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Health

US Coronavirus: US could be on cusp of the infection surge officials have been dreading, expert warns

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“I think we are going to see a surge in the number of infections,” emergency physician Dr. Leana Wen told CNN on Wednesday night. “I think what helps this time though is that the most vulnerable — particularly nursing home residents, people who are older — are now vaccinated. And so we may prevent a spike in hospitalizations and deaths.”

But governors cited fewer Covid-19 cases and more vaccinations while lifting measures aimed at curbing the spread of the virus.

All that while cases of the worrying variants — notably the highly contagious B.1.1.7 variant — climbed. The variants have the potential to wipe out all the progress the US made if Americans get lax with safety measures, Centers for Disease Control and Prevention Director Dr. Rochelle Walensky warned recently. The B.1.1.7 variant, she said this week, is projected to become the dominant variant in the US by the end of this month or early April.
Despite the warnings, spring break crowds are gathering — with Florida officials reporting too many people and not enough masks — and nationwide, air travel numbers are hitting pandemic-era records.
Now, as the country inches closer to 30 million reported infections, cases are rising by more than 10% in 14 states this week compared to last week, according to Johns Hopkins University data — with half of those states seeing a rise of more than 20%.

“We are really in a race here,” Dr. Richard Besser, the former acting CDC director, told CNN on Wednesday. “We’re in a race to get the population vaccinated. At the same time, we’re fighting people’s exhaustion with the restrictions that public health has put in place and we’re fighting the move by so many governors to remove the restrictions that are keeping us all safe.”

“These factors are really concerning,” he added.

What’s causing some local spikes

Michigan cases are increasing the fastest, with more than a 50% jump this week compared to last, according to the Johns Hopkins data. Delaware, Montana, Alabama and West Virginia have also seen big increases.

There’s a long list of factors contributing to the spike in cases in Michigan, according to Dr. Jennifer Morse, the medical director for the Mid-Michigan District Health Department.

Those include the rolling back of restrictions, a prison outbreak, Covid-19 fatigue, a failure to wear masks, and the B.1.1.7 variant fueling the surge, Morse told CNN. Michigan Gov. Gretchen Whitmer eased restrictions earlier this month, upping capacity limits at restaurants as well as in retail stores, gyms and other facilities.

“My one hope is that we have been really aggressively vaccinating and have been working through the different categories for vaccination quite well,” Morse told CNN. “And my hope is that that will help to keep (cases) from climbing as rampantly as (they) did back in the fall.”

In West Virginia, Gov. Jim Justice said Wednesday that Covid-19 hospitalizations have “jumped up” slightly in the state, asking residents to continue their mitigation efforts “a little while longer.”

“We have 70 people in the ICU, that’s up a little bit,” Justice said.

Justice had eased restrictions earlier this month, increasing capacity at bars, restaurants and other businesses to 100% and upping the social-gathering limit.

During Wednesday’s news briefing, he added that the state has had “seven outbreaks in our church community” across five counties.

Church gatherings “can really cause an issue, because we’re singing…probably embracing,” the governor said. “If you decided to go to church, please keep that pew in between you and wear your mask.”

You asked, we answered: Your top questions about Covid-19 and vaccines

More testing will help stop spread, CDC says

Even as vaccination numbers grow, what could play a key role in helping control the pandemic will be more accessible, inexpensive coronavirus tests, top health officials said Wednesday, speaking at a hearing of the House Energy and Commerce Committee.

“You are going to be seeing more of that soon,” said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases.

Walensky, the CDC director, added, “I do believe that once we have teachers vaccinated that we can use testing in the schools — serial testing, cadence testing — to identify potential infections, asymptomatic infections, shut down clusters and keep our schools open.”

Her remarks came the same day the CDC released updated guidance about testing, saying more and better testing should help catch asymptomatic cases and control the spread.

The overview guidance, Walensky told a White House briefing, describes available tests used to detect the virus, how to choose a test, the reasons for using them, and the impacts of vaccinations on testing.

“Importantly, until now, limited test capacity has resulted in our use of tests for largely diagnostic purposes, when someone presents with symptoms or has been exposed,” Walensky said. “Only in selected places have we capitalized on the benefits of how testing can be used as a screening intervention with frequent tests to identify asymptomatic disease and prevent clusters before they start.”

Nearly 1 in 8 Americans fully vaccinated

Meanwhile, vaccinations have accelerated as officials race to get as many shots into arms as quickly as possible.

More than 73.6 million Americans have received at least one dose of a Covid-19 vaccine, according to CDC data. And more than 39.9 million people are fully vaccinated — roughly 12% of the US population.
Check your state’s Covid-19 vaccine eligibility requirements here
But challenges — including vaccine hesitancy, disinformation and inequities — remain, and it’s not entirely clear when the US will hit herd immunity — the point at which enough people are protected against the virus to suppress spread.

On Wednesday, both Fauci and Walensky pushed back against questions about herd immunity, saying a lot depended on how quickly Americans take vaccines.

“Let’s just keep pushing to get as many people vaccinated as we possibly can,” Fauci said. “And as we do that, you will see the type of infection, the dynamics of the outbreak, get less and less and less, so whatever that time is — middle of the summer, end of the summer, early fall, we’ll be much, much better off than we are now.”

For now, the US still has a long way to go to overcome vaccine hesitancy, said National Institutes of Health Director Dr. Francis Collins.

Vaccination is the country’s best hope to get beyond the pandemic, he said, “and yet there’s all this overlay, and some of it is politics and some of it’s social media conspiracy theories and some of it is just distrust of anything that the government had anything to do with.”

“We have a long way to go yet to try to overcome that,” he told CNN on Wednesday.

Track Covid-19 vaccinations here

Achieving vaccine equity is important, CDC says

Additionally, in the first two and half months of vaccine distribution, counties considered to have high social vulnerability had lower vaccine coverage than counties considered to have low social vulnerability, according to a study published Wednesday by the CDC.

The agency’s social vulnerability index identifies communities that may need additional support during emergencies based on more than a dozen indicators across four categories: socioeconomic status, household composition, racial/ethnic minority status and housing type.

By March 1, vaccination coverage was about 2 percentage points higher in counties with low social vulnerability than in counties with high social vulnerability — and the differences were largely driven by socioeconomic disparities, particularly differences in the share of the population with a high school diploma and per capita income.

Only five states — Arizona, Montana, Alaska, Minnesota and West Virginia — had higher coverage in counties with high social vulnerability. And best practices in those states included prioritizing racial/ethnic minority groups in early vaccine coverage, actively monitoring barriers to vaccination, directing vaccines to vulnerable communities, offering free transportation to vaccination sites and working with community partners, the study said.

Achieving vaccine equity, the CDC said, is an important goal requiring “preferential access and administration to those who have been most affected” beyond proportionate distribution based on population.

CNN’s Brandon Miller, Deidre McPhillips, Melissa Alonso, Naomi Thomas, Nick Neville, Maggie Fox, Adrienne Broaddus and Rebekah Riess contributed to this report.

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Health

Covid-19 variants caused simultaneous infection in two cases, Brazil study suggests

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Both cases were women in their 30s who had typical mild-to-moderate flu-like symptoms and did not become severely ill or require hospitalization. In one case, the two variants identified had been circulating in Brazil since the beginning of the pandemic. In the other case, the person was simultaneously infected with both an older strain of the virus, and with the P.2 variant first identified in Rio de Janeiro.

The findings, based on analysis of genomic sequencing from 92 samples taken from Brazil’s Rio Grande do Sul state, will appear in April’s edition of Virus Research, a scientific journal.

According to the study, co-infection raises the possibility of recombination of the genomes of the different strains, which can generate new variants of the coronavirus.

“Although there are a few reported cases of reinfection, the possibility of co-infection by E484K adds a new factor to the complex interaction between immune response systems and SARS-CoV-2 Spike mutations,” wrote the authors.

The news comes as Brazil’s second wave plunges the country into crisis once again. The country registered 2,233 new Covid-19 deaths on Thursday, and at least 272,889 people have died due to the virus since the pandemic began.

ICUs and hospitals across the country are nearing capacity, and governors, state health secretaries, and mayors are calling for more restrictive measures to contain the spread of coronavirus.

On Thursday, Sao Paulo state’s Governor Joao Doria announced new emergency lockdown measures in Brazil´s richest and most populous state.

“Brazil is collapsing,” he said in a video released moments before a press conference about the new measures — drawing a striking contrast to assurances by Brazilian Health Minister Eduardo Pazuello just one day prior.

“Our health system is very impacted, but it has not collapsed nor will it collapse,” Pazuello had asserted Wednesday, attributing the country’s increasing hospitalizations and deaths “mainly to the new variants of the coronavirus.”

During the same remarks, Pazuello also downsized expectations for Brazil’s vaccination campaign, estimating that 22 to 25 million Covid-19 vaccine doses would be available through the month of March — a steep drop from the health ministry’s February prediction of 46 million doses.

Meanwhile Brazil’s President Jair Bolsonaro — himself under fire for his government’s handling of the pandemic — continues to reject lockdown measures, invoking instead the health of the economy.

“How long will our economy resist? If it (the economy) collapses it will be a disgrace. What will we have soon? Supermarket invasions, buses on fires, strikes, pickets, work stoppages,” he said in a video conference with lawmakers Thursday.

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Health

Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection

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Many people who experience long-term symptoms from the coronavirus did not feel sick at all when they were initially infected, according to a new study that adds compelling information to the increasingly important issue of the lasting health impact of Covid-19.

The study, one of the first to focus exclusively on people who never needed to be hospitalized when they were infected, analyzed electronic medical records of 1,407 people in California who tested positive for the coronavirus. More than 60 days after their infection, 27 percent, or 382 people, were struggling with post-Covid symptoms like shortness of breath, chest pain, cough or abdominal pain.

Nearly a third of the patients with such long-term problems had not had any symptoms from their initial coronavirus infection through the 10 days after they tested positive, the researchers found.

Understanding long-term Covid symptoms is an increasingly pressing priority for doctors and researchers as more and more people report debilitating or painful aftereffects that hamper their ability to work or function the way they did before. Last month, the director of the National Institutes of Health, Dr. Francis S. Collins, announced a major initiative “to identify the causes and ultimately the means of prevention and treatment of individuals who have been sickened by Covid-19, but don’t recover fully over a period of a few weeks.”

David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City, who was not involved in the new research, said that he and his colleagues at Mount Sinai’s center for post-Covid care are seeing a similar pattern.

“Many people who had asymptomatic Covid can also go on to develop post-acute Covid syndrome,” said Dr. Putrino, who is a co-author of a smaller study on the topic published last year. “It doesn’t always match up with severity of acute symptoms, so you can have no symptoms but still have a very aggressive immune response.”

The new study is published on the preprint site MedRxiv and has not finished undergoing peer review. Its strengths include that it is larger than many studies on long-term symptoms published so far and that the researchers used electronic records from the University of California system, allowing them to obtain health and demographic information of patients from throughout the state. The researchers also excluded from the study symptoms that patients had reported in the year before their infection, a step intended to ensure a focus on post-Covid symptoms.

Among their findings: Long-term problems affect every age group, including children. “Of the 34 children in the study, 11 were long-haulers,” said one of the authors, Melissa Pinto, an associate professor of nursing at the University of California Irvine.

The study found more than 30 symptoms, including anxiety, low back pain, fatigue, insomnia, gastrointestinal problems and rapid heart rate. The researchers identified five clusters of symptoms that seemed most likely to occur together, like chest pain and cough or abdominal pain and headache.

Most previous studies of long-term symptoms have tended to involve people who were sick enough from their initial infection to be hospitalized. One of the largest found that more than three-quarters of about 1,700 hospitalized patients in Wuhan, China, had at least one symptom six months later.

But increasingly, people who were never hospitalized are seeking care at post-Covid clinics, and scientists are recognizing the need to understand their circumstances.

Last month, researchers at the University of Washington reported on a survey of 177 people who had tested positive for the coronavirus. Most of them had not been hospitalized. About a third of both the people who had been hospitalized and the people who had only mild initial illnesses reported having at least one lasting symptom six months later, the researchers found.

Unlike some recent surveys, like one by a patient-led research team, the new study did not capture one of the most commonly reported “long Covid” issues: cognitive problems like brain fog, memory problems and difficult concentrating. One of the co-authors, Natalie Lambert, an associate research professor at Indiana University School of Medicine, said that may be because at the time, doctors may not have known to include diagnostic codes for such cognitive issues in the medical records of Covid patients. The team is seeking funding for a larger and more comprehensive study that combines information in medical records, doctors’ notes and patients’ reports, she said.

In the new study, about 59 percent of the patients with long-term symptoms were women, and about half of the patients were Hispanic and 31 percent were white. The authors and Dr. Putrino cautioned that any reliable demographic conclusions would require bigger studies that are national in scope.

Dr. Lambert said it was likely that the medical records used in the study reflected only a percentage of people who had asymptomatic Covid infections and experienced Covid aftereffects. “For some people, if they’re asymptomatic and they don’t know that they’re sick, they’re not going to go get tested,” she said.

“Another important component is that we know that some of the long-haul symptoms show up much later than two months,” Dr. Lambert said. “So there’s a potential for a wide range of long-haul symptoms that they’re not going to associate with Covid.”

Dr. Pinto said it would be important to study the condition over time, instead of in a static snapshot. “The long haul is a very dynamic process and symptoms can change from day to day,” she said. “One day they may have chest pain and a headache, and the very next day, the chest pain and headache is gone and they have backache and muscle aches. We need to capture trajectory and changing of symptoms across time, and we need this in a larger sample that represents America.”

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Health

In Surprise Twist, COVID-19 Can Cause Weird Skin Rashes. Here’s What to Look Out For

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The most common symptoms of COVID-19 are fever, a dry cough, and losing your sense of taste and smell. Other signs that are frequently seen include headaches, muscle and joint pain, nasal congestion, and fatigue.

 

A less common symptom are rashes of various forms. These have been slower to be reported, partly due to the wide variety that have appeared in COVID-19 patients, making it more challenging to establish a consistent correlation.

Nevertheless, knowing how COVID-19 affects the skin is important. A recent study found that for 17 percent of COVID-19 patients with multiple symptoms, skin rashes were the first symptom to appear, while for 21 percent of patients rashes were their only symptom.

Being able to identify the effects of COVID-19 on the skin may allow cases to be spotted earlier – or even picked up altogether in people who are otherwise asymptomatic. This could help limit transmission.

With that in mind, here are the four main types of skin changes to look out for, and the possible reasons why they occur.

Chilblain-like lesions

These are red, swollen or blistering skin lesions that affect mainly the toes and soles of the feet, colloquially known as “COVID toes”. Over the course of one to two weeks, the lesions will become even more discoloured and will flatten, and after this they will spontaneously resolve without treatment.

A substantial number of these lesions have been seen, primarily in adolescents and young adults with no or only mild symptoms of COVID-19. They make up the majority of skin issues associated with the virus. In two international reports on different types of suspected COVID-related skin conditions, around 60 percent of patients with skin complaints reported these lesions.

 

However, given these lesions correlate with mild disease, many of the patients with them in these studies didn’t qualify for a COVID-19 test at the time, and 55 percent were otherwise asymptomatic.

So while the swift rise of these lesions during the pandemic suggests they’re associated with COVID-19, direct confirmation of this hasn’t been established. It’s possible they’re caused by some other related factor.

Exactly when they appear is also somewhat unclear. In a study analysing 26 patients with suspected COVID-related skin changes, 73 percent presented with chilblain-like lesions. None of the patients had respiratory symptoms and they were all COVID-negative at the onset of their lesions. An explanation is that these lesions appear only after a long delay – up to 30 days after infection.

The cause of these lesions has been debated. A possible culprit could be type 1 interferons, proteins that regulate the antiviral properties of the immune system.

The theory is that high production of these interferons might result in patients rapidly clearing the coronavirus, but also cause injury to blood vessels and increased inflammation. This would explain the coincidence of mild or nonexistent disease, negative tests and skin damage.

 

Another theory concerns ACE2, the molecule that the coronavirus uses to get inside cells. It is present on many types of cell, including those in the sweat glands, which are common on the palms of the hand and soles of the feet. This could make these areas particularly vulnerable to damage from the virus.

Or, it could be that damage to blood vessels, caused either by the immune response or the virus, leads to cell death and multiple mini blood clots in the toes.

Maculopapular rash

This term describes both flat and raised areas of discoloured skin. A study of 375 patients in Spain found that 47 percent of patients with COVID-related skin changes had this kind of rash.

These were associated with more severe COVID-19 symptoms, and were mainly found on the trunk in middle-aged to elderly patients. They tended to last 7-18 days, appearing 20-36 days after infection.

A suggested cause is the body’s immune system going into overdrive. In some patients, a hyperinflammatory phase occurs 7-10 days after infection, which leads to tissue damage and, potentially, more severe disease and death.

 

Hives

Also known as urticaria, these are raised areas of itchy skin. In a study involving four hospitals in China and Italy, 26 percent of COVID-19 patients that complained of skin changes presented with hives.

Hives typically precede or present at the same time as other symptoms, making them useful for diagnosis. They are more common among middle-aged patients and are associated with more severe disease. Viral infections are a known trigger of hives, as they cause the breakdown of cells and the release of histamine through a cascade of reactions in the immune system.

However, it’s important to remember that hives are also a noted side-effect of many drugs that have been used to treat COVID-19, such as corticosteroids and remdesevir.

Vesicular lesions

These are clear fluid-filled sacs under the skin, similar to those seen in chicken pox. They are less common compared to the skin conditions above: in the previously mentioned Spanish study of skin changes associated with COVID-19, only 9 percent of patients had these vesicles.

However, they are thought to be a more specific indication of someone having COVID-19 than those already listed, and so are more useful for diagnosis. They appear to present in patients with mild disease around 14 days after infection.

It’s thought that they’re caused by prolonged inflammation, with antibodies attacking the skin and damaging its layers, resulting in fluid-filled sacs.

Vassilios Vassiliou, Senior Clinical Lecturer in Cardiovascular Medicine, University of East Anglia and Subothini Sara Selvendran, Visiting Researcher in Medicine, University of East Anglia.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

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Entertainment

Prince Philip moved to new hospital to treat infection and test preexisting heart condition

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The 99-year-old Duke of Edinburgh was admitted to the King Edward VII Hospital in London on February 17 after feeling unwell. The palace later confirmed that he was being treated for an infection.

Philip spent 14 days and 13 nights there — his longest stay in a hospital to date — before he was transferred on Monday to St. Bartholomew’s Hospital, also in London, where doctors will continue to treat him for an infection, as well as undertake testing and observation for a preexisting heart condition.

St. Bartholomew’s specializes in cardiac care, according to the hospital’s website, which bills it as “Europe’s largest specialised cardiovascular service.”

The Duke remains comfortable and is responding to treatment but is expected to remain in hospital until at least the end of the week, according to a statement from the royal communications office.

Prince Philip’s youngest son, Prince Edward, told the UK’s Sky News recently that his father was doing “a lot better” and was looking forward to returning home.

“We’ve had some brilliant and lovely messages from all sorts of people. And we really appreciate that and so does he. I’ve been passing them on,” Edward said.

Philip’s grandson, Prince William, previously said his grandfather was doing “ok” and that hospital staff were keeping an eye on him.

Prince Philip, who turns 100 in June, stepped back from public life in 2017 and has been taken to the hospital several times in recent years. In December 2019, he received hospital treatment for a pre-existing condition. The Duke of Edinburgh also surrendered his driving license in February 2019 after he was involved in a car crash.

The Queen and her husband have spent most of the past year at Windsor Castle, outside London, having moved away from Buckingham Palace during the first wave of the Covid-19 pandemic in spring 2020. In April 2020, the Duke of Edinburgh made a rare public statement, thanking key workers across the UK.

The Queen and Prince Philip both received the first dose of a Covid-19 vaccine in January 2021.

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Health

Ex-FDA chief Scott Gottlieb COVID infection rates will FALL into the summer as cases fall to 56K

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The former commissioner of the FDA has said he believes the downward trend in coronavirus infection rates will continue until the summer.

Dr. Scott Gottlieb said that despite new variants of the virus springing up which still creates a risk of infection, he believes that rates will continue to fall.

Daily average deaths and hospitalizations have fallen to their lowest levels since before the Thanksgiving and Christmas holidays. 

There were 1,286 daily deaths recorded in the last 24 hours with figures now at their lowest since October 23, at the start of this winter’s wave of infections.

Former FDA commissioner Dr. Scott Gottlieb said that the US will likely ‘continue to see infection rates decline into the spring and the summer.’

The number of daily cases, hospitalizations and deaths are all now falling

On Sunday, the number of people currently in hospital with the virus was 56,159 marking 40 straight days of falling hospitalization numbers. 

‘This has taken a tragic toll on the United States, but we should be optimistic, in my view. I think we’re going to continue to see infection rates decline into the spring and the summer. Right now, they’re falling quite dramatically. I think these trends are likely to continue,’ Gottlieb, who sits on the board of Pfizer, told CBS News.    

‘With rising vaccination rates and the fact we’ve injected about a third of the country, that is enough protected immunity. If you look at the counties in New York and New Jersey that had greater than 45% prevalence, meaning more than 45% of the population was infected going into the winter, they really didn’t have much of a winter surge.

‘Once you get to about 40% of the population with some sort of protected immunity — you don’t have herd immunity because it will continue to transfer, but it will transfer at a much slower rate,’ Gottlieb explained.    

RN Robert Villa (right) gives a Moderna Covid-19 vaccine to Armando Montes at the newly opened City of Los Angeles vaccination site at Pierce College

There has now been 40 straight days of falling hospitalizations

Gottlieb said that he believes Pfizer and other companies that are manufacturing vaccines will be able to ‘prepare much better for the fall’ and develop boosters for the new variants of the virus that are circulating. 

‘I think we’ll have the spring and the summer to work this out. I don’t think we’ll ever reach total herd immunity. Hopefully we will vaccinate the older population to protect them from dying from this, but this will continue to spread.’   

Gottlieb also said he believed this fall might be the right time for school children to also receive the vaccination.

‘I think it is possible this vaccine gets moved into the high school population in the fall. We have seen the spread more in the high schools than the elementary schools. There is less risk in the grade-school-aged children. I don’t believe this vaccine will get moved to 12-and-under into the fall.

‘It may be a question of trying to reformulate the vaccines at a lower dose for the younger kids because they develop a more robust immune response to the vaccine,’ Gottlieb theorized. 

Motorists and passengers wait in line for their Covid-19 vaccinations administered by members of the National Guard at a joint state and federal COVID-19 vaccination site on the campus of California State University of Los Angeles in Los Angeles on Wednesday 

More than 28 million COVID-19 cases have rocked the US since the virus arrived in the country almost exactly one year ago.

The virus’ effect was so severe it has taken a full year off the average life expectancy in the United States, the biggest decline since World War Two. 

So far, less than 15 per cent of the US population has received at least one vaccine dose, with nearly 43 million getting at least one shot and nearly 18 million getting a second shot, US statistics show.

Some locales are easing restrictions, such as on indoor dining, and moving to reopen schools even as millions await their shots, sparking debate over the safety of teachers, students and others.

The total number of people who have died in the U.S. fro the virus is fast approaching 500,000 

Financial pressures also continue to weigh even as economists express optimism for the year ahead. 

Congress is weighing Biden’s $1.9trillion coronavirus relief package, with the House of Representatives expected to vote on it this week and the Senate seeking to pass it before March 14. 

The White House said on Sunday it was planning a memorial event in which Biden would deliver remarks.

A White House spokesman said the president along with first lady Jill Biden, Vice President Kamala Harris and second gentleman Doug Emhoff would hold a moment of silence on Monday and there would be a candle-lighting ceremony at sundown.

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Business

US coronavirus: Covid-19 vaccines may prevent infection and not just symptoms, study suggests

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A team at the Mayo Clinic health system looked at more than 31,000 people across four states who had received at least one dose of either vaccine — and found their vaccines were upwards of 80% effective in preventing infection 36 days after the first dose.

Vaccine efficacy was 75% 15 days after the first dose, and appeared 89% effective from 36 days after the second dose, according to the research, which has not yet been peer-reviewed.

More than 59 million vaccine doses have so far been administered in the US, according to data from the US Centers for Disease Control and Prevention.

But Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, said Friday that the US is unlikely to achieve herd immunity for the virus before the winter.

“We know Covid is really seasonal, so when the next winter rolls around, we need to have a much higher level of protection to stop Covid in its tracks than we are likely to achieve,” he said.

Herd immunity doesn’t take effect until 80% or more of the population has immunity, either through infection or vaccination. And the new variants may complicate the picture, Murray said. If people can be reinfected with the new variants, the pandemic may take off again.

Though officials hope to have vaccines widely distributed by the end of the summer, President Biden said Friday that issues like weather, mutating strains and manufacturing delays make it hard to nail down a timeline.

“I believe we’re on the road, I promise you. I know we’ll run into bumps. It’s not going to be easy here to the end, but we’re going to beat this. We’re going to beat this,” he said while visiting a Pfizer facility in Michigan.

Too risky to give single doses, Fauci says

One way to protect more people quickly, some experts suggest, is to prioritize administering first doses of the vaccine.

Dr. Ashish Jha, Dean of the Brown University School of Public Health, advocated Friday for US officials to consider delaying the second dose.

“Would that really be a problem, because if we could do that, we could vaccinate a lot more high-risk people, quickly…Everybody needs a second dose, but I think we can do it in a way that’s still safe and get a lot more people protected,” Jha told CNN’s Poppy Harlow.

But Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Friday that a single-dose plan would be too risky.

Fauci said he worried that if large numbers of people got a single shot and had less than optimal immune responses, they could be exposed to the virus and start incubating viral mutations. In theory, new variants could arise, he said.

“We will stick with the scientifically documented efficacy and optimal response of a prime followed by a boost with the mRNA vaccines,” Fauci told a White House briefing.

Jha, for his part, said he agreed that everybody needed a second dose, “I think the question is, right now we wait four weeks between first and second dose. What if we went six weeks or eight weeks or 10 weeks — not much longer than that.”

School can reopen no matter the virus’ spread, CDC director says

In the hopes of returning to some sense of normalcy, a priority to many families and officials has been allowing students to resume in-person learning.

And CDC Director Dr. Rochelle Walensky said Friday that given the right precautions, schools may open no matter how much virus is spreading in the community.

As of Tuesday, CNN analysis indicated about 90% of children live in so-called red zones under the CDC’s guidance — meaning there is a high level of community spread of the virus. But even in those conditions, schools can safely reopen if they take precautions, Walensky told a White House briefing.

The CDC has said schools can reopen if they make sure they are mitigating the risk of spread with universal mask use, measures to keep children and staff six feet apart, frequent cleaning and disinfection and testing and contact tracing.

The CDC director’s assurances came as Fauci announced that the US should have vaccine safety data for high school-age kids by the beginning of the Fall.

Companies are just starting tests of younger age groups but have been testing their vaccines on 12- to 17-year-olds, Fauci told a White House briefing. Safety data for younger children will likely not be available until early next year, he said.

Vaccine hesitancy not an excuse for inequities

Meanwhile, vaccine trials and distribution have shed light on inequities in the medical field.

People of color have been vastly underrepresented in US-based vaccine trials for the last decade, according to a new study released Friday by researchers at Fred Hutchinson Cancer Research Center, Harvard, Emory and other institutions.

The study found that White people made up the majority, or 78%, of participants in trials conducted between June 2011 and June 2020.

The study, published in the JAMA Network Open, comes as the nation grapples with a pandemic that has disproportionately impacted people of color. Health care leaders are working to combat vaccine distrust among Black and brown people, saying the shot is the key to preventing further devastating in their communities.

But that hesitancy should not be an excuse for officials to explain away racial disparities in vaccination, Fauci said.

“It’s that we’ve got to really extend ourselves into the community to get the access to minority populations that they don’t have,” Fauci said in an interview with MSNBC.

CNN’s Christopher Rios, Amanda Sealy, Lauren Mascarenhas, Kevin Liptak, Maggie Fox, Nicholas Neville and Nicquel Terry Ellis contributed to this report.

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Health

Serrana, Brazil will vaccinate all adults against Covid-19 to study efficacy on infection rate

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The study will involve the city of Serrana, in the southeastern State of Sao Paulo, the research institute said

“The entire adult population, estimated at 30,000 people, will be immunized in three months, in an unprecedented action,” the Butantan Institute wrote via Twitter on Wednesday.

The idea to vaccinate the largest number of people will allow researchers to “follow the evolution of the epidemic. It has technical aspects that will make it possible to make calculations, make projections and calculate whether the vaccine is capable of reducing the transmission of the virus, ” said Dimas Tadeu Covas, the director of the institute.

The city of Serrana, with a population of approximately 45,000, has been divided in four color-coded regions. All people over 18 will be administered a Coronavac vaccine with the exception of pregnant or breastfeeding women and those with serious illnesses, according to the Butantan Institute.

“Based on what we are going to learn here, we will be able to tell the rest of the world what the actual effect of the vaccination against Covid-19 is,” Ricardo Palacios, director of clinical studies at Butantan, said.

Brazil has been hard-hit by the pandemic since it began, and is nearing a total of 10 million Covid-19 cases. The country currently has the most coronavirus related deaths in the world after the US — 242,090 according Johns Hopkins University — and ranks third in the world for cases.

There are rays of hope, Pan American Health Organization Director Dr. Carissa Etienne said on Wednesday. “After many weeks of increases in Covid cases and deaths, we are starting to see improving trends in some of the more heavily affected countries, including the US and Brazil,” she said during a weekly online briefing.

She warned, though, that those trends are “cause for hope, but not for celebration.”

Reporting contributed by Stefano Pozzebon.

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Health

France Stalls Between Stubbornly High Infection Rates and Slow Vaccine Rollout

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PONTOISE, France — In the town of Pontoise, which gently slopes upward from the Oise River about 15 miles northeast of Paris, Mayor Stéphanie Von Euw is laser-focused on her new vaccination center — a blocky, sand-colored recreational facility where up to 450 shots are administered daily to those over 75 or otherwise at high risk.

Ms. Von Euw was energetic on a recent visit, chatting with doctors and vaccine recipients. But here in Pontoise, as in many other parts of France, there is no hiding that a winter of pandemic doldrums has set in.

“To keep my chin up, I try to follow this rule: I take one day at a time,” Ms. Von Euw said across a table covered with chocolate boxes left by recent vaccine recipients. “If I look to the future, I lose myself.”

Caught between infection rates that remain stubbornly high despite months of economically damaging restrictions and a slow-moving vaccine rollout, there is a growing and glum sense in France that the country’s battle against the pandemic has stalled.

Last month, the country was bracing for a third nationwide lockdown when President Emmanuel Macron unexpectedly decided against it. He made a calculated gamble that he could tighten restrictions just enough to stave off a new surge of virus cases while avoiding the heavier economic and social toll of more drastic measures like those currently in force in Germany or Britain.

Weeks later, it is still unclear whether that bet will pay off or if, as some health experts have warned, there is little chance of containing the spread without a strict lockdown.

The average number of daily infections, at about 20,000, has neither spiked nor fallen much over the past month. But more contagious variants from other parts of the world are spreading.

Arnaud Fontanet, an epidemiologist at the Institut Pasteur who is also a member of the government’s Covid-19 advisory council, said on Sunday that the chances of containing the epidemic without a tight lockdown are thin.

“Everything will depend on our ability to control the spread of the British variant,” Mr. Fontanet told the Journal du Dimanche. “If we wait too long, we could be taken by surprise by the epidemic’s acceleration.”

Hospitalizations are stable but still at high levels, with about 28,000 Covid-19 patients across the country, including about 3,300 taking up more than half of the capacity in intensive care units.

Some experts said they worry that a plateau in infection numbers at these higher levels leaves little room to maneuver if hospitals face a new spike in cases.

The government is projecting optimism, and the health minister even told Franceinfo radio on Tuesday that the country might not have to go under lockdown ever again. But the public’s mood is one of uncertainty.

“There is a lot of wavering,” said Odile Essombé-Missé, 79, who was standing in line at the vaccination center in Pontoise for her 85-year-old husband’s injection. Asked about a new lockdown, she just shrugged.

“We put up with it,” she said finally, with her eyeglasses, perched atop a colorful blue and orange face mask, fogged over.

Mr. Macron has vowed that all adults who want to get vaccines would be offered them by summer’s end.

More than 2.2 million out of France’s population of 67 million have received at least one dose so far, and nearly 250,000 have been fully vaccinated. But with 3.1 doses administered per 100 people, according to a New York Times database, France still trails neighbors like Italy or Spain.

“We could double, even triple the rhythm,” Ms. Von Euw said, if her center were allocated more supply of vaccines.

But the European Union has struggled in recent weeks to secure a steady supply of doses. The French government has managed to open up a promising 1.7 million new appointment slots in the coming weeks as deliveries roll in.

“I’m not yet immune, but I’m still reassured,” said Eliane Coudert, an 80-year-old retiree who had come from the neighboring town of Éragny to Pontoise for her shot. She was sitting patiently with a handful of newly inoculated companions in a small waiting area, where doctors monitor for adverse side-effects.

Ms. Coudert, who is diabetic, said she was determined to get vaccinated so she could see her great-granddaughters again.

“I see them a bit outside,” she said. “But we can’t kiss each other.”

France has been under a night curfew since mid-January and restaurants, cafes, museums or movie theaters are closed, turning even the liveliest of French cities into ghost towns after 6 p.m.

So in some ways, the vaccination center — where the local Rotary Club sometimes brings croissants and other pastries — represented a much-needed social outing for seniors who have spent weeks or months in near-isolation.

“The restrictions imposed by social distancing are starting to exasperate everyone,” said Dr. Edouard Devaud, an infectious diseases specialist at the Centre Hospitalier René-Dubos, the main hospital in Pontoise. “There isn’t any speck of light at the end of the tunnel.”

Variants of the virus, mainly the British one, now account for one in seven of every new infection. Some areas, like the Paris region, have reported even higher proportions. But the country’s infection numbers have otherwise remained frustratingly stable.

Dr. Devaud said the average number of Covid-19 patients in his unit — about five to 10, plus another dozen in intensive care — was completely manageable so far thanks to better understanding and treatment of the disease.

But the prospect of a new lockdown worries him.

After the first lockdown last spring canceled all non-urgent care, doctors were alarmed to see the consequences of deferred treatment, like deteriorating cancers.

Health professionals have also seen an increased incidence of young people with severe mental health issues.

“So we need to get out of this pandemic,” Dr. Devaud said.

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Asymptomatic infection blunder let Covid-19 spin out of control

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Jan. 24 marks the one-year anniversary of a momentous but largely unnoticed event in the history of the Covid-19 pandemic: the first published report of an individual infected with the novel coronavirus who never developed symptoms. This early confirmation of asymptomatic infection should have set off alarm bells and profoundly altered our response to the gathering storm. But it did not. One year later we are still paying the price for this catastrophic blunder.

At least one of three people infected with SARS-CoV-2, the virus that causes Covid-19, do not develop symptoms. That’s the conclusion of a review we just published in the Annals of Internal Medicine. It summarizes the results of 61 studies with more than 1.8 million people.

But during much of the pandemic, fierce resistance — and even outright denialism — in acknowledging this not-so-typical disease pattern led to ineffective testing practices that allowed the pandemic to spin out of control.

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On Jan. 28, 2020, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “In all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks. … Even if there’s a rare asymptomatic person that might transmit, an epidemic is not driven by asymptomatic carriers.”

This was a widely held view. On June 8, 2020, a senior official of the World Health Organization called asymptomatic transmission “very rare.”

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To his credit, Fauci was among those who immediately criticized this remark. Based on epidemiological data that had become available since his earlier comments, he said it was “not correct” to characterize asymptomatic transmission as rare.

In June, when we published a report of 16 cohorts with sizable proportions of asymptomatic infection and suggested that it might play a role in the progression of the pandemic, several researchers wrote letters to the editor demanding that our paper be retracted.

Today, the best evidence suggests that about half of Covid-19 cases are caused by infected people who do not have symptoms when they pass on the virus. These symptom-free spreaders are roughly divided between those who later develop symptoms, known as pre-symptomatic individuals, and those who never develop symptoms.

While the importance of asymptomatic infection in understanding Covid-19 has been surprising to some, infectious disease experts have long known that infection without symptoms is common in many illnesses. More than 90% of people infected with poliovirus have no symptoms. And about 75% of influenza infections have been estimated to be asymptomatic. Yet these important precedents have largely been ignored.

Asymptomatic coronavirus infection is not necessarily benign. Several studies have reported abnormal lung scans in those infected without symptoms, as well myocarditis, a type of heart inflammation. The long-term health implications of asymptomatic infection aren’t known.

Even though knowledge about asymptomatic infection has greatly evolved, tactics for combating the pandemic have not. It is now obvious that testing only those with symptoms, as was common early in the pandemic, is a mistake because it ignores the invisible legions of infected people who have no symptoms. But it is not enough to merely increase the number of tests. The problem is that current testing practices are ill-suited to detecting and containing asymptomatic infection.

Virtually all of the coronavirus testing performed in the U.S. looks for the genetic material of the virus using the polymerase chain reaction (PCR). It requires expensive equipment and trained technicians. Results are typically returned days — sometimes even weeks — after the test. That means people learn they have been infected with SARS-CoV-2 long after they may have passed the virus to others. Testing becomes more about accounting — tallying the number of detected infections — than about containing the spread of the virus.

What’s needed is a pivot to a different type of testing. Antigen tests, which look for a bit of coronavirus protein, cost just a few dollars each and can yield results in minutes. Like home pregnancy tests, they require minimal instruction. Antigen tests are ideal for spotting people who are infectious, rather than those who may be long past the infectious phase of Covid-19, or who harbor such low levels of the virus that they are unlikely to infect others.

Inexpensive rapid home tests would help infected people isolate themselves before they could spread the virus. Frequent testing — at least several times per week — is essential, as demonstrated by successful testing efforts at some universities, which have enabled students to return to campus. A new focus on self testing, in combination with financial assistance and perhaps even temporary housing for isolation, would directly address the problem of asymptomatic infection.

The rollout of Covid-19 vaccines brings with it the risk of a new wave of asymptomatic infections. The two vaccines authorized by the Food and Drug Administration have been proven to prevent illness, but not asymptomatic infection. Even after vaccination, the coronavirus may still temporarily take up residence in the lining of the respiratory tract, making it possible to infect others. Preliminary results from one vaccine trial seem encouraging, with an apparent two-thirds reduction in asymptomatic infection after the first dose. But many other studies are underway.

There is no time machine that would allow us to return to Jan. 24, 2020, and make the plans we should have made, which would have acknowledged the importance of asymptomatic infection. But it is not too late to recognize the blunder and move aggressively toward testing practices that will help end the pandemic.

Daniel P. Oran is a member of the digital medicine group at Scripps Research Translational Institute, of which Eric J. Topol is founder and director.

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