W.H.O. Finally Lands in China to Begin Tracing the Coronavirus – The New York Times

Heres what you need to know:Experts from the World Health Organization at the airport in Wuhan, China, on Thursday.Credit...Ng Han Guan/Associated Press

More than a year after a new coronavirus first emerged in China, a team of experts from the World Health Organization arrived on Thursday in the central city of Wuhan to begin hunting for its source.

But in a sign of Beijings continuing efforts to control the investigation, the team of scientists and W.H.O. employees almost immediately ran into obstacles. Two scientists were unable to enter China at the last minute and remained in Singapore because they had tested positive for coronavirus antibodies, the W.H.O. said on Twitter.

The Chinese authorities required the remaining 13 experts to undergo two weeks of quarantine in Wuhan, where the virus first emerged in late 2019.

The investigation, which aims to gain an understanding into how the virus jumped to humans from animals, is a critical step so that another pandemic can be avoided. But getting answers is likely to be difficult.

Heres what to know about the investigation.

China set up hurdles and pushed for control.

Apparently worried about drawing renewed attention to the countrys early mistakes in handling the pandemic, Chinese officials have used a variety of tactics over the past year to hinder the W.H.O. investigation.

After resisting demands from other countries that it allow independent investigators onto its soil to study the origin of the pathogen, China let two W.H.O. experts visit in July to lay the groundwork. They were not allowed to visit Wuhan, where the virus first emerged.

For months, China delayed approving a visit by a full team of experts, frustrating the health agencys leaders. When the visit seemed to be finalized this month, it fell apart when Beijing declined to provide visas for the visitors, according to the health agency.

Now that the investigators have arrived, critics say Beijings desire for control means the inquiry will probably be more political than scientific.

Tracing the virus will be a painstaking task.

The team that has come to Wuhan will face a city radically transformed from when the virus first emerged, in late 2019. The city, which went into lockdown on Jan. 23 last year and became a symbol of the viruss devastation, has since been held up by Chinese officials as a success story in vanquishing the virus.

The W.H.O. experts have decades of experience plumbing the depths of viruses, animal health and disease control. But tracing the source of the virus that as of Thursday had killed almost two million people worldwide and infected more than 92 million will be painstaking. While experts believe the virus originated naturally in animals, possibly bats, little else is known.

How much access the team gets in China will be critical, public health experts say.

The team will have to sidestep attempts to politicize its inquiry.

The pandemic has hurt Chinas reputation, with many foreign governments still angry that Beijing did not do more to contain the crisis in its earliest stages. So Chinese propagandists are trying to use the W.H.O. inquiry to help shore up Chinas image and portray the country as a mature superpower.

Complicating that effort could be new virus flare-ups in recent weeks that have prompted fresh lockdowns in China. In all, more than 22 million people have been ordered to remain inside their homes double the number affected a year ago in Wuhan. On Thursday, Chinas National Health Commission reported a coronavirus death in the mainland for the first time since May.

The major concern here is the origin of the outbreak has been so politicized, said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. That has really narrowed the space for the W.H.O. to have an independent, objective and scientific investigation.

The overwhelming Covid-19 surge in California is as deadly now as it has ever been, and hospitals in much of the state are still full to bursting. But officials see signs that the situation may soon stop getting worse.

There are some good things to report, Gov. Gavin Newsom said in a video message posted late Tuesday night. Were starting to see some stabilization both in I.C.U.s as well as in our positivity rate.

One region of the state, the area around Sacramento, has improved enough to lift a strict stay-at-home order and allow some businesses to reopen at partial capacity, including restaurants offering outdoor dining and hair salons.

Three other large regions, home to tens of millions of people, remain under the most stringent tier of restrictions, which shut down nearly all nonessential businesses and ban residents from gathering with anyone they do not live with.

Dr. Mark Ghaly, the states secretary of health and human services, said Tuesday that the number of Covid-19 patients being admitted to hospitals each day was dropping. He called that the biggest signal to me that things are beginning to flatten and potentially improve.

Nationwide, the numbers largely remained grim, though in the Northern Plains, cases this week were about a quarter of their peak in mid-November, when the region was among the hardest hit in the country. A day after the U.S. recorded yet another daily record for deaths more than 4,400 reported deaths remained high on Wednesday.

And even as the pressure eased in some parts of California, hospitals across Southern California and the Central Valley were full, and the state reported a record total of more than 720 virus-related deaths on Tuesday, according to a New York Times database.

California has struggled to get its vaccination program into high gear, and had only used one-quarter of its available doses by Tuesday. Governor Newsom said Wednesday that the state would start a new system to alert residents when theyre eligible.

There is no higher priority than efficiently and equitably distributing these vaccines as quickly as possible to those who face the gravest consequences, he said in a statement. To those not yet eligible for vaccines, your turn is coming. We are doing everything we can to bring more vaccine into the state.

Dr. David Lubarsky, the chief executive of U.C. Davis Health, said Tuesday that the top priority should be getting shots into arms, rather than spending resources to ensure that people dont cut the line. If you are so hellbent on making sure Patient A should come before Patient B, before Citizen C, you cant get people in the door in a sufficient manner, he said.

Dr. Lubarsky said that as of Tuesday, roughly 12,000 of U.C. Davis Healths 13,000 employees had received at least a first vaccine dose. New Covid cases among the staff plummeted to about 20 in the last week, from a recent average of 135 a week.

Setting up mass vaccination centers and opening up eligibility are positive steps for the state, he said.

I think they are moving 100 percent in the right direction, Dr. Lubarsky said.

Johnson & Johnson expects to release critical results from its coronavirus vaccine trial in as little as two weeks but probably wont be able to provide as many doses this spring as it promised the federal government because of manufacturing delays.

If the vaccine can strongly protect people, as some outside scientists expect, it will offer big advantages over the two vaccines authorized in the United States. Unlike those, which require two doses, Johnson & Johnsons could need just one, greatly simplifying logistics for local health departments and clinics struggling to get shots in arms. Its vaccine can also stay stable in a refrigerator for months, whereas the others have to be frozen.

But the encouraging prospect of a third effective vaccine is tempered by apparent lags in the companys production. In the companys $1 billion contract signed with the federal government in August, Johnson & Johnson pledged to have 12 million doses ready by the end of February, ramping up to a total of 100 million doses by the end of June.

Federal officials have been told that the company has fallen as much as two months behind the original production schedule and wont catch up until the end of April, when it was supposed to have delivered more than 60 million doses, according to two people familiar with the situation who were not authorized to discuss it publicly.

Dr. Paul Stoffels, Johnson & Johnsons chief scientific officer, said he expected to see clinical trial data showing whether the companys vaccine is safe and effective in late January or early February. He declined to provide details about the companys production capacity.

The federal government, faced with an unrelenting surge in Covid-19 cases, issued a new appeal on Tuesday regarding which Americans should be vaccinated first. Here is what it might mean.

Who is now eligible to be vaccinated, according to federal guidance?

On Tuesday, Alex M. Azar II, the health secretary, urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19.

In all, that is more than 150 million people almost half the population. They now join millions of health care workers and residents of long-term care facilities who had previously qualified.

Mr. Azar did not specify which conditions would make someone eligible for vaccination now; presumably it will be up to governors to decide, as will the question of what documentation to require. But the federal Centers for Disease Control and Prevention has published a list of particularly high-risk conditions, including cancer, diabetes and obesity.

How does eligibility vary by state, and why? Although the C.D.C. issued recommendations last month for which groups states should vaccinate initially, while the vaccine supply is still relatively low, the priorities are not binding and each state has come up with its own groupings. Nor can the federal government require states to change the prioritization plans they have already announced, although the new pressure from Mr. Azar, and growing public impatience as deaths from the virus keep hitting new peaks, may sway many to do so. In coming up with priority groups, state officials considered criteria like who is most likely to die if they contract Covid-19 including people of color as well as the elderly and the sick and which professions are critical to helping the economy fully reopen. Each states unique demographics also played a role.

I qualify now. How do I sign up?

This depends very much on what state or even what county you live in. Some local public health departments have set up portals where people can make appointments; others are holding mass vaccination events and inoculating people on a first-come, first-served basis. Generally, doctors offices and pharmacies have asked that patients and customers not call them seeking vaccine appointments just yet, and instead wait to be contacted. Most pharmacies are not yet offering the vaccine, but CVS, Walgreens and a number of other chain pharmacies, including some in grocery and big-box stores, will soon start doing so through a partnership with the federal government.

With the federal government saying that older people and those with underlying medical conditions should get vaccinated next, what happens to essential workers whose jobs require them to come face to face with other people? Are they eligible now, too?

In some states, yes. Health care workers in every state were the first to be offered the vaccine. And before Mr. Azars directive this week, several states had already opened vaccination to certain categories of frontline essential workers, such as police officers, firefighters, teachers, child-care workers and public transit employees. But other states that had planned to start offering the vaccine to some essential workers in the coming weeks may reprioritize now, based on Mr. Azars new guidance. There is nothing stopping states from opening vaccination to a new priority group before they have reached everyone in an earlier group, but supply is an important consideration.

How many vaccine doses does the United States have access to? So far, Pfizer and Moderna, the only two companies whose vaccines have been approved for emergency use here, together have pledged to provide 400 million doses over the next seven months. Both vaccines require two doses, so that will be enough for 200 million people, out of roughly 260 million who are eligible at this point to be vaccinated. Children younger than 16 are not yet eligible for Pfizers vaccine, and those younger than 18 cannot yet take Modernas. Johnson & Johnson, which has a single-dose vaccine candidate in late-stage clinical trials, has a contract with the federal government to provide 12 million doses by the end of February, and a total of 100 million doses by the end of June. But the company has fallen behind on its production schedule.

How many people have been vaccinated so far? The publicly available data lags by at least a few days, so it is hard to know for sure. But the C.D.C. reported on Wednesday that about 10.3 million people had received an initial dose, out of a total 29.4 million doses distributed around the country so far. That includes nearly 1.1 million doses that have been given to residents and staff members in nursing homes and other long-term care facilities.

After falling over the summer, coronavirus infections among children, teens and young adults rose steadily from September through mid-December, paralleling the viruss trajectory among older adults in the U.S. population, the Centers for Disease Control and Prevention reported on Wednesday.

Of 2.8 million coronavirus infections diagnosed in children and young adults under the age of 25 between March 1 and Dec. 12, 2020, the incidence was lowest among children ages 10 and younger, who accounted for 18 percent of the cases. The majority of infections in those under 25 nearly 60 percent were among young adults aged 18 to 24, the study found.

The authors said the findings lend support to the argument that child- care centers and elementary schools can operate safely when community transmission rates are low and mitigation measures are followed.

Were recommending that child care centers and schools, especially elementary schools, be the last settings to close after all other mitigation measures are deployed, and the first to reopen, said Erin K. Sauber-Schatz, an epidemiologist at the C.D.C. and team lead of the agencys community interventions and critical populations task force.

The study was one of two published this week that also looked at how often children have been hospitalized.

In the C.D.C. study, which drew data from 44 states, the District of Columbia, two territories and an associated state, 2.5 percent of infected children and adolescents under 25 were hospitalized, compared with 16.6 percent of sick adults, and just 0.8 percent were transferred to intensive care.

The largest percentage of hospitalizations in this group occurred among children under 5 years old. Some 654 patients under the age of 25 died, about 0.1 percent.

But another study of children, adolescents and young adults, published in JAMA Pediatrics on Monday, has come to a very different conclusion. Researchers at the University of Minnesota found a troubling increase in hospitalizations among infected children and adolescents.

The study was based on data from 5,364 patients aged 19 and under who were hospitalized in 22 states between May 15, 2020, and Nov. 15, 2020. The cumulative average rate rose to 17.2 hospitalizations per 100,000 children in November from 2 per 100,000 children in May.

The increase was not surprising in itself, simply because more children were becoming infected over time. But the percentage uptick was more than double the rise in adult hospitalization rates over the same period, said Pinar Karaca-Mandic, an expert in health economics at the University of Minnesota and the senior author of the research report.

This demonstrates that Covid still has the potential to cause serious illness in children, said Dr. Karaca-Mandic, who also is co-lead of the universitys Covid-19 Hospitalization Project. Its not like children are immune. Its not like children are not at risk.

While older adults continue to be at the greatest risk, some hospitals may not be properly equipped to care for the youngest patients, she added.

Sometimes I feel like the message of lower risk in children may have been misinterpreted as no risk by many, she added. Our study is showing that is not the case.

More than 50 million people in the United States who are 65 or older as well as younger people with underlying conditions are now cleared to receive a coronavirus vaccine in the wake of the federal governments abrupt course reversal on who should get priority.

But thats much easier said than done.

Some experts have suggested that declaring so many more people eligible might actually make the process of signing up for a vaccine and getting one even more complicated.

This is creating a lot of confusion and chaos and anxiety days before a new administration comes in, Claire Hannan, executive director of the Association of Immunization Managers, told NPR on Wednesday morning.

The challenges are many.

States have struggled to set up phone and online sign-up systems, and many of the oldest Americans, who are most at risk of death from a coronavirus infection, have struggled to use them, encountering complicated registration sites, error messages and other roadblocks. Appointments have been booked as soon as they open up. Some in the first priority groups have succeeded in booking their shots but weeks out. Servers have crashed amid skyrocketing demand. Some areas have multiple sign-up systems, increasing confusion.

In Georgia, a man spoke to Atlantas Channel 2 Action News about how he had called the Troup County Covid hotline more than 100 times to try and make an appointment for his mother.

No ones ever picking up, Eric Moore said. I promise you, I called 134 times.

There are also questions about how to prioritize people at increased risk of severe illness from Covid-19, an expansive category that the Centers for Disease Control and Prevention estimates includes more than 100 million adults with conditions such as obesity, which affects at least 40 percent of adults, diabetes, cancer, and chronic lung and heart disease.

The federal governments revised guidance, announced by Alex M. Azar II, the secretary of health and human services, at a news conference on Tuesday, is not binding. As with testing and tracing earlier in the pandemic, each state has been left to devise its own plan based on local needs, at times creating confusion and scattershot approaches.

In New York, there was concern about the crush of demand outpacing availability. The governor said Tuesday the state would accept the new federal guidance to prioritize those 65 and older after eligibility had just been expanded statewide to include residents 75 and older and more essential workers.

On Wednesday, Mayor Bill de Blasio of New York City acknowledged that people may be frustrated by trying to make appointments online or on the phone.

As eligibility continued to expand, he said the city would keep administering doses over the next few weeks and then were going to run out of the vaccine. The city usually receives about 100,000 doses per week, the citys health commissioner said Tuesday at a City Council hearing to address problems with the rollout. But officials dont find out until a couple of days beforehand.

Even with normal supplies that we expect to have delivered next week, we will run out of vaccine at some point next week unless we get a major new resupply, the mayor said Wednesday.

Other states were reassessing their vaccination plans based on the new federal guidance, though some may not change course. In Arkansas, Dr. Jose Romero, the health secretary, said that Gov. Asa Hutchinson would stick to his plan of opening vaccinations to people 70 and older and some essential workers starting Monday.

The federal government has delivered about 29.4 million doses to states, territories and federal agencies as of Wednesday, and about 10.3 million doses had been administered. The Trump administration originally said that 20 million Americans would be vaccinated by Jan. 1.

West Virginia, South Dakota and North Dakota had administered the most first doses per capita among states, federal data shows. California, where the virus is raging, was among the states that had administered the fewest of its doses just 26 percent of those the state had already received. The state is moving to loosen eligibility and open mass vaccination centers, including one at Dodger Stadium in Los Angeles.

Mr. Azar said on Tuesday that the country was on track to reach the rate of one million vaccinations a day in about a week, and stressed that data collection about each states progress has been slow and faulty. He also faulted states that had been overly prescriptive and trying to micromanage every single dose of vaccine and said the government would send more doses to states based on their success in distributing ones they had already received.

The allocation will also be based on the size of a states population of people 65 and older, not on its general adult population, he said. It was unclear, however, whether that would hold past Jan. 20, when President-elect Joseph R. Biden Jr. takes office.

Mr. Biden is expected to announce details of his own vaccination plan which will include federally supported mass vaccination clinics on Thursday. Mr. Biden has set a goal of 100 million shots administered in his first 100 days.

As of Wednesday, the country had recorded more than 23 million cases and more than 380,000 deaths, according to a Times database. New cases have increased steadily since the fall, and a record number of deaths were reported on Tuesday: more than 4,400.

At least 60 sitting members of Congress more than one in 10 have tested positive for the coronavirus or are believed to have had Covid-19 at some point since the pandemic began. The list includes 44 Republicans and 16 Democrats.

Thats a higher proportion than the general population. As of Wednesday, a bit fewer than one in 14 Americans were known to have had the virus, according to a New York Times database, though many more cases have probably gone undetected.

Five House members have reported positive tests since the attack on the Capitol last week, when many lawmakers were holed up in a secure location together and some refused to wear masks a situation that angered several Democrats, including Representative Pramila Jayapal of Washington, one of those who has since tested positive.

And on Wednesday, Representative Ayanna Pressley of Massachusetts said that her husband, Conan Harris, who was at the Capitol to see her sworn in, has also tested positive. In a statement, Ms. Pressley said that Republican colleagues who had refused to wear masks while in a confined space had displayed an arrogant disregard for the lives of others.

Congresss attending physician warned members afterward that it was possible they were exposed while sheltering and recommended that they be tested.

Congress has struggled to stem the spread within its ranks in recent weeks. Most members who have tested positive have done so since the election in November, as cases have surged across the country.

Representative Jake LaTurner, Republican of Kansas, said he received word just after the attack on the Capitol last Wednesday that he had tested positive. He did not return to the House floor for a vote early on Thursday.

Representative Gus Bilirakis of Florida and Representative Michelle Steel of California, both Republicans, were absent from the House floor when the mob entered the Capitol because each had received positive test results earlier that morning. Representative Chuck Fleischmann, Republican of Tennessee, said on Sunday that he had tested positive after exposure to Mr. Bilirakis, with whom he shares a residence.

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Were speeding up the process of giving vaccines all the time. Yesterday, 28,599 doses given. We are opening up mega-sites, 24/7 mega-sites. We talked yesterday about CitiField, and again, thanks to the New York Mets for stepping up. Thats fantastic. Thats going to serve a lot of people. Well, weve heard back from the New York Yankees. And we welcome them into the fold too. Were working with them now to work out a plan to use Yankee Stadium as well. And thats got to be great for the people of the Bronx. So that plan is in motion, well announce it when the details have been worked through. But theres going to be more and more sites, not just stadiums, but more sites of all kinds, more hours reaching more people. And now anyone 65 years old or over does qualify. So if youre 65 or over, regardless of your health situation obviously, youre vulnerable, weve talked about this before you have the right to be vaccinated. You can sign up now. We have sites, as I said, 24/7 sites, and sites with other hours, extended hours, all over the five boroughs. On the 24/7 sites, yesterday, we opened a site at 125 Worth Street, right here, in the City Hall area, Lower Manhattan. Today, Staten Island, the Vanderbilt Clinic on Staten Island open 24/7 from this point on. And again, more sites coming in Staten Island. Saturday, the Health and Hospitals Corona Clinic in Queens will go to 24/7. And obviously, CitiField will be right behind that. Were going to just keep building and building out capacity.

An additional three cases of a variant of the coronavirus, which has been surging in the United Kingdom, have now been identified in New York, bringing the total number of cases in the state to 15, Gov. Andrew M. Cuomo announced on Wednesday.

State officials have narrowed down the new cases of the more contagious variant to two clusters, one on Long Island and another stemming from a jewelry store in Saratoga Springs, where the first case of the variant was discovered on Jan. 4.

Amid mounting evidence that the variant is continuing to spread in New York, hospitalizations statewide continued to climb more than 8,920 people reported Wednesday and state and city officials scrambled to accelerate a sluggish rollout of the vaccine.

Were locked in a footrace between its quick distribution and the spread of new cases, Mr. Cuomo, a third-term Democrat, said in a statement.

Both New York City and the state have added large vaccination sites in recent days. On Wednesday, Mayor Bill de Blasio said that the city was working with the New York Yankees to use their home stadium, in the Bronx, though there is no opening date yet.

The announcement followed the mayors reveal on Tuesday that Citi Field, the Mets stadium in Queens, would become a mass vaccination site starting the week of Jan. 25. The site at Citi Field will operate seven days a week and is expected to have the capacity to vaccinate 5,000 to 7,000 people a day.

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W.H.O. Finally Lands in China to Begin Tracing the Coronavirus - The New York Times