction OC heads from here, based on the recent patterns.
So heres the thing, were basically treading water. When I look at the OC numbers the past few days, I see a county thats not changing very much. And compared to three weeks ago, were worse. But compared to last week, were holding steady. So you can say were about to turn the corner and do better or take the plunge into a precipice. And I cant tell you exactly which of the two it is.
Heres the latest on the virus numbers across Orange County from county data:
Spencer Custodio is a Voice of OC staff reporter. You can reach him at scustodio@voiceofoc.org. Follow him on Twitter @SpencerCustodio
Dr. Glenn Lopez administered a standard test for the coronavirus to Daniel Contreras at a mobile clinic in South Los Angeles last week. Though highly accurate, such tests can take days or more to process. Mario Tama/Getty Images hide caption
Dr. Glenn Lopez administered a standard test for the coronavirus to Daniel Contreras at a mobile clinic in South Los Angeles last week. Though highly accurate, such tests can take days or more to process.
Anybody who has waited for hours in line for a coronavirus test, or who has had to wait a week or more for results, knows there has to be a better way. In fact, the next generation of tests will focus on speed.
But what should the Food and Drug Administration do with a rapid test that is comparatively cheap but much less accurate than the tests currently on the market? A test like that is ready to go up for FDA approval, and some scientists argue it could be valuable despite its shortcomings.
At first blush, you wouldn't want a medical test to be pushing out untrustworthy results. And that's certainly the case for a medical diagnosis. But rapid test could be valuable if used to screen large numbers of people for infection repeatedly and frequently.
For example, some of the rapid tests under development don't detect the virus in a person who is in the early or late stages of infection they only catch an infection at its peak. Dr. Michael Mina at the Harvard T.H. Chan School of Public Health says that's OK, under certain circumstances.
"As long as you're using the test on a pretty frequent basis," Mina says, "you will be more likely than not to catch the person on the day they might go out and transmit. And they'll know to stay home."
To be useful, such tests need to be widely available and affordable, he says. "I envision a time when everyone can order a pack of 50 tests for $50 and have those and use them every other day for a couple of months."
When it comes to controlling the epidemic, that could be an appealing alternative to the current laboratory-based system, an overburdened process that has become a serious bottleneck. These days, some people are waiting a week or more for results, and by then they have potentially spread the virus to others.
Highly accurate at-home tests are probably many months away. But Mina argues they could be here sooner if the FDA would not demand that tests for the coronavirus meet really high accuracy standards of 80 percent or better.
A Massachusetts-based startup called E25Bio has developed this sort of rapid test. Founder and Chief Technology Officer Irene Bosch says her firm has field-tested it in hospitals. "What we learned is that the test is able to be very efficient for people who have a lot of virus," she says.
It's nowhere near as good at detecting low levels of virus. But you can have the most sensitive test in the world, she says, and if you only test people once a month, that test, too, will miss a lot of people who are infected. So, her company is focusing on quick, easy and cheap.
"These are very simple strips," she says. "They're [like] miniaturized pregnancy tests. So, you can imagine you can't find anything more simple than this."
The sample for this test would come via a swab of the nose or mouth. Results would be available within 15 minutes, according to the manufacturer. Most important is the price.
"The test has to be affordable. It cannot work if it's not affordable," Bosch says. "Right now it might cost $3 to make it [or] $4 to make it. So affordable will be what it costs."
E25Bio would like to set the price at cost, though for the start-up company to stay in business, Bosch says, the test would need a government subsidy. The company has a local partner that's poised to produce a million of these tests a week, she says, adding that another company in the United Kingdom is poised to produce 8 million tests a day.
E25Bio has asked the governor of Massachusetts to approve the rapid test for sale not for use at home just yet, but in pharmacies and out in the community.
To bring people back to work, or teachers and students back to the classroom safely, "this is the kind of test you need," Bosch says.
The company would like to pair the test with a smartphone app. The app would take a photo of the test result and upload it to a public database. The information would be stripped of personal details and precise location, but if people volunteered to take this step, she says, the public could crowdsource information about the spread of the coronavirus that would be useful to researchers. The information would also be available to public health authorities.
The company is in talks with the FDA about approving this test, even though it would be a departure for the federal agency, which has so far required a higher level of accuracy.
She isn't sure how the FDA is responding to the company's request. "This is a Pandora's box and this like is a black box," she says with a laugh.
In other words, the FDA doesn't want to take an action that backfires, and it also doesn't tend to reveal its thinking as it deliberates. The FDA told NPR that the agency weighs the benefits and risks of all coronavirus tests, but didn't elaborate on its thinking about this novel testing strategy.
"There's always a tradeoff here. There's no free lunch," says Trevor Martin, chief executive officer of the Bay Area biotech startup, Mammoth Biosciences. His company is also making a rapid test, based on the gene-editing technology CRISPR. Though CRISPR is best known for its ability to edit DNA, part of that process involves pinpointing specific sequences. And by targeting the coronavirus' genetic sequence, this approach can be highly accurate, he says.
"Our goal is to have a test that delivers extremely high-quality results with a single test. The same as you would get in a lab, or better," Martin says.
His company's test isn't likely to be on the market until the end of the year, which seems like the distant future, considering the pace of the epidemic. He agrees tests need to be affordable, but he didn't name a price range for the test.
Martin says precision has a place in controlling the epidemic, too. A test that can detect very low levels of virus is more likely to pick up someone with a mild infection, even in the absence of symptoms. And that's "super important if you want to prevent spread," he says.
Other labs are pursuing tests based on CRISPR as well. And two companies have temporary approval by the FDA to sell a rapid test that detects certain proteins antigens from the coronavirus. These antigen tests are less accurate than the standard PCR tests, which detect genetic material from the virus. The average wholesale price for antigen tests is in the $20 range. Such tests are currently in limited supply, and available at hospitals, medical clinics and some doctor's offices.
It's unlikely that there will be one single testing solution for the coronavirus, and the best blend of approaches is still a work in progress.
You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.
Read: We dont even have a COVID-19 vaccine, and yet the conspiracies are here
The good news, because it is worth saying, is that experts think there will be a COVID-19 vaccine. The virus that causes COVID-19 does not seem to be an outlier like HIV. Scientists have gone from discovery of the virus to more than 165 candidate vaccines in record time, with 27 vaccines already in human trials. Human trials consist of at least three phases: Phase 1 for safety, Phase 2 for efficacy and dosing, and Phase 3 for efficacy in a huge group of tens of thousands of people. At least six COVID-19 vaccines are in or about to enter Phase 3 trials, which will take several more months.
We are almost five months into the pandemic and probably another five from a safe and effective vaccineassuming the clinical trials work out perfectly. Even when a vaccine is introduced, says Jesse Goodman, the former chief scientist at the Food and Drug Administration, I think we will have several months of significant infection or at least risk of infection to look forward to.
All of this means that we may have to endure more months under the threat of the coronavirus than we have already survived. Without the measures that have beat back the virus in much of Europe and Asia, there will continue to be more outbreaks, more school closings, more loneliness, more deaths ahead. A vaccine, when it is available, will only mark the beginning of a long, slow ramp down. And how long that ramp down takes will depend on the efficacy of a vaccine, the success in delivering hundreds of millions of doses, and the willingness of people to get it at all. It is awful to contemplate the suffering still ahead. It is easier to think about the promise of a vaccine.
Theres a lot of hope riding on these vaccines, says Kanta Subbarao, the director of the World Health Organizations flu collaborating center in Melbourne, who has also worked on other coronavirus vaccines. Nobody wants to hear its not just right around the corner.
Vaccines are, in essence, a way to activate the immune system without disease. They can be made with weakened viruses, inactivated viruses, the proteins from a virus, a viral protein grafted onto an innocuous virus, or even just the mRNA that encodes a viral protein. Getting exposed to a vaccine is a bit like having survived the disease once, without the drawbacks. A lot remains unknown about the long-term immune response to COVID-19, but, as my colleague Derek Thompson has explained, there are good reasons to believe getting COVID-19 will protect against future infections in some way.
Vaccine-induced immunity, though, tends to be weaker than immunity that arises after an infection. Vaccines are typically given as a shot straight into a muscle. Once your body recognizes the foreign invader, it mounts an immune response by, for example, producing long-lasting antibodies that circulate in the blood.
WASHINGTON Americans struggling through the worsening coronavirus outbreak got some rare good news this week as researchers delivered encouraging updates about potential vaccines. Even Dr. Anthony Fauci, whose gloomy warnings have frustrated President Donald Trump, has sounded consistently enthusiastic about the prospects.
Its a heartening thought that even as the country has failed to contain the virus or implement the kinds of public health measures experts have called for, theres a deus ex machina coming to rescue us if we can just hold out long enough.
But some experts are worried about Americans getting too used to the idea that a miracle vaccine or treatment is around the corner. While theres broad agreement the latest news is promising, some are concerned that the prospect of future relief could breed complacency amid raging outbreaks that are killing hundreds of people each day.
I think we absolutely have to have a backup plan in place, Carl Bergstrom, a biologist at the University of Washington, said. It's something thats not talked about enough.
Even in a best-case scenario, the country may be six months or more away from widespread inoculations. And we may not be in a best-case scenario, which could require policymakers and the public to develop plans for the long haul.
So far the story of the vaccine development seems to be that none of the things that could have gone wrong have gone wrong, Bergstrom said. That doesn't mean were home free by any means.
If theres a Plan B, its not clear what it is at the moment. The White House and its allies in Congress are struggling to negotiate even the next temporary relief bill, and Trump has repeatedly speculated that the U.S. will soon find a vaccine or cure, or that the virus will disappear on its own.
That has some people nervous. Ken Frazier, CEO of the pharmaceutical giant Merck, recently warned that anyone hyping a medical breakthrough before 2021 was doing a grave disservice to the public given the inherent challenges of developing and administering a vaccine.
The reality of the world is that this time next year very well may look like what we're experiencing now, Frazier said in an interview with Harvard Business School professor Tsedal Neeley. "I think when we do tell people that a vaccine's coming right away, we allow politicians to actually tell the public not to do the things that the public needs to do, like wear the damn masks, he added.
While multiple vaccine candidates in the U.K., China and America are progressing well, its possible the next phase of larger trials could reveal more serious side effects or limits to their effectiveness. And if public expectations are too high, some worry it could put pressure on officials especially in an election year to authorize their use too quickly. (The head of the FDA has insisted it will not cut corners on safety.)
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Even if a vaccine hits every mark on safety and effectiveness, theres a possibility governments could struggle to distribute it quickly. The Trump administration is buying up hundreds of millions of doses of vaccine candidates in advance in the hopes that it can move quickly if theyre approved, but roadblocks could still emerge.
Topher Spiro, vice president of health policy at the left-leaning Center for American Progress, has spent months researching the logistics of inoculating the public against coronavirus once a vaccine is approved.
Potential problems hes looked at include failing to produce enough glass vials to bureaucratic snafus over who administers the vaccine to simply struggling to convince enough people that its safe to get vaccinated. An Associated Press poll this week found 20 percent of respondents said they did not plan to get a vaccine if it became available, with another 31 percent unsure.
We shouldn't get ahead of ourselves and we should start preparing for the possibility we have a vaccine, but that does not mean we should stop looking for strategies to contain the virus in the meantime, Spiro said.
Avik Roy, president of the conservative Foundation for Research on Equal Opportunity, co-wrote a coronavirus response framework in April that argued officials should assume for planning purposes that advances in vaccines or treatments dont materialize.
I spent a dozen years as an investor in biotech companies, Roy said. When you're close to the ground in development of novel treatments, you're acutely aware of how often they fail, how often data that looks promising in the early stages doesn't pan out in the late stages."
According to Roy, accepting the prospect of no vaccine as an organizing principle could lend more urgency to installing security measures like temperature scanners, protecting vulnerable populations like seniors, and advancing plans to safely reopen schools.
If were going to say its OK to lock down the economy and keep schools closed because we'll have a vaccine in six months, that involves a lot of premature assumptions, he said.
Many expert suggestions involve redoubling current efforts to confront the virus.
Improving testing availability and turnaround times, which the White House has been reluctant to put more federal dollars into, could help detect outbreaks before they get out of hand. Hiring and training more contact tracers, and maybe even experimenting with apps to assist them, could help track the spread of the virus. Finding effective treatments that speed up recovery and increase survivability could make the pandemic easier to manage as a day-to-day threat. Former Obama health official Andy Slavitt has called for a national push to produce high-quality N95 masks for daily public use, rather than the more common cotton masks.
Any struggles on the vaccine front could affect the economic response as well. The longer the crisis persists, the more that temporary shifts like virtual offices or increased e-commerce sales could become entrenched habits. That could make aid programs like Paycheck Protection that are built on maintaining existing businesses, which may no longer be viable in a world ravaged by coronavirus, harder to sustain. As it stands, many businesses are already closing their doors permanently.
The CARES Act was mainly based on the premise that we would freeze jobs and firms in place and then everyone would go back, University of Chicago economics professor Steven Davis told NBC News. Theres a great deal of evidence that the post-pandemic economy will look significantly different and many of the lost jobs are not coming back.
Then theres the less desirable backup scenario: The virus wins.
If enough people are infected waiting for a vaccine to emerge, the country could approach herd immunity and gain at least temporary respite from major outbreaks. Some experts have estimated reaching that point would require as much as 60 percent to 70 percent of the population to get infected, while others see a potentially lower threshold. According to a study this week by the CDC, America is still a long way off either way, with only 24 percent of even worst-hit New York City believed to have antibodies against the virus.
But some argue were likelier to reach that point earlier than we might think if current outbreaks worsen.
Former FDA Commissioner Scott Gottlieb, a CNBC contributor who sits on the board of Pfizer, predicted that by early 2021, we will either have a vaccine, or we will have herd immunity.
The country probably wont be celebrating either way, however.
We are a long way from it now, and a lot of death and disease until we get there, Gottlieb said.
When a coronavirus vaccine becomes available, who should get it first?
A preliminary plan devised by the Centers for Disease Control and Prevention this spring gives priority to health care workers, then to people with underlying medical conditions and older people. The C.D.C. has not yet decided whether the next in line should be Blacks and Latinos, groups disproportionately affected by the coronavirus.
But lets suppose that health care workers and people with underlying medical conditions use up the first doses of the available vaccine. Should some be held in reserve for Black and Latino people? What about bus drivers and train conductors? Perhaps teachers or schoolchildren should get it so they can return to classrooms with peace of mind.
If shortages happen, most of the nation will have no chance to get the initial lots of a vaccine under the C.D.C.s plan. And as the United States combats a soaring number of coronavirus cases, rising demand for drugs and maybe ventilators is expected. They, too, will need a fair system of distribution.
One solution that is starting to attract the attention of public health experts is a so-called weighted lottery, which gives everyone a chance at access, although some get a better shot than others.
Doctors and ethicists rank patients, deciding which groups should be given preference and how much. First-responders, for example, may be weighted more heavily than, say, very sick patients who are unlikely to recover.
The goal is to prevent haphazard or inequitable distribution of a treatment or vaccine when there isnt enough to go around. Such a system has already been used in allocations of remdesivir, the first drug shown to be effective against the coronavirus.
This is all very new, said Dr. Douglas White, an ethicist and vice chairman of the department of critical medicine at the University of Pittsburgh, which began using a weighted lottery last month to distribute remdesivir.
Patients have accepted the results, even when they lost in the lottery and ended up being denied the drug, he added.
I speculate that is because we are very transparent about the reason and the ethical framework that applies to everyone who comes into hospital, whether that is the hospital president or someone who is homeless, he said.
To allocate the drug, Pittsburg doctors decided that the lottery would give preference to health care workers and emergency medical workers. The doctors also weighted the odds to favor people from economically disadvantaged areas, who tend to be mostly Black and Hispanic.
People with other illnesses and limited life spans, like end-stage cancer patients, had the odds weighted against them, giving them a smaller chance to win in the lottery. The system did not consider age, race, ethnicity, quality of life, ability to pay or whether a patient has a disability.
The lottery began in early June, Dr. White said: We had 64 patients. We had to make the supply of remdesivir last at least two weeks. We only had enough to treat one in four patients.
They had a brief respite from the lottery when cases began falling and supplies of remdesivir seemed adequate. But on Sunday, with cases rising again and enough remdesivir for only about half the patients who could be helped by taking it, the hospital system was forced to go back to a lottery.
A weighted lottery will be used in South Carolina if the swelling number of patients causes a shortage, said Dr. Dee Ford, an infectious disease specialist at the Medical University of South Carolina and a member of an advisory group to the state health department. So far, she said, the states supply of remdesivir remains adequate.
Dr. White and his colleagues were considering a weighted lottery before the remdesivir shortage began. And so were other ethicists, like Dr. Robert Truog at Harvard Medical School who had learned about the system when hed feared a ventilator shortage in March.
He consulted with Dr. White, who had developed a system that awarded points to severely ill coronavirus patients depending on their estimated likelihood of surviving. After Dr. Truog and his colleagues published a paper on ventilator distribution, Dr. Truog said, we got a call from an economist at M.I.T.
The economist, Parag Pathak, told Dr. Truog that he and other economists had spent years thinking about how to allocate resources, and have developed and successfully used weighted lotteries.
For example, Dr. Pathak told him, such systems are used allocate spots in oversubscribed charter schools, giving preference to children from certain neighborhoods. Dr. Truog was intrigued, but it turned out that there were enough ventilators, so a lottery was not needed.
Updated July 23, 2020
But remdesivir was another story, Dr. White and Dr. Truog realized: The shortages were not just possible; they were happening.
When remdesivir shortages began, we felt that a lottery system would be a much better allocation methods than a point system, he explained. His group and Dr. Truog developed a weighted lottery for remdesivir, and the Pittsburgh hospitals began using it.
They also noted another advantage: Weighted lotteries can allow researchers to find out, in a rigorous way, which subgroups of patients do best with a new drug or vaccine.
That is because allocation within a group is random. The distribution is, in effect, a randomized, controlled clinical trial. The only difference between, say, people over age 60 who got the drug and those who did not is the toss of a coin in the lottery.
For that reason, outcomes can reveal how well a drug or vaccine works for subgroups of people.
That sort of analysis has been done to study the variations in students performances at different schools, answering questions like: Did students with higher test scores do just as well with or without a charter school? Did the school benefit those who were not doing well in their neighborhood schools?
A large, federal clinical trial showed that remdesivir slightly improved recovery times for hospitalized patients. That study, though, was not designed to show whether some groups like younger people, or those who were earlier in the course of their infection benefited more than others.
These outcome data are buried in the patients electronic health records. Were the patients participating in a weighted lottery, it would be far easier to see who benefited and who did not from remdesivir.
Similar questions can be addressed if a vaccine were to be distributed with such a lottery. But getting that data would be more complicated, because vaccine distribution may involve tens of millions of people.
Still, in principle, lottery data about a vaccine can be as useful as randomized clinical trial data, Dr. Pathak said.
We would like to get people to think ahead about how vaccines are allocated, he said. There is no way we can vaccinate everybody, so we have to think about whats fair and whats just.
