An Eli Lilly and Company pharmaceutical manufacturing plant is pictured at 50 ImClone Drive in Branchburg, New Jersey, March 5, 2021.
Mike Segar | Reuters
A key monoclonal antibody used to treat people with weak immune systems who catch Covid is no longer authorized for use in the U.S. because it is not effective against emerging omicron subvariants.
The FDA, in a notice Wednesday, said bebtelovimab is not approved for use because it is not expected to neutralize the omicron BQ.1 and BQ.1.1 subvariants. They are causing 57% of new infections nationally and make up a majority of cases in every U.S. region except one.
The Health and Human Services Department is putting on hold pending requests for bebtelovimab, and the manufacturer Eli Lilliy has also halted commercial distribution of the antibody treatment until further notice, according to the FDA notice.
But bebtelovimab stocks should be kept on hand in the event that Covid variants which the antibody can neutralize become dominant again in the future, according to FDA.
Bebtelovimab is a single-dose injection administered to people who catch Covid and are at high risk of developing severe disease, but cannot take any other FDA-approved treatments such as the oral antiviral Paxlovid. Many people with weak immune systems, such as organ transplant patients, cannot take Paxlovid with other medications they need.
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U.S. health officials have warned that people with weak immune systems face a heightened risk from Covid this winter, because more immune evasive omicron subvariants threaten to knock out antibody treatments they rely on to stay safe from Covid.
Dr. Ashish Jha, the White House Covid coordinator, said in October that the failure of Congress to pass additional Covid funding means treatments will dwindle as new variants render them ineffective.
“We had hoped that over time as the pandemic went along, as our fight against this virus went along, we would be expanding our medicine cabinet,” Jha told reporters. “Because of lack of congressional funding that medicine cabinet has actually shrunk and that does put vulnerable people at risk.”
President Joe Biden has called on people with weak immune systems to consult with their physicians about what extra precautions they should take this winter to stay safe.
As smoke crept through the 21-story apartment building in far western China, panicked messages filled the residents’ chat group. “On the 16th floor, we don’t have enough oxygen,” a woman gasped in an audio message. “Soon our children won’t be OK.”
Another person added a plea about the people in apartment 1901: “They wouldn’t be able to open the door. Can you break into it and take a look? There are many children inside.”
Many who heard the reports were shocked, not by a tragedy in the remote city of Urumqi, but because it had taken firefighters three hours to control the fire. People across the country believed the delays happened in part because of the pandemic restrictions that have been a running source of discontent throughout the country. The impact has reached into the heart of Chinese politics.
Excerpts of residents’ panicked conversation began to circulate on social media, along with videos of the emergency response. They showed fire crews struggling to get around barriers to approach the building. Videos showed fire crews’ water streams falling short of the fire as its flames slithered toward the top of the apartment tower.
Pandemic controls imposed by Chinese authorities around, and possibly inside, the apartment building had delayed the fire response, neighbors and family members of those killed have said. That would mean that the death toll, which many believed was much higher than the official tally of 10, was ultimately in part a product of China’s strict, already widely detested zero-tolerance Covid policy. The government denies all that.
Outrage spilled onto the streets of Urumqi, the capital of the heavily Muslim Chinese region of Xinjiang, where residents had been locked down for more than 100 days. Footage of the fire and the protest in Urumqi spread on Chinese social media and on the popular do-everything app
WeChat.
Firefighters sprayed water on a residential-building fire in the city of Urumqi that killed 10 and triggered protests against Covid-19 lockdowns.
Photo:
Associated Press
To large numbers of Chinese people who have had the experience of being locked inside their own apartments because of Covid controls, the words and images flowing out of Xinjiang conjured a scenario that seemed terrifyingly plausible.
“The 100-plus day lockdown is real. The many deaths from Covid controls are real. Discontent has accumulated and is destined to erupt,” said a user on the Twitter-like
Weibo
platform in one widely endorsed comment about the fire.
Within days, the protest would spread throughout China, growing into the largest show of public defiance the Communist Party has faced since the 1989 pro-democracy protests at Tiananmen Square. The demonstrations have posed a rare challenge to the recently extended rule of Chinese leader
Xi Jinping,
compounding the government’s challenges over how to ease its Covid restrictions.
Large protests erupted across China as crowds voiced their frustration at nearly three years of Covid-19 controls. Here’s how a deadly fire in Xinjiang sparked domestic upheaval and a political dilemma for Xi Jinping’s leadership. Photo: Thomas Peter/Reuters
China has experienced public outrage over its strict Covid-19 restrictions before, most of which the authorities had managed to contain online. Going back nearly three years, the death from the coronavirus of Li Wenliang, a doctor who was punished for warning others about the initial outbreak in Wuhan, unleashed a flood of grief and anger.
This September, a bus crash in Guizhou province that killed 27 people who were being sent to quarantine in the middle of the night raised an outcry about steps taken to control the coronavirus.
Mourners in Hong Kong paid their respects in February 2020 to Chinese physician Li Wenliang. Dr. Li raised early alarms about the coronavirus outbreak in Wuhan but was silenced by police, only to die of the disease himself.
Photo:
jerome favre/EPA/Shutterstock
More recently, after an announcement that Covid restrictions would be eased led to little actual change, public frustration spilled out onto the streets. Workers at
Foxconn Technology Group’s
main plant in the city of Zhengzhou, the world’s largest iPhone factory, clashed with police while protesting a contract dispute with roots in pandemic lockdowns. In some Beijing neighborhoods, people argued with officials over the legality of controls.
In maintaining the lockdowns in Xinjiang, local authorities have been able to rely on the country’s most advanced and suffocating security apparatus, originally built to carry out a campaign of ethnic re-engineering against the region’s 14 million Uyghurs and other Turkic Muslims.
Most if not all of the fire’s victims belonged to these groups, according to relatives and overseas Uyghur activists. Discrimination by China’s Han majority against Turkic minorities has long fueled ethnic tensions in the region, which exploded into deadly race riots in Urumqi in 2009.
Yet in the past week, the sides found common cause, at least temporarily, in anger over the fire.
According to an official account published in the state-run Xinjiang Daily newspaper, the blaze began on the 15th floor, in the apartment of a Uyghur woman who was having a bath in a home spa when a circuit breaker flipped. She flipped it back, then was alerted by her daughter to the smell of smoke. When she re-emerged from the bathroom, flames had risen to the wooden ceiling from the bed.
A community worker arrived just as they were fleeing the flames, according to Xinjiang Daily. He called the fire service at 7:49 p.m. last Thursday, then helped rush the pair and their neighbors downstairs.
A still taken from a social media video shows a fire truck shooting water at the burning residential building in Urumqi. The fire and delays in fighting it proved a catalyst for nationwide protests against Covid-19 lockdowns.
Photo:
REUTERS
At the ground level, burning debris had begun falling over the doorway. Those who couldn’t leave through the front gate in time had to climb out of a window from an apartment, the newspaper reported.
Firefighters didn’t reach some of the apartments until around 90 minutes after they were called, according to posts on the chat group.
Video footage showed that traffic-control structures had to be removed as a line of fire trucks waited, causing delays. The government denied the structures had been installed for pandemic-control reasons.
At a press briefing convened late Friday night as protests unfolded, officials said that three fire trucks from a nearby station arrived at the scene five minutes after the fire was reported, but they were blocked by cars that had to be moved.
On social media, residents said those cars had been parked there for months during the fall Covid lockdown, and the engines couldn’t start.
Li Wensheng, Urumqi’s fire chief, said at the press briefing that some residents’ “self-rescue abilities were weak,” a comment that added to the simmering anger.
The Xinjiang and Urumqi governments didn’t respond to requests for comment.
Han residents of Urumqi led the protests that unfolded in the freezing night air the day following the fire. Uyghur residents have faced the strictest lockdowns and largely stayed home out of fear they would bear the brunt of any reprisals, overseas activists said.
Demonstrations were fueled by the group chat conversations and footage of obstructed fire trucks, as well as by videos circulating online that appeared to capture the screams of people from the smoldering building. “Open the gate!” one woman could be heard shouting in horror in one video.
On Saturday night, several female students stood for hours on the campus of Communication University of China in Nanjing, holding blank sheets of paper in silence, widely taken to be a reference to Chinese censorship. A male student from Xinjiang offered a tribute to the victims in Urumqi and to “all other victims nationwide,” saying he had been a coward for too long.
A man was arrested on a Shanghai street when protests erupted following a deadly apartment-building fire in China’s Xinjiang region.
Photo:
hector retamal/AFP/Getty Images
That same night, dozens of people in Shanghai gathered for a vigil with flowers and candles near a street named after Urumqi. Passersby joined in, and the crowd grew into the hundreds. Just past midnight, some demonstrators began chanting for Mr. Xi to step down.
Similar protests emerged in half a dozen Chinese cities and more than a dozen university campuses in the following days. In several instances, demonstrators chanted “We are all Xinjiang people.” Others called for democracy and free speech.
Chinese authorities have devoted enormous resources to building domestic security and surveillance systems specifically designed to prevent such wide and unified outbreaks of dissent. While protests aren’t uncommon, scholars who study China say they are almost always local events with little capacity to spread.
The Cyberspace Administration of China issued guidance to companies on Tuesday, including Tencent Holdings Ltd. and ByteDance Ltd., the Chinese owner of short video apps TikTok and Douyin, asking them to add more staff to internet censorship teams, according to people familiar with the matter. The companies were also asked to pay more attention to content related to the protests, particularly any information being shared about demonstrations at Chinese universities and the fire.
In imposing its stringent Covid controls, human-rights activists and other observers say, the Communist Party created an issue that China’s citizens only have to look out their front door to understand. Some Uyghurs affected by the fire said the fear and frustration stemming from pandemic controls crossed deep-seated ethnic divides.
Marhaba Muhammad, now a resident of Turkey, said she read news of the fire with a sense of horror. She recognized the building as the home of her aunt, whom she last visited in 2016, shortly before leaving China. The family lived in apartment 1901, the subject of one of the desperate messages left in the residents’ chat group.
Ms. Muhammad said she and her family abroad learned that the aunt, Qemernisahan Abdurahman, 48, had died in the apartment, along with four children age 5 to 13.
Ms. Abdurahman’s husband wasn’t there. He and an elder son were detained as part of the crackdown in Xinjiang in 2017 and now are imprisoned, said Ms. Muhammad and her brother, Abdulhafiz Maiamaitimin, who lives in Switzerland.
“This news is so painful. No one imagined,” she said.
Qemernisahan Abdurahman, 48, with 3 of her four children who died in the fire in Urumqi.
Photo:
Marhaba Muhammad
In apartment 1801, directly below where Ms. Muhammad’s aunt and children died, a woman also died along with her children, according to Abduweli Ayup, a Uyghur activist in Norway who spoke with relatives and neighbors of the fire victims.
Han Chinese don’t have to fear the level of oppression faced by Uyghurs, Ms. Muhammad said, referring to the Chinese government’s detention of upwards of a million Uyghurs and other Turkic Muslims in internment camps and prisons—a practice the United Nations has said may constitute a crime against humanity.
Yet “after the fire, they realized that Uyghurs today would be the Chinese tomorrow,” she said.
Police have targeted protest participants by using some of the surveillance techniques honed in Xinjiang to target Uyghurs. In chat rooms used to organize demonstrations, protesters have reported police scanning the smartphones of pedestrians for overseas apps such as Twitter and Telegram, a common experience on the streets of Urumqi.
A lawyer representing more than a dozen protesters taken by police said she believes many of her clients were tracked through mobile-phone data, another echo of the Uyghur experience in Xinjiang.
On Tuesday, Chinese-Australian activist and cartoonist Badiucao, who goes by one name, reposted a widely shared video of police on the Shanghai subway checking the phones of passengers on Twitter. He appended a single phrase: “Xinjiang-ization.”
Protesters in Beijing lighted candles during a protest against China’s strict zero-Covid measures.
Photo:
Kevin Frayer/Getty Images
Write to Austin Ramzy at austin.ramzy@wsj.com and to Wenxin Fan at Wenxin.Fan@wsj.com
Deaths from drug and alcohol use are rising among America’s seniors.
Drug overdose deaths more than tripled among people age 65 and older during the past two decades while deaths from alcohol abuse increased more than 18% from 2019 to 2020, according to data published Wednesday by the National Center for Health Statistics.
More than 800,000 seniors suffered from drug addiction and 2.7 million suffered from alcohol addiction in 2020, according to separate data from the Health and Human Services Department.
In total, more than 5,000 seniors died of drug overdoses in 2020 and more than 11,600 succumbed to alcohol, according to the NCHS data. Though drug overdose death rates are lower for seniors than other age groups, they have increased substantially from 2.4 per 100,000 in 2000 to 8.8 per 100,000 in 2020.
“We’ve got a public health problem coming at our door — these trends have been increasing for a long time now,” said Alexis Kuerbis, a professor at the Silberman School of Social Work and an expert on substance use among older adults.
Seniors today are baby boomers, a generation that had a much more open attitude toward drugs and alcohol than their parents, Kuerbis said. Some baby boomers have carried alcohol and drug habits from their youth and middle age into their later years when their bodies are no longer able to tolerate them, she said.
“Baby boomers obviously are very different generation than the silent generation or the World War II generation,” Kuerbis said. “Baby boomers were far more open to using alcohol and drugs during their younger years but also through their middle-aged years and now they are older adults,” she said.
Deaths from fentanyl and other synthetic opioids increased 53% among seniors from 2019 to 2020, according to the data. Kuerbis said there’s some evidence to suggest people who were prescribed opioids in their middle age for an injury later switched to fentanyl once it became harder to get a prescription.
If you are having suicidal thoughts or are in distress, contact the Suicide & Crisis Lifeline at 988 for support and assistance from a trained counselor.
While some drug deaths among seniors are from accidental misuse of drugs, many are suicides from overdosing on opioids, Kuerbis said. Although seniors tend to be happier than younger adults, they also have a higher prevalence of chronic pain, terminal illness and dementia, she said.
Some older adults also use drugs or alcohol to cope with major life changes such as retirement, grief and loss, or a change in their living situation, according to the National Institute of Drug Abuse.
Drug overdose deaths were highest among Black seniors. The death rate from drugs among Black men ages 65 to 74 was more than four times higher than Hispanic or white men in that age group, according to the data. Black women ages 65 to 74 died more often from drug overdoses than white and Hispanic women. White women older than 75 had a higher death rate from drugs than Black and Hispanic women.
Alcohol deaths were highest among American Indian seniors followed by Hispanics, white Americans, Black Americans and Asian Americans, according to the data.
faces a difficult choice between loosening China’s zero-tolerance Covid-19 policy or doubling down on restrictions that have locked down neighborhoods and stifled the country’s economy over the past three years.
Neither option is a good one for a regime focused on stability. Stock markets around the globe declined Monday as protests in China fueled worries among investors about the outlook for the world’s second-largest economy.
“Xi’s leadership is in a bind,” said
Yuen Yuen Ang,
a political scientist focused on China at the University of Michigan. “If they compromise and relax zero-Covid, they fear it will encourage mass protests. If they repress more, it will create wider and deeper grievances.”
Protesters across China have directly challenged the authority of the Chinese leader and the Communist Party in scenes unthinkable just a month ago, when Mr. Xi secured a third term in power.
In Shanghai over the weekend, protesters used call-and-response chanting to demand political change. In Beijing, crowds shouted “Freedom.” In other large cities, demonstrators marched holding blank sheets of paper—a swipe at government censorship.
China experts say the protests are unlikely to translate into a leadership change, in the near term at least. But Beijing’s dilemma is a tough one. It could lift restrictions and risk a large and potentially deadly wave of Covid infections that could undermine its credibility. Or it could crack down on the demonstrators and stick with a strict pandemic strategy that large parts of the population are clearly fed up with.
All three benchmark U.S. stock indexes closed more than 1% lower on Monday as investors worried that the protests would lead to more market volatility.
Widespread and public outpourings of political grievance have been extremely rare in a country where people have long consented to obey party authorities—as long as they deliver prosperity and allow citizens relative freedom in their personal lives.
People sang slogans and chanted for political change on a street in Shanghai on Sunday.
Photo:
hector retamal/Agence France-Presse/Getty Images
Police cars were parked on a Shanghai street on Monday, a day after rare demonstrations were held.
Photo:
hector retamal/Agence France-Presse/Getty Images
The protests put in stark relief the fraying of that social contract, showing that the climbing economic and social costs of China’s zero-Covid policies—coupled with an increasingly authoritarian regime’s zero-tolerance for dissent—have driven many to a kind of breaking point.
Demonstrations aren’t unusual in China, but they are largely over local grievances such as unpaid wages, land disputes or pollution. Since the Tiananmen Square protests in 1989, the party has made it a priority to prevent nationwide protests of a political nature.
The current wave of unrest started last week in the remote northwestern region of Xinjiang after 10 people died in a fire. Residents contended that Covid restrictions were partly to blame for delaying rescuers and contributing to the death toll. Officials said some barriers had to be moved but attributed the delay to parked cars in the way.
In the days since, the anger has spread across China. On Monday, authorities moved broadly to prevent any new protests, including dozens of uniformed and undercover police swarming the area around a highway bridge in Beijing where a lone protester hung a banner denouncing Mr. Xi in October. On Sunday, protesters had chanted lines from the banners.
In a rare show of defiance, crowds in China gathered for the third night as protests against Covid restrictions spread to Beijing, Shanghai and other cities. People held blank sheets of paper, symbolizing censorship, and demanded the Chinese president step down. Photo: Kevin Frayer/Getty Images
The unrest also underlined how anger about the Covid restrictions has united people from a range of social backgrounds—from migrant workers assembling iPhones in central China and residents of the remote region of Xinjiang to college students and middle-class urbanites in the nation’s biggest cities.
“The mass protests represent the biggest political crisis for Xi,” said
Minxin Pei,
editor of quarterly academic journal China Leadership Monitor. “It’s the first time in recent decades that protesters from a broad coalition of social groups have mounted a direct challenge to both the top leader himself and the party.”
Students staged a small protest Sunday at Tsinghua University in Beijing.
Photo:
Associated Press
Sudden reopening could lead to millions of intensive-care admissions in a country with fewer than four ICU beds per 100,000 people, and where many elderly still haven’t been fully vaccinated, according to public-health experts and official data. In addition, such a compromise would send a signal to the general public that mass protests are an effective means to win change, not something the government would want to encourage.
On the other hand, sticking to the zero-Covid policy could stir up even greater public resentment toward the leadership, with hard-to-gauge consequences.
The University of Michigan’s Ms. Ang and others say that the protests are unlikely to lead to any radical policy shift. Rather, one likely outcome is a mixture of selective relaxation of controls and harsh retaliation against select protesters.
Protesters and police stood on a street in Beijing on Monday.
Photo:
Kevin Frayer/Getty Images
“The danger is that if the leadership responds with repression, that could take China down a vicious cycle of control, leading to more grievances, to more control,” Ms. Ang said.
China’s Covid struggle underscores the limits of a political system where a lack of public debate has made it hard to adjust policies as other countries have done.
Many public-health experts say Beijing has missed the window to put in place a gradual exit plan out of zero-Covid. For the past three years, the government has spent significant resources on building ever more quarantine facilities and expanding mass-testing capabilities, while China’s progress on developing more effective vaccines has been slow.
Partly thanks to Beijing’s early successes at stemming infections, the Chinese population has developed little natural immunity. It only has access to homegrown vaccines that are less effective than some of the global alternatives.
A neighborhood in Beijing where access is restricted because of Covid regulations.
Photo:
Ng Han Guan/Associated Press
Notably, negotiations between China and the European Union over mRNA vaccine imports from the bloc fell through nearly two years ago, according to people familiar with the matter, after Beijing insisted that Europe recognize Chinese vaccines.
Beijing has also resisted approving any large-scale adoption of the mRNA vaccine co-developed by
Pfizer Inc.
and
BioNTech SE,
a decision healthcare and foreign-policy experts attribute partly to China’s strained relations with the U.S.
Mr. Xi and the party have faced public anger before, most notably during the early days of the pandemic when emotions swelled with the death from the virus of
Li Wenliang,
a young doctor in the city of Wuhan who was punished for trying to raise an early alarm. Ultimately, much of the nation’s anger then was directed at local authorities.
In the years since, Mr. Xi has identified himself closely with the zero-Covid strategy. That is now turning him into the natural target of protesters’ fury and has also made it nearly impossible to shift course without diminishing his standing. Notably, a People’s Daily article on Sunday continued to stress the importance of unwaveringly sticking to the existing Covid-control policy.
A Covid testing station in Shanghai on Monday. The government has built quarantine facilities and expanded mass-testing capabilities, while its development of more-effective Covid vaccines has been slow.
Photo:
Bloomberg News
As repeated lockdowns kept businesses closed and pushed up unemployment, some hoped there would be a shift away from the zero-Covid strategy once an October party conclave that handed Mr. Xi another five-year term was over.
As long as the top leader felt politically secure enough, those people argued, he would want to adjust the policy to help the economy—which still matters to the leadership despite its increased emphasis on ideology and party control.
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Businesses and investors alike cheered when Beijing earlier this month unveiled plans to “optimize and adjust” the Covid policy, including shortened quarantine restrictions. Many market analysts viewed the step as the beginning of a gradual exit from zero-Covid.
However, as Covid cases surged again along with the colder season, local officials across the country reimposed strict restrictions for fear of putting their jobs in jeopardy. Keeping Covid under control has remained the overarching political priority for localities that are also struggling to reboot economic activity.
The contrast of China’s continued Covid lockdowns as the rest of the world has moved on became more obvious over the past week as many Chinese soccer fans have seen TV images of thousands of maskless spectators cheering in stadiums during the World Cup in Qatar.
Then came the deadly fire in Urumqi, the capital of Xinjiang, where residents had struggled with lockdowns of more than 100 days, prompting protesters across the country to defy the risks of expressing dissent to seek change.
People lighted candles on Sunday in Beijing for victims of a deadly fire in the northwestern city of Urumqi, the capital of Xinjiang.
A sign advertising flu shots is displayed at a Walgreens pharmacy on January 22, 2018 in San Francisco, California. A strong strain of H3N2 influenza has claimed the lives of 74 Californians under the age of 65 since the flu season began in October of last year.
Justin Sullivan | Getty Images
A variant of the flu that hits kids and seniors worse than other strains of the virus is dominant in the U.S. right now, setting the country up for a potentially bad flu season.
Public health labs have detected influenza A(H3N2) in 76% of the more than 3,500 respiratory samples that have tested positive for the flu and were analyzed for the virus subtype, according to a surveillance report published Friday by the Centers for Disease Control and Prevention.
The H3N2 variant has been associated with more severe flu seasons for children and the elderly in the past, according to Dr. Jose Romero, director the CDC’s National Center for Immunization and Respiratory Disease.
“There are also early signs of influenza causing severe illness in precisely these two groups of individuals this season,” Romero told reporters on a call earlier this month.
The flu hospitalization rate has surged to a decade high this season. Overall, about 8 people per 100,000 are being hospitalized with the flu right now but seniors and the youngest children are much harder hit than other age groups, according to CDC data.
The hospitalization rate for seniors is more than double the general population at 18 per 100,000. For kids younger than age five, the hospitalization rate is about 13 per 100,000.
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At least 4.4 million people have fallen ill with the flu, 38,000 have been hospitalized, and 2,100 have died since the season started. Seven kids have died from the flu so far this season.
“When we have more H3N2, we usually have a more severe flu season — so longer duration, more children affected, more children with severe disease,” said Dr. Andi Shane, a pediatrician and infectious disease expert at Children’s Healthcare Atlanta.
The other influenza A variant, H1N1, is generally associated with less severe seasons compared with H3N2, Shane said. H1N1 makes up about 22% of sample that have tested positive for flu and were analyzed for a subtype, according to CDC.
The percentage of patients reporting symptoms similar to the flu, a fever of 100 degrees or greater plus a sore throat or cough, is the highest in Virginia, Tennessee, South Carolina, Alabama and Washington D.C right now, according to CDC.
Respiratory illnesses are also very high in Arkansas, Colorado, Georgia, Kentucky, New Jersey, Maryland, Mississippi, New Mexico, North Carolina and Texas, according to CDC.
The CDC recommends that everyone 6 months or older get a flu shot. Children younger than age 8 who are receiving the vaccine for the first time should get two doses for the best protection.
The flu vaccine is normally 40% to 60% effective at preventing illness, but people who do still get sick are less likely to end up in the hospital or die, according to the CDC.
Public health officials are also encouraging people to stay home when they are sick, cover coughs and sneezes and wash hands frequently. Those who want to take extra precautions can consider wearing a facemask indoors in public.
Flu activity continued to rise across the U.S. in the past week, adding to a crunch on emergency departments and pediatric hospitals from an early surge in respiratory viruses.
Flu has caused an estimated 4.4 million illnesses, 38,000 hospitalizations and 2,100 deaths so far this season including seven pediatric deaths, the Centers for Disease Control and Prevention said Friday. The highest flu hospitalization rates are among adults ages 65 and older, followed by children under the age of 5, the CDC said.
Pediatric hospitals across the U.S. have been under strain for weeks from a rush of patients with RSV and other respiratory viruses. RSV amounts to a cold in most people, but the virus can be dangerous for younger children and older adults, especially those with other healthconcerns.
“You have flu that is starting to surge in other areas where they’re trying to deal with the RSV surge, and you also have Covid,” said Tina Tan, vice president of the Infectious Diseases Society of America. “It’s one after the other after the other.”
RSV cases appear to be plateauing or declining in parts of the U.S., doctors said. Within the CDC’s RSV-surveillance network of 12 states, the hospitalization rate for RSV remains higher than the most recent prepandemic peak.
Some 76% of pediatric inpatient beds are occupied across the U.S. and occupancy of pediatric intensive-care beds is just above 80%, according to the Department of Health and Human Services. That’s up from 65% of pediatric beds and 70% pediatric ICU beds occupied in early August.
States including Massachusetts, Nevada, Pennsylvania and Texas have more than 90% of their pediatric intensive-care beds occupied, the data show. The data doesn’t specify why patients are in the hospital.
Researchers say the coronavirus is having a persistent effect, keeping millions out of work and reducing the productivity and hours of millions more.
Photo:
Neeta Satam for The Wall Street Journal
“We really maxed out all the space we have,” said Kristina Deeter, physician-in-chief at Renown Children’s Hospital in Reno, Nev., and specialty medical officer for pediatric critical care at
Pediatrix Medical Group.
Pediatric patients at Renown Children’s are backed up into the waiting room, some teenagers have been sent to the adult floor and a list of kids from nearby emergency departments are waiting for a bed, she said.
Other respiratory viruses, including Covid-19, and high demand from pediatric mental-health patients are contributing to the strain at pediatric hospitals, doctors said. Nursing shortages and a decrease in pediatric beds have compounded the crunch.
From 2008 to 2018, the number of pediatric inpatient beds in the U.S. decreased by 12%, according to a 2021 study in the journal Pediatrics. Declines in rural areas were steeper than average, and pediatric specialty care has been increasingly concentrated at large children’s hospitals. The pandemic exacerbated those trends, doctors said.
“When we combine that decrease in beds with a surge in the need for those beds, I certainly think we feel it,” said Anna Cushing, lead author on the study and a pediatric emergency medicine physician at Children’s Hospital Los Angeles. Children’s Hospital Los Angeles hasn’t had space to accept all the transfer patients looking for a bed, said chief medical officer James Stein.
At Rady Children’s Hospital-San Diego, emergency department wait times have fluctuated between two and six hours. In October, the hospital started sending administrative staffto volunteer there, freeing up the regular workers to focus on the sickest patients.
The staffers give kids blankets and alert a triage nurse if patients get sicker, said Nicholas Holmes, chief operating officer at Rady Children’s. A trained pediatric urologist, Dr. Holmes said he worked in the emergency room several times last week.
“Handing out a coloring book and giving a kid a Popsicle, it helps them feel a little bit better,” Dr. Holmes said.
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People should wash their hands, stay home if they’re sick, consider wearing masks indoors and while traveling and get vaccinated against Covid-19 and the flu, doctors and health officials said. They said people should be particularly conscious of risks to infants and older adults during Thanksgiving gatherings.
There are no specific treatments for RSV, but over-the-counter medication can help with fever and patients should stay hydrated. Parents should consult pediatricians if a child is having trouble breathing, having trouble staying hydrated or appears lethargic, doctors said.
The American Academy of Pediatrics said eligible high-risk infants could receive more than the standard five consecutive doses of the monoclonal antibody palivizumab to protect them during this unusually early and long RSV season. Hospital referrals should be reserved for children who need a higher level of care, to avoid overcrowding and extended wait times, the academy said.
Flu hospitalizations have surged to a decade high in the U.S. with the Southeast the hardest region right now.
Five out every 100,000 people in the U.S. were hospitalized with the flu during the week ending Nov. 5, according to data from the Centers for Disease Control and Prevention. That’s the highest hospitalization rate this early in the flu season since 2010, more than 10 years ago.
But the percentage of patients reporting symptoms similar to the flu, a fever of 100 degrees or greater plus a sore throat or cough, is the highest in Alabama, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and Washington D.C., according to CDC data.
Flu activity is also very high in Arkansas, Louisiana, Maryland, New Mexico, New Jersey, New York City and Texas, according to the CDC.
More than 6,400 people were admitted to the hospital with the flu during the week ending Nov. 5, according to data from the Health and Human Services Department. About 54% of these patients were hospitalized in the Southeast and South-Central portion of the U.S.
Just over 2,000 people were hospitalized with the flu in the region that includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. More than 1,400 were admitted to the hospital in Arkansas, Louisiana, New Mexico, Oklahoma and Texas.
In the Southeast, the influenza A H3N2 strain appears to be the most common right now, according to Dr. Jose Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases. This strain is associated with more severe illness in the elderly and young children, Romero said.
“There are also early signs of influenza causing severe illness in precisely these two groups of individuals this season,” Romero told reporters during a call earlier this month.
Nearly 11 out of every 100,000 seniors were hospitalized with the flu during the week ending Nov. 5 while about 10 out every 100,000 kids younger than age 5 were admitted to the hospital, according to CDC data. The hospitalization rate for these age groups is about double the national rate.
So far this season, at least 2.8 million people have fallen ill with the flu, 23,000 have been hospitalized, and 1,300 people have died from the virus, according to CDC.
Hospitals across the U.S. are getting slammed with a surge of patients, particularly kids, sick with the flu or respiratory syncytial virus. Romero said these viruses are probably surging because immunity declined as pandemic-era public health measures crushed transmission of these viruses. May kids, as a consequence, are getting infected for the first time.
Public health officials are also expecting another wave of Covid infection this winter. The CDC, the Food and Drug Administration and the White House have called for everyone whose eligible to receive a flu shot and Covid booster ahead of the holidays.
For much of the past year, China’s economy has been reeling under Xi Jinping’s dual campaigns to rein in soaring property prices and to stamp out any traces of Covid-19 within the country’s borders.
Now, as he moves to loosen pandemic restrictions, China’s leader, Mr. Xi, is signaling a reversal of his real estate crackdown, too, a tacit acknowledgment of the economic pain and public frustration that the two policies have engendered.
China’s central bank and top banking regulator issued a wide-ranging series of measures aimed at bolstering housing demand and supply, according to a notice circulated on Friday to the country’s financial institutions and officials involved in policy-making. The authenticity of the document was confirmed by people close to the central bank.
The new policies, which were signed off on by Mr. Xi, according to the officials involved in policy-making, unwind some of the previous restrictions aimed at curbing property developer debt and give lenders permission to extend loans to home builders in financial trouble.
“These property measures, on top of announcements of Covid loosening, are a clear indication that Beijing’s efforts to support growth are intensifying,” said
Michael Hirson,
head of China Research at 22V Research, a New York-based firm focused on investment strategy.
While local governments across China have taken more modest measures to ease some of the pressure facing real-estate companies, the new bundle of 16 measures represents the single biggest step yet to rescue a sector that has for decades been a key pillar of growth for the world’s second-largest economy.
The property measures had led to falling home sales, hurting overall growth in the real-estate sector.
Photo:
Cfoto/Zuma Press
Chinese home prices for decades outpaced the rate of broader economic growth.
Photo:
Anthony Kwan/Bloomberg News
The new measures are “massive in scale” and amount to “targeted credit easing for the property industry,” said
Dan Wang,
chief economist at
Hang Seng
Bank China, who drew a contrast with previous rounds of incremental support measures.
As developers face looming loan repayment deadlines, regulators are eager to avoid any systemic risks in the financial sector triggered by a wave of potential defaults, Ms. Wang said. Even so, she added, “demand for home purchase remains weak,” with any reversal in housing-market sentiment likely to depend on the longer-term outlook for the economy.
The easing of real estate and Covid restrictions comes just weeks after Mr. Xi secured another five years in power at a closely watched Communist Party congress. With Mr. Xi having consolidated political control, he now faces the prospect of a third term in office facing the country’s worst prolonged economic slowdown in decades.
Much of the economic weakness is a direct product of his campaign-style clampdowns to crush Covid and, starting last year, tame a four-decade-old property market boom that officials have warned may be a bubble.
The property measures led to increased defaults by property developers, rising bad debts for banks, falling home sales and investment—all of which have weighed heavily on overall growth in recent quarters.
China’s gross domestic product expanded just 3.0% in the first nine months of 2022, well below the government’s official full-year target of about 5.5%, set in March.
China Evergrande Group, long the country’s largest developer, is now its biggest debtor.
Photo:
ALY SONG/REUTERS
Chinese home prices have for decades outpaced the rate of broader economic growth, driving more credit into real estate speculation and further pushing up property values. Authorities in recent years have repeatedly tried to break the vicious cycle with various tightening measures, only to loosen them whenever growth appears threatened.
By 2019, the total value of Chinese homes and developers’ inventory was $52 trillion, according to
Goldman Sachs Group Inc.,
twice the size of the U.S. residential market.
As Beijing tightened the screws on developers last year—and then reaffirmed their commitment to the tougher rules—several private developers began to teeter on the brink of crisis. Among the most prominent was
China Evergrande Group,
long the country’s largest developer and now its biggest debtor, though the concerns have spread to other large private players.
More than 30 developers have defaulted on their dollar-denominated bonds. International investors have dumped their bonds, driving price levels to new lows and leaving even the strongest private developers struggling to sell new debt.
Shares of Chinese property developers surged on Monday following the news.
Country Garden Holdings Co.
, one of the country’s largest real-estate companies by contracted sales, jumped 40% in early trading in Hong Kong, taking its gains this month to more than 200%. A Hang Seng subindex of property stocks rose 7%.
Prices of dollar bonds of developers that haven’t defaulted on their debt—including
Agile Group Holdings Ltd.
and
Longfor Group Holdings Ltd.
—also rose sharply from deeply distressed levels, as investors placed bets on their potential recovery.
As the broader economic pain mounted this year, regulators and regional governments moved only modestly to try to avert a full-blown housing crisis, introducing limited measures such as tax rebates, cash rewards and lower down payments, as well as providing banks with window guidance to increase property lending. But those piecemeal moves have so far failed to reverse sentiment and lift the sector.
In October, sales at the country’s 100 largest property developers fell to the equivalent of $76.7 billion, down 28.4% from a year earlier and the 16th straight month of year-over-year declines, according to China Real Estate Information Corp., an industry data provider.
As foreign investors and home buyers lose confidence in China’s property market, developers are offering cars and pigs to boost sales. WSJ examines ads and policies to see how the country’s real estate turmoil could ripple out into the global economy. Photo composite: Sharon Shi
Now, with a new leadership team in place after the party congress—one packed with party members loyal to Mr. Xi—the top leader is moving toward a more concerted approach to shoring up the economy, part of a broader effort to brace for greater competition with the U.S.
“It seems that room for policy easing has widened post-party congress,” said
Larry Hu,
a Hong Kong-based economist at Macquarie. “After the impact of previous efforts turned out to be muted, policy makers are giving a big push now to get credit to flow to the property sector.”
Credit has been a particular headache for developers, since many had relied on heavy borrowing to build new projects and stay afloat. In the first nine months of this year, funds raised by China’s property developers dropped by 24.5%, according to data from the National Bureau of Statistics.
The new notice, jointly issued by the People’s Bank of China and the China Banking and Insurance Regulatory Commission, doesn’t represent a total reversal of Mr. Xi’s earlier efforts to tamp down exuberance in the sector.
“‘Policy makers are giving a big push now to get credit to flow to the property sector.’”
— Larry Hu, a Hong Kong-based economist at Macquarie
The notice, which has been billed as a package aimed at ensuring the sector’s “stable and healthy development,” still underlines the need to curb speculative real estate buying, repeating Mr. Xi’s mantra that “housing is for living in, not for speculating on.”
Under the new measures, developers’ outstanding bank loans and some types of nonbank credit due within the next six months can be extended for a year. Repayments on developers’ bonds can also be extended.
In addition, banks are encouraged to offer financing to unfinished housing projects and negotiate with home buyers on extending mortgage repayment, an apparent effort to help defuse growing resentment among those who have boycotted mortgage payments since the summer.
Banks are also encouraged to offer financing to support acquisitions of real-estate projects by financially sounder developers from weaker ones.
The new policies require financial institutions to treat state-owned developers and private developers equally, a measure that appears aimed at addressing banks’ reluctance to lend to private developers, according to
Yan Yuejin,
research director at Shanghai-based E-House China R&D Institute, a research firm.
“Regulators are making all-round efforts to target a soft landing for the property sector,” said
Bruce Pang,
chief China economist at Jones Lang LaSalle. Still, with the measures’ heavy skew toward improving liquidity for cash-strapped developers, he said, “these measures likely aren’t enough to avert the slowdown in the physical market.”
—Rebecca Feng contributed to this article.
Write to Lingling Wei at Lingling.Wei@wsj.com, Cao Li at li.cao@wsj.com and Stella Yifan Xie at stella.xie@wsj.com
Even healthy infants face a considerable risk of hospitalization from respiratory syncytial virus, according to a large European study published Thursday.
Dutch and British scientists, in a study published in Lancet Respiratory Medicine, found that 1.8% of healthy infants are hospitalized with RSV before their first birthday. This means about 1 in 56 healthy infants are hospitalized with the virus annually.
Dr. Louis Bont, one of the authors of the study, stressed that the incidence of RSV hospitalization in healthy infants was about twice as high as the researchers had expected.
The scientists found that a majority of the infants hospitalized with RSV were younger than 3 months. About 1 in 18 infants hospitalized with RSV required treatment in the intensive care unit.
RSV is a common respiratory virus that normally results in mild symptoms similar to the common cold. But for infants younger than 6 months, it can cause lung infections that result in hospitalization and in some cases require assisted breathing.
The scientists followed more than 9,000 healthy newborns to at least their first birthday across five sites in Spain, Finland, England, Scotland and the Netherlands.
They found that 145 of the healthy babies were hospitalized with RSV, eight of whom required treatment in the intensive care unit, about 5%, and three of whom needed mechanical ventilation, or 2%.
Bont said the findings highlight the importance of bringing vaccines to market that can significantly lower the amount of disease in infants and relieve pressure on pediatric hospitals.
The European Medicines Agency this month approved an antibody called nirsevimab, developed by AstraZeneca and Sanofi, to prevent lower respiratory tract disease from RSV in newborns and infants.
Pfizer is developing a single-dose vaccine given to pregnant mothers to protect their newborns against severe disease from RSV. Clinical trials found the shot was about 81% effective at preventing severe lower respiratory tract illnesses in the first 90 days of the baby’s life.
Pfizer plans to submit an application to the Food and Drug Administration by the end of 2022 for the vaccine’s approval in the U.S.
The U.S. is facing a significant increase in RSV cases among kids in almost every region of the country, according to the Centers for Disease Control and Prevention. About 77% of pediatric hospital beds are occupied as RSV and the flu surge, according to data from the Health and Human Services Department.
The CDC is encouraging parents to seek immediate medical attention for their children if they show any of the following warning signs: Trouble breathing, blueish lips or face, chest or muscle pain, dehydration (dry mouth, crying without tears, or not urinating for hours), or not being alert or interactive when awake.
RSV symptoms include runny nose, loss of appetite, and a cough that can progress to wheezing. Infants almost always show symptoms, but for babies younger than 6 months these symptoms can be more subtle, according to the CDC. RSV does not always result in a fever.
Irritability, decreased activity and appetite, as well as pausing while breathing, are all signs that an infant might have RSV, according to the CDC.
When my 14-year-old son tested positive for flu recently, questions ran through my mind that didn’t occur to me before the coronavirus pandemic. Should we run for our masks? Pump up the air purifier? Remind our 9-year-old to time her hand-washing to “Happy Birthday”?
Covid-19 has given us all a crash course in viral transmission and prevention. We know far more than we ever wanted to about how the virus that causes Covid spreads, how long it can incubate in the body and what kind of masks are most effective. That new awareness has made some of us ask similar questions about other viruses now that respiratory illnesses like flu and RSV are surging.
So how much do we really know about how flu spreads and how it compares with the virus that causes Covid? Here’s what scientists say.
How flu spreads
One of the big questions at the beginning of the Covid pandemic was how the virus transmits. Was it mainly through contact with contaminated surfaces? Was it droplets spreading when you’re close to an infected person? Or was transmission largely through aerosols, smaller particles that can be emitted and inhaled through talking and breathing, and which can linger in the air even after a contagious person has left?
We eventually learned that tiny aerosol particles are a major way Covid spreads, which is why indoor spaces are so much riskier than outdoor ones—because the particles fill up and linger in the air.
What about flu?
Most scientists agree that influenza is transmitted most commonly through the air, but there is disagreement about whether the main vehicle is aerosols or droplets.
Some scientists who study aerosol particles say flu mainly transmits through these tiny particles rather than through the larger droplets. That would mean you can get infected just by being in the same room with a contagious person—even far away—rather than having them sneeze on you or emit droplets while talking in proximity to them.
Studies show that aerosols containing influenza virus are infectious for more than an hour, says
John Volckens,
an environmental health professor at Colorado State University in Fort Collins, Colo., who studies aerosols.
Some infectious-disease doctors and the U.S. Centers for Disease Control and Prevention say that influenza is spread most often through droplets emitted from sneezing, coughing or talking, which requires closer contact with an infected person, usually within 6 feet.
“The closer you are, the easier it is to get flu,” says
Peter Chin-Hong,
an infectious-disease specialist at the University of California, San Francisco.
Some studies suggest that most flu transmission is largely through short ranges, notes Dr. Chin-Hong. But a 2013 study in Nature Communications found that aerosol spread might account for about half of all household influenza transmissions, he said.
The CDC guidelines say that surface transmission of flu—by touching a contaminated surface such as a doorknob or table—is less common but possible. It is still a good idea to wash hands frequently, doctors say.
Children 6 months and up and all adults should get their annual flu shot, according to the CDC, with rare exceptions.
Photo:
Mark J. Terrill/AP
How contagious is flu?
Covid-19 is more contagious than influenza, doctors say. One reason is that most people have had flu multiple times and many have gotten multiple flu shots over the years.
The most common calculation of a virus’s infectiousness is a measure called the R0 (pronounced “R naught”). This metric estimates how many people one contagious person will infect on average. The R0 of influenza is between one and two. R0 data for Covid-19 isn’t definitive, especially as the virus continues to mutate, but studies indicate the number for many Covid strains is higher than for flu.
When are you contagious with flu?
The CDC and many doctors say you are likely contagious with flu a day before you develop symptoms, which can include a fever, congestion, cough, sore throat, headache, body aches and fatigue. Doctors also say it is possible to be infected with influenza and never develop symptoms, and that asymptomatic people can still transmit the virus to others.
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Up to half of flu infections may be asymptomatic, says Dr. Chin-Hong, but people with such infections probably transmit less efficiently. A 2021 study in the Lancet Global Health found that asymptomatic individuals transmitted the flu to only about 6% of household contacts.
The incubation period for influenza—the time between when you get exposed to a virus and when you develop symptoms—is about one to two days, says
Seema Lakdawala,
an associate professor in the department of microbiology and immunology at Emory University who studies flu transmission.
Like people with Covid-19, those with influenza start shedding virus before they develop symptoms and can be contagious before they know they are sick, says Dr. Lakdawala. People with influenza are most infectious early on in their illness, in the first two to three days after being infected, she says.
If you’re older, have a chronic disease or are immunocompromised you may shed virus for longer.
Related Video: The new bivalent vaccine might be the first step in developing annual Covid shots, which could follow a similar process to the one used to update flu vaccines every year. Here’s what that process looks like, and why applying it to Covid could be challenging. Illustration: Ryan Trefes
Preventing the spread of flu
Covid-19 precautions also work against flu. Pandemic measures largely quashed the flu around the world for two years. Many of us aren’t used to taking those same precautions for flu. Doctors say we should reconsider—but we may not have to be as rigid about it.
Studies show that influenza can spread easily within a household. If someone in your home tests positive for flu, have them isolate as best as possible, recommends
Kristin Englund,
an infectious-disease physician at Cleveland Clinic. Eating separately or having them wear a high-qualitymask helps if strict isolation isn’t possible. If they are unable to wear a mask, others in the household should do so to lower risk. And when you’re in the same space, improve ventilation by opening the windows or running a HEPA air purifier.
Dr. Englund says schools and offices should re-evaluate their guidelines for returning after a flu infection. “It’s safest to wear a mask as long as somebody is symptomatic,” she says, as congestion and coughs can linger for days.
Masking in indoor spaces and avoiding large crowds in poorly ventilated indoor spaces are other smart precautions to take to combat flu during flu season, says Dr. Lakdawala. Most important, stay home if you have symptoms.
“Be thoughtful,” says Dr. Lakdawala. “We don’t need to take all the precautions that were maybe a little onerous during the Covid-19 pandemic, but we can still take some measures to help reduce risk in our communities.”
