South Heartland District Health Department (SHDHD) officials reported nine new COVID-19 positive cases Saturday.
This brings the total number of cases in the four-county health district to 216 200 in Adams County, 11 in Clay County, 5 in Webster County and zero in Nuckolls County.
The new case is in Clay County a male in his 40s.
The new cases in Adams County are five females (1 under 20, 1 in her 20s, 1 in her 30s, 2 in their 40s) and three males (1 in his 40s, 1 in his 50s, 1 in his 60s).
Residents who are ill or have any symptoms consistent with coronavirus disease should stay home from work and isolate at home to avoid spreading the illness to others.
Health director Michele Bever reminds residents that they may have very mild or no symptoms at all, but the virus can spread easily through close person to person contact.
It is gatherings and close contact at work or other settings that often result in new cases of COVID-19, she said.
Bever encourages South Heartland residents to protect older adults and other individuals at higher risk.
Please continue practicing social distancing, including keeping 6 feet between people, and staying home when we are sick," she said. "Please continue practicing prevention, including wearing masks, washing your hands, keeping your hands away from your face, and disinfecting frequently-touched surfaces.
This week Gov. Pete Ricketts reminded Nebraskans that the 10-person rule for gatherings remains in effect through the month of May and encouraged residents to only celebrate and gather with their households.
The revised directed health measures issued by the governor and Nebraska Department of Health and Human Services for South Heartland Districts four counties will be effective at midnight on May 4 and continue until May 31.
All restrictions from the previous DHMs will continue through May 31, except for elective surgeries/procedures and religious services (to include wedding and funerals). NDHHS developed COVID-19 Guidelines for the Conduct of Faith-Based Services, which can be found on the South Heartland website: https://southheartlandhealth.org/public-health-data/corona-virus.html.
South Heartland District case counts by county are updated daily on SHDHDs COVID webpage: https://southheartlandhealth.org/public-health-data/corona-virus.html. The Nebraska Department of Health and Human Services (DHHS) provides daily updates to Nebraska's coronavirus COVID-19 cases on their Data Dashboard at http://dhhs.ne.gov/Pages/Coronavirus.
Apple and Google have released the first version of their exposure notification API, which they previously called the contact tracing API. This is a developer-focused release, and is a seed of the API in development, with the primary intent of collecting feedback from developers who will be using the API to create new contact tracing and notification apps on behalf of public health agencies.
Last week, Apple CEO Tim Cook told EU Commissioner Thierry Breton that the API would be arriving shortly, and this version is indeed now available albeit to a specific and limited group that includes select developers working on behalf of public health authorities globally, according to the companies. This is a test release thats intended to provide the opportunity for development and feedback in advance of the APIs public release in mid-May, at which time developers will be able to use the software feature on devices with publicly available apps released through the iOS and Google software stores, respectively.
Apple and Google say they will be providing this coming Friday additional details about the API and its release, including sample code to show how it operates in practice. Both are intent on providing updates to the documentation as they become available, and in adding access to new developers throughout testing, though this will be gated because the companies are limiting access to this API to authorized public health authorities only.
Already, Apple and Google have made available on their respective developer websites documents that describe the specification in detail, and provided an update with improvements to the techs functioning, including in terms of its protection of user privacy, and the ease with which developers can deploy it within their apps, as discussed during a press call last week.
This update includes an added ability for health authorities to define and calculate an exposure risk level for individuals based on their own criteria, as that varies organization to organization. This will be variable based on approximate distance of an individual to a confirmed exposed COVID-19 patient, as well as the duration of that exposure. Developers can customize notification messaging based on their defined exposure levels to ensure alerts correspond correctly to calculated risk.
The beta update also includes a new setting for users that allows them to toggle COVID-19 exposure notification access for individual apps, as pictured in the screenshot below.
Apple and Google first announced the combined API and eventual system-level contact tracing feature on April 10, and intend to release the first version of the API publicly in mid-May, with the system-level integration to follow in the coming months. The tech is designed to be privacy-preserving, ensuring that contact IDs are rotating and randomized, and never tied to an individuals specific identifying information.
Models predicting the potential spread of the COVID-19 pandemic have become a fixture of American life. Yet each model tells a different story about the devastation to come, making it hard to know which one is right. But COVID-19 models arent made to be unquestioned oracles. Theyre not trying to tell us one precise future, but rather the range of possibilities given the facts on the ground.
One of their more sober tasks is predicting the number of Americans who will die due to COVID-19. FiveThirtyEight with the help of the Reich Lab at the University of Massachusetts Amherst has assembled six models published by infectious disease researchers to illustrate possible trajectories of the pandemics death toll. In doing so, we hope to make them more accessible, as well as highlight how the assumptions underlying the models can lead to vastly different estimates. Here are the models U.S. fatality projections for the coming weeks.
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Forecasts like these are useful because they help us understand the most likely outcomes as well as best- and worst-case possibilities and they can help policymakers make decisions that can lead us closer to those best-case outcomes.
And looking at multiple models is better than looking at just one because it's difficult to know which model will match reality the closest. Even when models disagree, understanding why they are different can give us valuable insight.
Each model makes different assumptions about properties of the novel coronavirus, such as how infectious it is and the rate at which people die once infected. They also use different types of math behind the scenes to make their projections. And perhaps most importantly, they make different assumptions about the amount of contact we should expect between people in the near future.
Understanding the underlying assumptions that each model is currently using can help us understand why some forecasts are more optimistic or pessimistic than others.
Below are individual forecasts for all 50 states and the District of Columbia.
See forecasts from
Forecasts from
TodayMay 1April 21April 14April 7
Scroll to a state
AllAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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AllColumbia Univ.IHMELos AlamosMITNortheastern Univ.Univ. of Texas
288deathsas ofMay 2
9deaths
330deaths
72deaths
2,180deaths
832deaths
2,436deaths
168deaths
240deaths
1,364deaths
1,177deaths
16deaths
64deaths
2,559deaths
1,115deaths
175deaths
142deaths
248deaths
1,993deaths
56deaths
1,251deaths
3,846deaths
4,021deaths
394deaths
291deaths
376deaths
16deaths
73deaths
255deaths
84deaths
7,742deaths
138deaths
24,198deaths
431deaths
24deaths
1,022deaths
238deaths
109deaths
2,695deaths
296deaths
267deaths
21deaths
209deaths
863deaths
49deaths
51deaths
617deaths
830deaths
48deaths
334deaths
7deaths
The novel coronavirus tends to affect men more severely than it does women. Though nobody can yet explain the oddity, researchers are hot on the case.
It's possible that the sex hormones estrogen and testosterone play a role, according to previous research on respiratory illnesses. Or perhaps it's because the X chromosome (which women have two of, but men have only one) has a larger number of immune-related genes, giving women a more robust immune system to fight off the coronavirus, SARS-CoV-2. Or, maybe the virus is hiding in the testes, which has abundant expression of ACE2 receptors, the portal that allows SARS-CoV-2 into cells.
Uncovering the real reason is, of course, imperative because it could help improve patient "outcomes during an active public health crisis," according to an editorial published April 10 in the Western Journal of Emergency Medicine (WJEM).
Related: When will a COVID-19 vaccine be ready?
Since the first known COVID-19 case was reported in China late last year, countless studies have shown that the disease tends to be more severe and deadly in men than in women.
For instance, in an analysis of 5,700 COVID-19 patients hospitalized in New York City, just over 60% were men, according to an April 22 study published in the journal JAMA. What's more, "mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years," the researchers wrote in the study.
Furthermore, of the 373 patients who ended up in intensive care units, 66.5% were men, the JAMA study reported.
Related: 13 Coronavirus myths busted by science
Results are similar in other studies. When the WJEM editorial was published in early April, the authors noted that between 51% and 66.7% of hospitalized patients in Wuhan, China, were male; 58% in Italy were male; and 70% of all COVID-related deaths worldwide were male. In one large study of more than 44,600 people with COVID-19 in China, 2.8% of men died versus just 1.7% of women.
These COVID-19 sex differences are not unexpected. Other coronavirus outbreaks, including outbreaks of SARS in 2003 and the Middle East respiratory syndrome (MERS) in 2012, had higher fatality rates in men than in women, according to the WJEM editorial. For example, a 2016 study found that men had a 40 percent higher odds of dying of MERS than women did.
Even the comically labeled "man flu" is so named because men tend to have a weaker immune response to respiratory viruses that cause flu and the common cold. As a result, men tend to get more severe symptoms from these viruses than women do, a 2017 review in BMJ found. That review pinned these results on the differences in "sex dependent hormones" in men and women.
A mouse experiment offers clues about this hormonal mystery; when scientists infected both male and female mice of different ages with SARS, the male mice were more susceptible to the infection than females of the same age, according to a 2017 study, which was published in The Journal of Immunology. However, when the female mice had their estrogen-producing ovaries removed or were treated with an estrogen-receptor blocker, they died at higher rates than those with working ovaries and normal estrogen.
"These data indicate that sex hormones produced in female [mice] may help to defend against coronaviruses like SARS and SARS-CoV-2," Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine, who was not involved in the study, told Live Science.
Related: Is 6 feet enough space for social distancing?
To learn more, scientists at Cedars-Sinai Medical Center in Los Angeles and the Renaissance School of Medicine at Stony Brook University in New York are testing estrogen or another sex hormone called progesterone on small groups of people who have COVID-19, Live Science previously reported.
There's another way to look at the COVID-19 sex difference; perhaps the X chromosome is protective because it has more immune-related genes than the Y chromosome does. This may also explain why women are more likely than men to have autoimmune diseases, the authors of the WJEM editorial noted.
The second X chromosome is usually silenced in women, but almost 10% of those genes can be activated, Veena Taneja, who studies differences in male and female immune systems at the Mayo Clinic, told NPR. "Many of those genes are actually immune-response genes," she said. This could give women a "double-dose" of protection, Taneja said, although research is needed to see whether these genes factor into protection against COVID-19.
New research offers yet another idea; men seem to clear SARS-CoV-2 from their bodies more slowly than women do. To explain that possibility, researchers have suggested the virus may have found a hiding place in men: the testes.
In the research, published on the preprint medRxiv database, 68 people confirmed to have COVID-19 in Mumbai, India, were tested with nasal swabs until they tested negative for the virus. At the end of the experiment, scientists found that women cleared the virus from their bodies in an average of 4 days, compared with men's average of 6 days. The same test in three different Mumbai households found similar results.
Related: 13 Coronavirus myths busted by science
"Our collaborative study found that men have more difficulty clearing coronavirus following infection, which could explain their more serious problems with COVID-19 disease," study lead researcher Dr. Aditi Shastri, assistant professor of medicine at the Albert Einstein College of Medicine in New York City and a clinical oncologist at the Montefiore Einstein Center for Cancer Care, said in a statement.
Previous research has shown that SARS-CoV-2 invades certain human cells by plugging into these cells' ACE2 receptors. So, the researchers consulted a database, and found that the testes have high levels of ACE2 expression. In contrast, ACE2 could not be detected in the ovaries, the female equivalent of the testes.
However, the research did not actually look in the testes to see if SARS-CoV-2 is hanging out there, so "it does not tell us whether the virus infects testes or whether it is a reservoir of virus," said Iwasaki, who was not involved in the research.
Other research has suggested that smoking may play a role, as smoking is related to higher expression of ACE2 receptors. But while more men than women smoke in China, that's not true in other countries, which likely puts a kibosh on smoking to explain the sex difference.
"What we saw in Wuhan [with the sex difference] has been replicated in every country around the world where we have accurate reporting," Sabra Klein, a researcher at the Johns Hopkins Center for Women's Health, Sex, and Gender Differences, told NPR. "In countries like Spain, where the percentages of males and females who report smoking is not significantly different, we still are seeing this profound male bias in severity of COVID-19."
Other explanations: Women are simply less likely to engage in health-related risks and are better at washing their hands, studies find, and perhaps that's behind the gender disparity
Sex differences aren't the only factor at play, however. Other groups more vulnerable to COVID-19 include the elderly and people with diabetes, high blood pressure and obesity, Live Science previously reported.
Originally published onLive Science.
May 3, 2020, 7:30 PM
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ISTANBUL -- Turkeys health minister has announced 61 new deaths from COVID-19 in the past 24 hours, which is the lowest number in over a month. The country's total death toll stands at 3,397.
Fahrettin Koca tweeted Sunday that 1,670 more cases were confirmed, with the total number of infections now at 126,045. The daily increase is the lowest climb in over a month, but the number of administered tests has also decreased.
Turkey ranks eighth in confirmed cases, according to Johns Hopkins University, but experts believe the tally around the world is higher than reported.
The health minister said 4,892 people were discharged from hospitals Sunday, with total recoveries now above 63,000.
The country extended restrictions put in place in early April of entry and exits from 31 Turkish cities for another day until President Recep Tayyip Erdogan reviews the measures Monday.
Follow AP pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak
A woman has had to bury her daughter and husband within days of each other after both died from coronavirus.
Tributes were paid to former police officer and Red Cross director David Whincup, 79, and his daughter Joanne Rennison, 52, who both passed away after contracting the disease.
MP David Davis described Whincup, from Cottingham in east Yorkshire, as an utterly decent man. David was the kindest, most thoughtful and utterly decent man I have ever had the privilege to meet. He had a fantastic commitment to selfless public service. We shall all miss him greatly, he added.
Whincup, who lived with his wife, Margaret, their daughter Joanne and granddaughter Alice, said his greatest achievement was his family. He worked as a director for the Red Cross and prior to that he was a Humberside police officer for more than 30 years.
His charity work raised thousands of pounds for causes in Hull and East Yorkshire and he supported many other charities as a founder member of Haltemprice Lions club in 1973, serving as president four times and as secretary.
Rennison also became a Red Cross fundraising manager. Diagnosed with multiple sclerosis when she was 30, her family said the MS Society was always a focus in her fundraising efforts.
Tributes have also been paid to 25-year-old Nasro Ade a beautiful spirit. Her devastated family told how they had to say their final goodbyes on a video call as she lay in a hospital bed.
Ade, originally from Somalia, had kidney failure and died within 11 days of being diagnosed with the virus at St Georges hospital in Tooting, south London, last month.
Her sister Fartuun Ade, 23, said the family were unable to visit her before she passed away, and had to say their goodbyes via FaceTime.
Its been so difficult for family not to be with her and tell her how much we love her. Its been so hard to take in. But all this love we have been receiving from people all around the world, who were touched by Nasros story. It has brought comfort to our family, said Fartuun.
She added: Theres probably thousands of millions of families around the world experiencing the same thing. I pray for everyone, for their health, for their life. Nasro was a blessing to us and to so many she touched.
For one family there was relief after a 16-year-old girl managed to recover from the disease waking from a coma on her birthday.
Marisa Bappoo spent 21 days in Southampton childrens hospitals intensive care unit, much of the time on a ventilator, when she woke to find nurses had put up birthday banners, cards and pictures of her family.
She said: Mum and dad say the nurses were always holding my hand and stroking my head. They gave me massages and plaited my hair. I came round still attached to the ventilator.
I was frightened, but one of the nurses was there holding my hand to reassure me. I was amazed when I saw the happy birthday banner. Later they gave me loads of presents as if I was their daughter. Its something I will never forget.
Bappoo is among just a small number of children to have fallen seriously ill with the virus. Her father, Roshan, 48, a graphic designer from Basingstoke, said: Wed all been suffering from the virus and were recovering, but Marisa didnt.
She became very poorly. It was shocking to see her struggling to breathe. They were going to start to bring her round when she woke up by herself on her 16th birthday. We were elated. It was the best birthday present.
Emelita Hurboda was named as the latest healthcare worker to die from the virus. The 62-year-old nurse and mother of three originally from the Philippines, who worked in Nottingham, was described as a strong woman with a kind heart.
Her daughter Michelle said: Our mum is a dedicated nurse who spent her life caring for others. The doctors and nurses have given us the opportunity to see her one last time and say our goodbyes. We stayed by her side until she passed away.
Emotional tributes were also paid to nurse Philomena Cherian, 62, who worked at John Radcliffe hospital in Oxford. Originally from India, she was remembered as an incredibly caring friend and colleague. A fundraising page described Cherian as a great human being, caring mother and wife who lived her whole life supporting them.
Her friend Jayakrishnan Nair wrote: For her nursing was not just a profession but it was her passion.
Other victims included healthcare support worker Afua Fofie and Gill Oakes, a senior nurse at Bolton hospice.
Piggott, head of capital estates at Birmingham womens and childrens NHS foundation trust, was remembered as an all-round great guy. His wife, Julie, said: Mark was a great family man, a loving husband and fantastic dad to our sons Daniel and Alex. Were devastated to have to say goodbye to him.
WHOs response to the COVID-19 pandemic requires collaboration between experts in several departments and teams. From supportive health financing initiatives to a globalized research network, a coordinated effort is essential to limit the scope and impact of the disease.
These health topics highlight WHOs broad focus on global public health, as well as how each team contributes to the fight against COVID-19.
Explore WHO's work on COVID-19 and other health issues.
This page isregularly updated based on new scientific findingsas the epidemic evolves.
The number of confirmed and probable deaths from COVID-19 coronavirus were vastly greater than those due to flu this year in New York City, researchers determined.
From February 1 to April 18, the ratio of excess deaths in New York City was 21 times the number of deaths from seasonal influenza during this time period, reported Jeremy Samuel Faust, MD, of Harvard Medical School in Boston and Carlos del Rio, MD, of Emory University School of Medicine in Atlanta, in a preprint posted on medRxiv.
COVID-19 has been compared to seasonal flu many times, with annual deaths from seasonal flu often cited in comparison. The CDC estimated a range of 12,000 to 61,000 influenza-associated and pneumonia deaths per year from 2010 to 2019. In fact, the CDC estimated 24,000 to 62,000 Americans have died of influenza in the current flu season.
These, however, are based on "a series of assumptions about the underreporting of flu deaths." CDC statisticians boost the number to account for perceived under-testing, hospitals' record-keeping lapses, and flawed death certificates.
In contrast, the COVID-19 death toll as of April 27 reached 55,000, according to the widely cited Johns Hopkins University tracker. This is a raw number, Faust and del Rio pointed out, making the comparison to the CDC's heavily massaged estimates an apples-to-oranges situation. Many researchers have argued that deaths involving COVID-19 are also undercounted for many of the same reasons.
Faust and del Rio said a better comparison would use influenza deaths as actually recorded.
In New York City, they found, raw CDC data indicated 619 flu deaths from Feb. 1 to April 18, 2020 -- as opposed to the agency's count of 5,870 COVID-19 deaths in the city.
The authors also examined excess all-cause deaths in New York City as counted by the CDC, which totaled 13,032 in the same period. That figure was nearly identical to the city health department's count of confirmed and probable COVID-19 deaths (13,240).
"Conditions on the ground do not support statistics that suggest that seasonal influenza has killed approximately the same if not many more Americans than COVID-19 has," they wrote. "By abandoning the statistical misadventure of estimating influenza deaths, and instead simply relying on reported counts, a far better quantitative and qualitative portrait of the relative mortality burdens of ... COVID-19 and seasonal influenza emerges," they wrote.
Limitations to the data include over- or underreporting of both influenza and COVID-19 deaths, and that it cannot be explicitly proven that COVID-19 is the cause of excess mortality. Also, New York City is obviously not representative of the country as a whole.
Disclosures
Faust and del Rio disclosed no relevant relationships with industry.
CHICAGO, Ill. (WIFR) -- The Illinois Department of Public Health (IDPH) today announced 2,994 new cases of coronavirus disease (COVID-19) in Illinois, including 63 additional deaths.
- Cook County: 2 males 40s, 3 females 50s, 3 males 50s, 4 females 60s, 7 males 60s, 1 female 70s, 9 males 70s, 5 females 80s, 5 males 80s, 4 females 90s, 4 males 90s
- DuPage County: 1 female 70s, 1 female 80s, 1 female 90s
- Jefferson County: 1 male 80s
- Kane County: 1 male 70s
- Lake County: 1 male 30s, 1 female 70s
- Madison County: 1 female 60s, 1 male 90s
- Monroe County: 1 female 90s
- Will County: 1 female 70s
- Winnebago County: 1 male 50s, 1 female 60s, 1 female 70s, 2 females 90s
Currently, IDPH is reporting a total of 61,499 cases, including 2,618 deaths, in 97 counties in Illinois. The age of cases ranges from younger than one to older than 100 years.
Within the past 24 hours, laboratories have processed 19,417 specimens for a total of 319,313. This is the highest number in a 24 hour period thus far.
Pritzker emphasized that the gross number of positive tests is less of an important figure than positivity rates, which have been in the range of 15-21% each day and which officials want to see drop.
WASHINGTON Four months after a mysterious new virus began its deadly march around the globe, the search for a vaccine has taken on an intensity never before seen in medical research, with huge implications for public health, the world economy and politics.
Seven of the roughly 90 projects being pursued by governments, pharmaceutical makers, biotech innovators and academic laboratories have reached the stage of clinical trials. With political leaders not least President Trump increasingly pressing for progress, and with big potential profits at stake for the industry, drug makers and researchers have signaled that they are moving ahead at unheard-of speeds.
But the whole enterprise remains dogged by uncertainty about whether any coronavirus vaccine will prove effective, how fast it could be made available to millions or billions of people and whether the rush compressing a process that can take 10 years into 10 months will sacrifice safety.
Some experts say the more immediately promising field might be the development of treatments to speed recovery from Covid-19, an approach that has generated some optimism in the last week through initially encouraging research results on remdesivir, an antiviral drug previously tried in fighting Ebola.
In an era of intense nationalism, the geopolitics of the vaccine race are growing as complex as the medicine. The months of mutual vilification between the United States and China over the origins of the virus have poisoned most efforts at cooperation between them. The U.S. government is already warning that American innovations must be protected from theft chiefly from Beijing.
Biomedical research has long been a focus of theft, especially by the Chinese government, and vaccines and treatments for the coronavirus are todays holy grail, John C. Demers, the assistant attorney general for national security, said on Friday. Putting aside the commercial value, there would be great geopolitical significance to being the first to develop a treatment or vaccine. We will use all the tools we have to safeguard American research.
The intensity of the global research effort is such that governments and companies are building production lines before they have anything to produce.
We are going to start ramping up production with the companies involved, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases and the federal governments top expert on infectious diseases, said on NBC this week. You dont wait until you get an answer before you start manufacturing.
Two of the leading entrants in the United States, Johnson & Johnson and Moderna, have announced partnerships with manufacturing firms, with Johnson & Johnson promising a billion doses of an as-yet-undeveloped vaccine by the end of next year.
Not to be left behind, the Britain-based pharmaceutical giant AstraZeneca said this week that it was working with a vaccine development project at the University of Oxford to manufacture tens of millions of doses by the end of this year.
With the demand for a vaccine so intense, there are escalating calls for human-challenge trials to speed the process: tests in which volunteers are injected with a potential vaccine and then deliberately exposed to the coronavirus.
Because the approach involves exposing participants to a potentially deadly disease, challenge trials are ethically fraught. But they could be faster than simply inoculating human subjects and waiting for them to be exposed along with everyone else, especially as the pandemic is brought under control in big countries.
Even when promising solutions are found, there are big challenges to scaling up production and distribution. Bill Gates, the Microsoft founder, whose foundation is spending $250 million to help spur vaccine development, has warned about a critical shortage of a mundane but vital component: medical glass.
Without sufficient supplies of the glass, there will be too few vials to transport the billions of doses that will ultimately be needed.
The scale of the problem and the demand for a quick solution are bound to create tensions between the profit motives of the pharmaceutical industry, which typically fights hard to wring the most out of their investments in new drugs, and the publics need for quick action to get any effective vaccines to as many people as possible.
So far, much of the research and development has been supported by governments and foundations. And much remains to be worked out when it comes to patents and what national governments will claim in return for their support and pledges of quick regulatory approval.
Given the stakes, it is no surprise that while scientists and doctors talk about finding a global vaccine, national leaders emphasize immunizing their own populations first. Mr. Trump said he was personally in charge of Operation Warp Speed to get 300 million doses into American arms by January.
Already, the administration has identified 14 vaccine projects it intends to focus on, a senior administration official said, with the idea of further narrowing the group to a handful that could go on, with government financial help and accelerated regulatory review, to meet Mr. Trumps goal. The winnowing of the projects to 14 was reported Friday by NBC News.
But other countries are also signaling their intention to nationalize their approaches. The most promising clinical trial in China is financed by the government. And in India, the chief executive of the Serum Institute of India the worlds largest producer of vaccine doses said that most of its vaccine would have to go to our countrymen before it goes abroad.
George Q. Daley, the dean of Harvard Medical School, said thinking in country-by-country rather than global terms would be foolhardy since it would involve squandering the early doses of vaccine on a large number of individuals at low risk, rather than covering as many high-risk individuals globally health care workers and older adults to stop the spread around the world.
Given the proliferation of vaccine projects, the best outcome may be none of them emerging as a clear winner.
Lets say we get one vaccine quickly but we can only get two million doses of it at the end of next year, said Anita Zaidi, who directs the Bill and Melinda Gates Foundations vaccine development program. And another vaccine, just as effective, comes three months later but we can make a billion doses. Who won that race?
The answer, she said, is we will need many different vaccines to cross the finish line.
At 1 a.m. on March 21, 1963, a 5-year-old girl named Jeryl Lynn Hilleman woke up her father. She had come down with the mumps, which had made her miserable with a swollen jaw.
It just so happened that her father, Maurice, was a vaccine designer. So he told Jeryl Lynn to go back to bed, drove to his lab at Merck to pick up some equipment, and returned to swab her throat. Dr. Hilleman refrigerated her sample back at his lab and soon got to work weakening her viruses until they could serve as a mumps vaccine. In 1967, it was approved by the F.D.A.
To vaccine makers, this story is the stuff of legend. Dr. Hilleman still holds the record for the quickest delivery of a vaccine from the lab to the clinic. Vaccines typically take ten to fifteen years of research and testing. And only six percent of the projects that scientists launch reach the finish line.
For a world in the grips of Covid-19, on the other hand, this story is the stuff of nightmares. No one wants to wait four years for a vaccine, while millions die and economies remain paralyzed.
Some of the leading contenders for a coronavirus vaccine are now promising to have the first batches ready in record time, by the start of next year. They have accelerated their schedules by collapsing the standard vaccine timeline.
They are combining trials that used to be carried out one after the other. They are pushing their formulations into production, despite the risk that the trials will fail, leaving them with millions of useless doses.
But some experts want to do even more to speed up the conveyor belt. Writing last month in the journal Vaccines, the vaccine developer Dr. Stanley A. Plotkin and Dr. Arthur L. Caplan, a bioethicist at NYU Langone Medical Center, proposed infecting vaccinated volunteers with the coronavirus the method known as challenge trials. The procedure might cut months or years off the development but would put test subjects at risk.
Challenge trials were used in the early days of vaccine research but now are carried out under strict conditions and only for illnesses, like flu and malaria, that have established treatments.
In an article in March in The Journal of Infectious Diseases, a team of researchers wrote, Such an approach is not without risks, but every week that vaccine rollout is delayed will be accompanied by many thousands of deaths globally.
Dr. Caplan said that limiting the trials to healthy young adults could reduce the risk, since they were less likely to suffer serious complications from Covid-19. I think we can let people make the choice and I have no doubt many would, he said.
In Congress, Representative Bill Foster, Democrat of Illinois and a physicist, and Representative Donna E. Shalala, Democrat of Florida and the former secretary of the Department of Health and Human Services, organized a bipartisan group of 35 lawmakers to sign a letter asking regulators to approve such trials.
The organizers of a website set up to promote the idea, 1daysooner.org, say they have signed up more than 9,100 potential volunteers from 52 countries.
Some scientists caution that truly informed consent, even by willing volunteers, may not be possible. Even medical experts do not yet know all the effects of the virus. Those who have appeared to recover might still face future problems.
Even without challenge trials, accelerated testing may run the risk of missing potential side effects. A vaccine for dengue fever, and one for SARS that never reached the market, were abandoned after making some people more susceptible to severe forms of the diseases, not less.
It will be extremely important to determine that does not happen, said Michel De Wilde, a former senior vice president of research and development at Sanofi Pasteur, a vaccine maker in France.
When it comes to the risks from flawed vaccines, Chinas history is instructive.
The Wuhan Institute of Biological Products was involved in a 2018 scandal in which ineffective vaccines for diphtheria, tetanus, whooping cough and other conditions were injected into hundreds of thousands of babies.
The government confiscated the Wuhan institutes illegal income, fined the company, and punished nine executives. But the company was allowed to continue to operate. It is now running a coronavirus vaccine project, and along with two other Chinese groups has been allowed to combine its safety and efficacy trials.
Several Chinese scientists questioned the decision, arguing that the vaccine should be shown to be safe before testing how well it works.
Nationalism Versus Globalism
In the early days of the crisis, Harvard was approached by the Chinese billionaire Hui Ka Yan. He arranged to give roughly $115 million to be split between Harvard Medical School and its affiliated hospitals and the Guangzhou Institute of Respiratory Diseases for a collaborative effort that would include developing coronavirus vaccines.
We are not racing against each other, we are racing the virus, said Dr. Dan Barouch, the director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School who is also working with Johnson & Johnson. What we need is a global vaccine because an outbreak in one part of the world puts the rest of the world at risk.
That all-for-one sentiment has become a mantra among many researchers, but it is hardly universally shared.
In India, the Serum Institute the heavyweight champion of vaccine manufacturing, producing 1.5 billion doses a year has signed agreements in recent weeks with the developers of four promising potential vaccines. But in an interview with Reuters, Adar Poonawalla, the companys billionaire chief executive, made it clear that at least initially any vaccine the company produces would have to go to Indias 1.3 billion people.
The tension between those who believe a vaccine should go where it is needed most and those dealing with pressures to supply their own country first is one of the defining features of the global response.
The Trump administration, which in March put out feelers to a German biotech company to acquire its vaccine research or move it to American shores, has awarded grants of nearly half a billion dollars each to two U.S.-based companies, Johnson & Johnson and Moderna.
Johnson & Johnson, though based in New Jersey, conducts its research in the Netherlands.
Paul Stoffels, the companys vice chairman and chief scientific officer, said in an interview that the Department of Health and Human Services understood we cant pick up our research and move it to the United States. But it made sure that the company joined a partnership with Emergent BioSolutions a Maryland biological production firm to produce the first big batches of any approved vaccine for the United States.
The political reality is that it would be very, very hard for any government to allow a vaccine made in their own country to be exported while there was a major problem at home, said Sandy Douglas, a researcher at the University of Oxford. The only solution is to make a hell of a lot of vaccine in a lot of different places.
The Oxford vaccine team has already begun scaling up plans for manufacturing by half a dozen companies across the world, including China and India, plus two British manufacturers and the British-based multinational AstraZeneca.
In China, the governments instinct is to showcase the countrys growth into a technological power capable of beating the United States. There are nine Chinese Covid-19 vaccines in development, involving 1,000 scientists and the Chinese military.
Chinas Center for Disease Control and Prevention predicted that one of the vaccines could be in emergency use by September, meaning that in the midst of the presidential election in the United States, Mr. Trump might see television footage of Chinese citizens lining up for injections.
Its a scenario we have thought about, one member of Mr. Trumps coronavirus task force said. No one wants to be around that day.
Traditional Versus New Methods
The more than 90 different vaccines under development work in radically different ways. Some are based on designs used for generations. Others use genetic-based strategies that are so new they have yet to lead to an approved vaccine.
I think in this case its very wise to have different platforms being tried out, Dr. De Wilde said.
The traditional approach is to make vaccines from viruses.
When our bodies encounter a new virus, they start learning how to make effective antibodies against it. But they are in a race against the virus as it multiplies. Sometimes they produce effective antibodies quickly enough to wipe out an infection. But sometimes the virus wins.
Vaccines give the immune system a head start. They teach it to make antibodies in advance of an infection.
The first vaccines, against diseases like rabies, were made from viruses. Scientists weakened the viruses so that they could no longer make people sick.
A number of groups are weakening the coronavirus to produce a vaccine against Covid-19. In April, the Chinese company Sinovac announced that their inactivated vaccine protected monkeys.
Another approach is based on the fact that our immune system makes antibodies that lock precisely onto viruses. As scientists came to understand this, it occurred to them that they didnt have to inject a whole virus into someone to trigger immunity. All they needed was to deliver the fragment of a viral protein that was the precise target.
Today these so-called subunit viral vaccines are used against hepatitis B and shingles. Many Covid-19 subunit vaccines are now in testing.
In the 1990s, researchers began working on vaccines that enlisted our own cells to help train the immune system. The foundation of these vaccines is typically a virus called an adenovirus. The adenovirus can infect our cells, but is altered so that it doesnt make us sick.
Scientists can add a gene to the adenovirus from the virus they want to fight, creating whats known as a viral vector. Some viral vectors then invade our cells, stimulating the immune system to make antibodies.
Researchers at the University of Oxford and the Chinese company CanSino Biologics have created a viral vector vaccine for Covid-19, and theyve started safety trials on volunteers. Others including Johnson & Johnson are going to launch trials of their own in the coming months.
Some groups, including the American company Inovio Pharmaceuticals, are taking a totally different approach. Instead of injecting viruses or protein fragments, theyre injecting pure DNA, which is read by the cells machinery, making a copy as an RNA molecule. The RNA is then read by the cells protein-building factories, making a viral protein. The protein in turn comes out of the cell, where immune cells bump into it and make an antibody to it.
Other teams are creating RNA molecules rather than DNA. Moderna and a group at Imperial College London have launched safety trials for RNA vaccines. While experimental, these genetic vaccines can be quickly designed and tested.
It is one thing to design a vaccine in record time. It is an entirely different challenge to manufacture and distribute one on a scale never before attempted billions of doses, specially packaged and transported at below-zero temperatures, to nearly every corner of the world.
If you want to give a vaccine to a billion people, it better be very safe and very effective, said Dr. Stoffels of Johnson & Johnson. But you also need to know how to make it in amounts weve never really seen before.
So the race is on to get ahead of the enormous logistical issues, from basic manufacturing capacity to the shortages of medical glass and stoppers that Mr. Gates and others have warned of.
Researchers at Johnson & Johnson are trying to make a five-dose vial to save precious glass, which might work if a smaller dose is enough for inoculation.
Each potential vaccine will require its own customized production process in special clean facilities for drug making. Building from scratch might cost tens of millions of dollars per plant. Equipping one existing facility could easily cost from $5 million to $20 million. Ordering and installing the necessary equipment can take months.
Governments as well as organizations like the Gates Foundation and the nonprofit Coalition for Epidemic Preparedness Innovations are putting up money for production facilities well before any particular vaccine is proven effective.
Whats more, some vaccines including those being tested by the American companies Moderna and Inovio rely on technology that has never before yielded a drug that was licensed for use or mass-produced.
But even traditional processes face challenges.
Because of staff illnesses and social distancing, the pandemic this spring slashed productivity by 20 percent at the MilliporeSigma facility in Danvers, Mass., that supplies many drug makers with the equipment used for brewing vaccines.
Then, about three weeks ago, the first clinical trials for new proposed vaccines started. Urgent calls poured from customers around the world. Even before the first phase of the first trials, manufacturers were scrambling.
Demand went through the roof, and everybody wanted it yesterday, said Udit Batra, MilliporeSigmas chief executive, who has expanded production and asked other customers to accept delays to avoid becoming a bottleneck.
Treatments Versus Vaccines
Even as the world waits for a vaccine, a potential treatment for coronavirus is already here and more could be on the way.
Remdesivir showed modest success in a federally funded clinical trial, slowing the progression of the disease, but without significantly reducing fatality rates.
The F.D.A.s decision to allow its use comes as hundreds of other drugs mainly existing medicines that are being used for other conditions are being tested around the world to see if they hold promise. The F.D.A. said there are currently 72 therapies in trial.
Studies of drugs tend to move more quickly than vaccine trials. Vaccines are given to millions of people who are not yet ill, so they must be extremely safe. But in sicker people, that calculus changes, and side effects might be an acceptable risk.
As a result, clinical trials can be conducted with fewer people. And because drugs are tested in people who are already sick, results can be seen more quickly than in vaccine trials, where researchers must wait to see who gets infected.
Public health experts have cautioned there will likely be no magic pill. Rather, they are hoping for incremental advances that make Covid-19 less deadly.
Almost nothing is 100 percent, especially when you are dealing with a virus that really creates a lot of havoc in the body, said Dr. Luciana Borio, a former director of medical and biodefense preparedness for the National Security Council under President Trump.
Antiviral drugs like remdesivir battle the virus itself, slowing its replication in the body.
The malaria drug hydroxychloroquine which has been enthusiastically promoted by Mr. Trump and also received emergency authorization to be used in coronavirus patients showed early promise in the laboratory. However, small, limited studies in humans have so far been disappointing.
Many in the medical community are closely watching the development of antibody drugs that could act to neutralize the virus, either once someone is already sick or as a way of blocking the infection in the first place.
Dr. Scott Gottlieb, a former F.D.A. commissioner, and others said that by the fall, the treatment picture for Covid-19 could look more hopeful.
If proven effective in further trials, remdesivir may become more widely used. One or two antibody treatments may also become available, providing limited protection to health care workers.
Even without a vaccine, Dr. Borio said, a handful of early treatments could make a difference. If you can protect people that are vulnerable and you can treat people that come down with the disease effectively, she said, then I think it will change the trajectory of this pandemic.
David E. Sanger reported from Washington, David D. Kirkpatrick from London, Carl Zimmer and Katie Thomas from New York and Sui-Lee Wee from Singapore. Denise Grady and Maggie Haberman contributed reporting.
