administration official who led the White House’s Covid-19 response, to be his next chief of staff, according to people familiar with the decision.
Ron Klain,
Mr. Biden’s current chief of staff, is expected to step down in the coming weeks after more than two years on the job. The Washington Post earlier reported that Mr. Zients was expected to replace him. Mr. Zients didn’t respond to requests for comment, and the White House declined to comment.
Mr. Zients helmed the White House efforts to increase distribution of the Covid-19 vaccine during the first year of Mr. Biden’s presidency, helping to cobble together a network to make the shots available nationally.
He left the administration in April last year, saying he had no specific job plans, and in recent months was tapped by Mr. Klain to prepare for staff departures and help identify potential replacements, according to people familiar with the matter. Mr. Zients co-chaired Mr. Biden’s presidential transition team in 2020.
The president is turning to Mr. Zients as his next chief of staff because of his reputation as a manager with a history of navigating government bureaucracy, the people familiar with the matter said.
Mr. Zients is expected to bring to the job a more decentralized approach than the one favored by Mr. Klain, who was involved in nearly every aspect of day-to-day operations at the White House, some of the people familiar with the matter said.
While Mr. Zients is expected to focus on policy and governing, other longtime aides to Mr. Biden are likely to be more involved in advising the president on political matters as he faces investigations from newly empowered House Republicans and prepares to announce his reelection bid.
White House Chief of Staff Ron Klain and President Biden greeting each other at a White House event.
Photo:
KEVIN LAMARQUE/REUTERS
In the coming year, White House officials expect to focus on implementing a slate of laws signed by the president since he took office, including measures to fix the country’s aging infrastructure, invest in renewable energy and boost semiconductor manufacturing. Options for major legislative breakthroughs will be limited now that Republicans have taken control of the House.
Mr. Zients was a top economic adviser to President
Barack Obama,
serving as the director of the National Economic Council and a senior official at the Office of Management and Budget. Mr. Zients joined the board of
Facebook Inc.
—now part of Meta Platforms Inc.—in 2018 after leaving the Obama administration. He was a top executive with the Cranemere Group, an investment holding company.
At the beginning of Mr. Obama’s presidency, Mr. Zients was appointed the administration’s chief performance officer, a newly created role that centered on making the government more efficient. He later led a mission aimed at fixing HealthCare.gov, the federal website for the Affordable Care Act, when it experienced technological difficulties in 2013. He brought in private companies and technology firms to undertake a rapid review of the platform’s problems.
Mr. Zients is known as a meticulous planner. In his beginning days handling the Covid-19 response, he scheduled hour-by-hour what needed to be done to execute his pandemic plan. He and Mr. Biden spoke three to four times a week while he was overseeing the coronavirus response.
While Mr. Zients’ selection to handle the pandemic was initially criticized by some progressives who said he lacked public health experience, he earned bipartisan praise in hearings for his efforts to rapidly disseminate vaccines after a bumpy rollout during the end of the Trump administration. About 65% of the population, or more than 200 million people, were fully vaccinated by the time he announced in March 2022 that he would be leaving his position.
He also won high marks for shifting the administration from a more reactive approach to the pandemic to responding to Covid-19 as an ongoing public health issue. He pledged a wartime response to the administration’s global response to Covid-19 but some donations to poor countries fell short of targets because of low demand and limited funding.
Mr. Biden was criticized in 2021 for holding a massive July Fourth party on the South Lawn and declaring “we’re closer than ever to declaring our independence from a deadly virus” just as the Delta variant began spreading in the U.S., causing another round of shutdowns.
Later that winter when the Omicron wave caused infections to spike, the lack of testing kits caused long lines and concerns across the country. The president acknowledged in a January 2022 speech that the situation was “frustrating.”
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Messrs. Biden and Zients developed a relationship during the Obama administration, and became closer when Mr. Zients was brought on as an adviser to Mr. Biden’s 2020 presidential campaign. Mr. Zients doesn’t have the kind of decadeslong relationship with Mr. Biden that some of the president’s closest aides have. But those advisers—including senior White House aides
Mike Donilon,
Steve Ricchetti
and
Bruce Reed
—are expected to continue working closely with Mr. Biden as he prepares to announce his reelection bid in the coming month.
“He has the utmost integrity and that’s why everyone trusts him,” said Andrew Slavitt, who was a senior adviser for the Biden administration Covid-19 response. “He over-communicates and seeks out everyone’s views but does it in a way to push the ball down the field every day.”
Mr. Zients’ experience and ties in the business world has engendered skepticism from some progressive groups, many of whom developed close relationships with Mr. Klain.
Matt Stoller, the director of Research at the American Economic Liberties Project, a nonprofit that advocates for strict antitrust enforcement, called Mr. Zients “an ugly choice” for the job, noting that he joined the board of Facebook in the wake of the Cambridge Analytica scandal.
Write to Andrew Restuccia at andrew.restuccia@wsj.com, Stephanie Armour at Stephanie.Armour@wsj.com and Annie Linskey at annie.linskey@wsj.com
Mary Barket, a 66-year-old widow with a degenerative muscular disorder and no family around to help, has had seven different caregivers come through her home in the past six months.
On a recent Saturday morning, she was told by the home care agency that her caregiver wasn’t coming that day and that it couldn’t send a substitute, she says. Ms. Barket had one meal to last her until Monday, when the next caregiver was due.
“My hands don’t work. I can’t even open a box,” says Ms. Barket, who has ALS, or amyotrophic lateral sclerosis. “It’s a very tenuous situation.”
High turnover among in-home caregivers is straining the daily lives of America’s aging population, which relies on them to remain in their homes.
The median caregiver turnover rate—or the percentage of all caregivers who left or were terminated from jobs—was about 64.9% in 2021, according to a report by Home Care Pulse, a company that provides data and training to home care agencies. Though the number has improved from a peak of 81.6% in 2018, it represents a major supply gap, according to people in the home care industry.
Turnover among the 1,461 home care agencies participating in the 2022 HCP Benchmarking Report remained relatively stable during the pandemic, says Home Care Pulse president Todd Austin. Agencies increased wages and more offered benefits to recruit and retain workers, while also doing more to recognize workers as “care heroes” to improve job satisfaction, he says.
But the pandemic added to demand, as the high number of Covid deaths at long-term-care facilities contributed to the desire for people to remain in their homes.
Between 2008 and 2018, the number of home care workers more than doubled to 2.26 million from about 900,000, according to a 2022 report from the Home Care Association of America, an industry trade organization representing home care providers.
The Labor Department projects 25% employment growth in the next decade for home health and personal care aides, which includes those who work in group homes and day service programs, compared with an average expected growth rate of 5% for all occupations.
Even with rapid growth, home care agencies can’t meet demand. More than 85% of the home care agencies in the 2022 HCP Benchmarking Report turned down cases in 2021 due to the shortage, and 59.7% consistently turned down clients.
To help address the staffing problem, many home care agencies boosted incentives and bonuses and are offering training in areas like end-of-life care, meal planning and Alzheimer’s care, says Mr. Austin and others in the industry.
Ms. Espinosa helps Ms. Barket, who has ALS, change clothes.
Ms. Barket lives alone with no family in the area available to assist in her care. She relies on help from two home care agencies.
About 40% of agencies now offer signing bonuses, and 94% have increased pay, some by as much as $10 an hour based on experience, according to the 2022 report from the Home Care Association of America.
But wages remain relatively low. Median pay in 2021, the latest figure available, was $14.15 an hour, or $29,430 a year, for home health and personal care aides, according to the Labor Department.
The jobs are difficult in other ways, too—clients can be demanding, the work can be physically and emotionally taxing and the hours inconsistent.
Waiting list
In Lackawanna County, Pa., about 40 older adults are on a waiting list for in-home care, says
Jason Kavulich,
outgoing director of the county Area Agency on Aging, who was recently named Secretary of Aging for Pennsylvania. Six years ago, when he became director of the agency, there was no waiting list, he says.
“This is the postpandemic world,” says Mr. Kavulich. “People are not entering the help field. They have found other work.” To try to help meet demand, the county agency is working on a scholarship program at a local college for students to provide 15 to 18 hours of in-home care a week to older adults.
For families, high turnover adds a layer of uncertainty to the already stressful task of finding care for loved ones. Some families receive last-minute phone calls saying a worker isn’t coming, which leaves them scrambling to find a substitute so they themselves can go to work.
John Giurini, who shares a home with his 93-year-old mother and his sister in the Los Angeles area, says there had been times when he received a call the night before—or even the morning of—from the agency that provides full-time in-home care, saying the worker they expected for the next shift wasn’t available. Usually a substitute was sent but not always.
“We would not know in the morning who was coming to the front door” other than a name, says Mr. Giurini, assistant director of public affairs at the J. Paul Getty Museum.
He says rotating people in and out of the home is stressful for the family, but even more so for their mother, who has dementia and gets confused. One caregiver became combative with their mother about how much toothpaste she was using, and another young man ran personal errands instead of staying at the doctor’s office while their mother had a medical appointment, he says. He and his sister explored other options, including hiring a caregiver directly, rather than relying on an agency, but decided against it.
“Say you hire someone and are fortunate to find a good person. What happens when that person is sick?” he asks. An agency, at least, has other workers. Mr. Giurini says they have lucked out in the past six months with a caregiver from their agency who is attentive and professional.
They pay the agency $32 an hour and rates will increase to $35 an hour in February.
In-home care workers are generally employed by home care agencies, which are paid by individuals and families, or through private long-term-care insurance or Medicaid, Veterans Affairs or Medicare Advantage insurance, or by some nonprofit organizations.
Some home care companies have adopted technology to help provide consistent scheduling and care.
Jisella Dolan,
chief advocacy officer for Home Instead, which has 1,200 home-care franchises across the U.S., says the company uses a technology platform that coordinates scheduling and allows family members, using a downloaded app, to see who is coming each day, when, and if there are any changes.
Home Instead, which is a subsidiary of Honor Technology Inc., doesn’t guarantee it will find replacements if a scheduled worker isn’t available, but it strives to do so, she says. The company no longer has the waiting list for services that it did last year during the height of Omicron infections, she says.
Extra training
Home Instead also has training for those working with clients who have special conditions such as Parkinson’s and Alzheimer’s disease.
Routine and regularity are especially important for those with Alzheimer’s, says
Amy Goyer,
the family caregiving expert at AARP, who cared for and managed paid caregivers for her parents, including a father with Alzheimer’s, before they died.
“Every time you get a new paid caregiver, you have to train them,” she says. “ ‘This is what time my parents get out of bed. This is when they eat breakfast and lunch. These are the clothes my dad wears, the TV shows he watches and the music he listens to.’ ”
She advises families to have at least two caregivers, each with a different shift so one can fill in when the other can’t work, and to keep a checklist of daily routines with tasks and times listed for showers, meals, medications and getting in and out of bed, so those coming in on short notice know what to do. Families that can afford it can also hire a geriatric care manager to coordinate care and find backups, which is especially helpful if family members live out of town.
Ms. Espinosa, who was referred by the local ALS chapter, preps meals for Ms. Barket.
Frances Copeland says she had 10 caregivers in a 15-month-period between 2021 and 2022 for her 91-year-old mother, with the longest lasting eight months. “We had an occasion where two caregivers showed up and they stood outside arguing about whose day it was to be there,” she says.
Ms. Copeland, who is a certified nursing assistant and has been a caregiver for others, understands why some quit. “The pay isn’t great, and the clients can be demanding and critical,” she says. She recalls driving 45 minutes to one client’s house and being told to turn around and go back because she wasn’t needed that day.
Not all home healthcare agencies are comfortable working with people who have ALS or Alzheimer’s because of their advanced needs, says Jessie Meier, a social worker with the ALS Association Greater Philadelphia Chapter.
“The care is so personal and deeply intimate. You are helping a person shower, bathe and toilet,” she says, which makes familiarity even more important.
Ms. Barket, the widow, who lives in Bethlehem Township, Pa., says her family is small and distant. One brother lives in North Carolina and an aunt lives more than an hour away. Her daughter lives closer but has mental-health challenges and is unable to help with care.
Ms. Barket relies on caregivers from one agency, who come three hours a day, five days a week. Another caregiver, referred to her by the ALS Association, comes on a sixth day for three hours. The caregivers assemble meals in takeout containers, the lids laying across the top because she can’t get them off. She can’t carry a plate.
“My hands and wrists are too unstable at this point,” she says. If something falls to the floor, she tries to use a hangar to get it up to her. “I try to MacGyver everything,” she says. Unable to open drawers, she keeps clothes in a basket.
Each time a new caregiver arrives, she asks them if they know anything about ALS. If they don’t she tells them to Google it, so they understand her limitations. “I can’t fault caregivers, who are doing their best,” she says. “Ninety-five percent of them are wonderful.”
The unpredictability, though, is frightening, especially since her disease is progressive. On the recent Saturday when the caregiver couldn’t come, she says she had the “wherewithal” to call a friend who brought meals.
“Down the road, I won’t be able to speak,” she says. “Then what? It’s very scary at times.”
Ms. Barket says she has had seven different caregivers come through her home in the past six months.
When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.
Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.
New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.
“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”
Dr. Kirsten St. George of the Wadsworth Center is looking for clues in the state’s sewage.
An analysis conducted at the Wadsworth Center indicates the presence of the hepatitis A virus.
Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.
For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help trackother respiratory viruses, too.
Researchers built surveillance networks around the country to track Covid-19 and monitor for variants.
Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention.
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“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.
Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.
Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to opentesting sites.
Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.
Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said.
The wastewater treatment plant in Schenectady, N.Y., is participating in the study of sewage.
Workers at the Schenectady treatment plant collect samples and ship them for analysis.
Analysis of the wastewater samples is conducted at the Wadsworth Center in Albany, N.Y.
The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.
The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach.The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.
“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.
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After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.
The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.
“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.
No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily.
“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”
Poliovirus was found in Orange County, N.Y., last month.
That’s the takeaway from a major study published this month in JAMA Internal Medicine. Scientists led by a team from the Harvard T.H. Chan School of Public Health found that people who most closely adhered to at least one of four healthy eating patterns were less likely to die from cardiovascular disease, cancer or respiratory disease compared with people who did not adhere as closely to these diets. They were also less likely to die of any cause.
“These findings support the recommendations of Dietary Guidelines for Americans that multiple healthy eating patterns can be adapted to individual food traditions and preferences,” the researchers concluded, adding that the results were consistent across different racial and ethnic groups. The eating habits and mortality rates of more than 75,000 women from 1984 to 2020 over 44,000 men from 1986 to 2020 were included in the study.
The four diets studied were the Healthy Eating Index, the Alternate Mediterranean Diet, the Healthful Plant-Based Diet Index and the Alternate Healthy Eating Index. All four share some components, including whole grains, fruits, vegetables, nuts and legumes. But there are also differences: For instance, the Alternate Mediterranean Diet encourages fish consumption, and the Healthful Plant-Based Diet Index discourages eating meat.
The Alternate Mediterranean Diet is adapted from the original Mediterranean Diet, which includes olive oil (which is rich in omega-3 fatty acids), fruits, nuts, cereals, vegetables, legumes and fish. It allows for moderate consumption of alcohol and dairy products but low consumption of sweets and only the occasional serving of red meat. The alternate version, meanwhile, cuts out dairy entirely, only includes whole grains and uses the same alcohol-intake guideline for men and women, JAMA says.
The world’s ‘best diets’ overlap with study results
The Mediterranean Diet consistently ranks No. 1 in the U.S. News and World Report’s Best Diets ranking, which looks at seven criteria: short-term weight loss, long-term weight loss, effectiveness in preventing cardiovascular disease, effectiveness in preventing diabetes, ease of compliance, nutritional completeness and health risks. The 2023 list ranks the top three diets as the Mediterranean Diet, the DASH Diet and the Flexitarian Diet.
The DASH (Dietary Approaches to Stop Hypertension) Diet recommends fruits, vegetables, nuts, whole grains, poultry, fish and low-fat dairy products and restricts salt, red meat, sweets and sugar-sweetened beverages. The Flexitarian Diet is similar to the other diets in that it’s mainly vegetarian, but it allows the occasional serving of meat or fish. All three diets are associated with improved metabolic health, lower blood pressure and reduced risk of Type 2 diabetes.
Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health and co-author of the latest study, said it’s critical to examine the associations between the U.S. government’s Dietary Guidelines for Americans and long-term health. “Our findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being formed to evaluate current evidence surrounding different eating patterns and health outcomes,” he said.
Reducing salt intake is a good place to start. In 2021, the Food and Drug Administration issued new guidance for restaurants and food manufacturers to, over a two-and-a-half-year period, voluntarily reduce the amount of sodium in their food to help consumers stay under a limit of 3,000 milligrams per day — still higher than the recommended daily allowance. Americans consume around 3,400 milligrams of sodium per day, on average, but the Centers for Disease Control and Prevention recommends that people consume less than 2,300 milligrams each day.
Related: Eating 400 calories a day from these foods could raise your dementia risk by over 20%
Parents and doctors are looking for new strategies to help adolescents with obesity. One controversial approach drawing the interest of some families is intermittent fasting, which limits people to eating for just a part of the day or week.
Intermittent fasting has gained traction among adults who use it to try to manage weight and improve health. Doctors have largely avoided trying it with adolescents out of concern that introducing a fasting period to their schedules might result in nutritional gaps or trigger eating disorders when teens are rapidly growing and developing.
Now, a small number of doctors and researchers are evaluating types of intermittent fasting in adolescents, searching for solutions as rates of obesity and Type 2 diabetes rise. One pediatric endocrinologist in Los Angeles is launching a clinical trial looking at eating within a set time window in adolescents with obesity. Researchers in Australia are completing a separate trial, the results of which they expect to publish later this year.
Roughly one-fifth of children in the U.S. are considered obese, according to data from the Centers for Disease Control and Prevention. Pediatricians are so concerned that the American Academy of Pediatrics for the first timethis month recommended physicians offer weight-loss drugs for children with obesity.
Any approach that limits when and how an adolescent eats must be handled cautiously, doctors say.
Families and doctors need to be very careful with any form of intermittent fasting in youth as it can be a slippery slope with a potential risk of eating disorders, says
Jason Nagata,
a pediatrician and eating-disorder specialist at the University of California, San Francisco. Doctors have also raised questions about the potential long-term effects of intermittent fasting on developing bodies.
Courtney Peterson,
an associate professor of nutrition sciences at the University of Alabama at Birmingham who studies intermittent fasting in adults, says she would be worried about adolescents’ getting enough nutrients. “I think it’s worth testing but testing with caution,” she says.
Her research has found that adults with obesity who ate between 7 a.m. and 3 p.m. lost on average an extra 5 pounds more than a control group eating over 12 hours or more, and adults with prediabetes who ate over a six-hour period starting early in the day showed improvements in blood-sugar levels.
Intermittent fasting is an umbrella term for eating strategies that involve fasting. One such strategy, time-restricted eating, or TRE, limits eating to a set number of hours a day—often eight—with no limitations on what or how much you eat. In the remaining hours, you refrain from eating or drinking except for water.
Alaina Vidmar,
a pediatric endocrinologist and obesity-medicine specialist at Children’s Hospital Los Angeles, is starting a clinical trial to evaluate whether an eight-hour window of eating, from 11 a.m. to 7 p.m., results in changes in insulin and glucose response for teens with obesity.
The researchers are also looking at weight loss and body-fat mass, as well as blood pressure and cholesterol.
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The research stems from conversations Dr. Vidmar had with families of patients with obesity in recent years. Some had asked her about time-restricted eating, or had tried it and said they liked it. She tested the concept in teenagers with obesity to see if setting an eight-hour window of eating was feasible in a pilot study published in the journal Nutrients in 2021.
“They enjoyed doing it, they felt like their whole family could do it, and over time they were losing weight,” Dr. Vidmar says of the teens.
Now, her lab is enrolling 100 youth between 12 and 21 years old with Type 2 diabetes and obesity in a 12-week trial. Participants are screened and monitored for any negative eating behaviors, she says. So far, she hasn’t found that time-limited eating “impacts eating behaviors or worsens disordered eating in any way,” she says.
In Australia, researchers are studying how teens with obesity respond to a different form of fasting called intermittent energy restriction.
In this approach, for three days a week you eat roughly one-quarter of the calories you normally do, says
Natalie Lister,
a researcher and dietitian at the University of Sydney. On the other four days, you have no calorie limits.
Dr. Lister says she and colleagues started looking into intermittent fasting in adolescents with obesity a few years ago when patients started asking about it. They conducted a pilot trial with 30 adolescents, published in 2019. Now, the researchers are completing a trial whose results they expect to publish later this year.
The health team monitors for eating disorders and depression, and the study doesn’t enroll anyone with a high risk of disordered eating, says Dr. Lister. Dietitians provide guidelines to help ensure participants are meeting nutritional requirements.
In adults with obesity, the data on TRE is mixed when it comes to weight loss, but two systematic reviews of the existing research both found a modest weight-loss benefit overall, says Dr. Peterson. Studies have also found that adults experience improvements in measures such as insulin resistance, reducing blood-glucose levels, particularly when their eating window starts early in the day.
Matthew Muros, a 15-year-old in Carson, Calif., struggles with his weight and prediabetes. Matthew participated in Dr. Vidmar’s pilot studies last year. The first two weeks were challenging, he notes.
“I did feel really hungry. I just kept on drinking water,” he says.
He says it got easier, and when the study was over he decided to stick with the schedule. He has lost about 30 pounds, and his blood-glucose levels have improved.
He has also changed his diet, having less soda, fast food and carbohydrates. “I’m trying to eat a little bit more healthy,” he says.
People who exercise regularly had lower rates of hospitalization and death from Covid-19 in a study published recently in the American Journal of Preventive Medicine.
Regular exercise improves overall health and healthier people generally have fewer serious complications with Covid-19 infections. Earlier research has shown an association between exercise and better Covid-19 outcomes. This latest study goes a step further and suggests that even people whose age or health conditions make them higher-risk have better outcomes if they are regular exercisers.
Higher amounts of physical activity were associated with lower rates of death and hospitalizations from Covid across nearly all demographics, says Jim Sallis, a public health professor at the University of California San Diego and co-author of the study. A very active 70-year-old still had a higher risk of Covid-related complications than did a similarly active 40-year-old, but the exercisers in both groups had hospitalization rates lower than those who didn’t work out.
The study used data from nearly 200,000 adult Covid-19 patients across the Kaiser Permanente network in Southern California. It asked patients to self-report the number of minutes of moderate exercise they did per week and analyzed the records of how many people in the study cohort were hospitalized, experienced deterioration, such as admission into an intensive-care unit, or died within 90 days of a Covid diagnosis.
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“You don’t have to run, you don’t have to sweat, you don’t have to do anything except get up and go out for a walk,” Dr. Sallis says. “That’s what most people do, and we see how much protection they’re getting from that.”
The findings add to a growing body of evidence that physical activity provides several types of protection from severe illness.
Exercise improves the body’s immune response by mobilizing and redistributing immune cells that can recognize and kill infected cells, says Richard Simpson, a professor at the University of Arizona whose research focuses on exercise immunology and who wasn’t involved with the Kaiser Permanente study. Without exercise, viruses have more time to replicate inside our bodies, which can result in more severe symptoms, he says.
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Physical activity can also help reduce inflammation, the body’s natural immune response to damage or pathogens. Chronic inflammation has been linked to more severe Covid-19 outcomes, especially in the lungs. Cytokines, small messenger proteins that help regulate inflammation, are released during exercise.
The study data were collected from the beginning of the pandemic to May 2021, when vaccines were just starting to become more available and before more recent waves of Covid. However, the researchers believe the results of the study are still broadly applicable.
“Exercise is as effective as many of the drugs that we use and has no side effects,” says Jordan Metzl, a sports medicine physician in New York City who wasn’t involved with the study. “We want to get people taking it every day.”
BEIJING—Chinese health authorities plan to lift Covid-19 quarantine requirements on international arrivals early next month, taking one of the country’s biggest steps to ease restrictions since the pandemic began even as case numbers remain high.
China has maintained among the world’s most restrictive coronavirus lockdown measures, slowing its economy significantly and sparking anger. Following waves of protests this fall, authorities abruptly abandoned the country’s stringent zero-Covid-19 strategy early this month.
From Jan. 8, China will scrap all quarantine measures for Covid-19, including requirements for inbound visitors, both foreigners and Chinese nationals, according to the National Health Commission.
The commission late Monday issued a plan to stop treating Covid-19 as a “Class A” infectious disease, which calls for stringent control measures, and downgrade the management of the virus to “Class B,” which requires more basic treatment and prevention. The Wall Street Journal reported last month that China was weighing such a move, which would give it room to further loosen public-health measures.
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The change means people traveling to China from abroad will need to have only a negative Covid-19 test within 48 hours to be allowed into the country, the NHC said. International arrivals will no longer be required to be tested on arrival or undergo quarantine—a major step toward opening up for a country that has been largely closed off to the outside world for three years.
The commission in its statement pledged to facilitate foreigners’ visits to China, including those for business, studying and family reunions, and to provide visa assistance.
The shift came as fever clinics and hospital emergency rooms in Beijing continued to overflow with patients on Monday and Chinese leader
Xi Jinping
called on local officials to take pains to save lives.
Before Monday’s loosening of Covid restrictions, Mr. Xi addressed his country’s new pandemic reality for the first time in comments marking the 70th anniversary of the Patriotic Health Movement, a campaign to wipe out flies and mosquitoes launched by
Mao Zedong
during the Korean War to fortify China against the possibility of American germ warfare.
“At present, our country’s Covid prevention and control efforts are facing new circumstances and a new mission,” Mr. Xi said. China should launch “a more targeted Patriotic Health Movement” to “effectively guarantee the lives and health of the people.”
Visits to three major hospitals in Beijing by the Journal on Monday showed the capital’s healthcare system still swamped with an influx of patients following the government’s about-face on Covid-19 controls, which has left many citizens, especially the elderly, scrambling to find treatment.
In the emergency room of eastern Beijing’s Chaoyang Hospital, known for treating respiratory diseases, hallways at the intensive-care unit were packed with dozens of elderly patients lying on portable beds. One nurse said all the ICU beds were full and only patients with the most life-threatening symptoms were being admitted. “Those patients with less severe symptoms can only get a temporary bed and stay in the hallway,” she said.
To cope with the surge in patients, Beijing’s Chaoyang Hospital opened a second fever clinic in a nearby sports stadium for some Covid-19 patients.
Photo:
Chen Zhonghao/Zuma Press
On Monday, the Chinese Center for Disease Control and Prevention issued a report showing fewer than 2,700 new infections and no new deaths on Christmas Day. Over the weekend, local officials presented a much grimmer picture.
A senior health official in the coastal province of Zhejiang, home to e-commerce giant
Alibaba Group Holding Ltd.
, said on Sunday that new daily infections had topped one million, with the wave expected to peak at around two million cases around New Year’s Day.
Roughly half a million people were being infected every day in the northeastern city of Qingdao, a local health official said in a since-removed interview with a state-owned broadcaster.
To minimize the impact of the infection surge on China’s already battered economy, some cities said people could return to work even if they had mild symptoms. Authorities in Shanghai said Saturday that the city’s 25 million residents wouldn’t need to be isolated at home for more than seven days, even if they are still testing positive.
Rapid transmission of Covid-19 in China raises the likelihood for fresh outbreaks beyond its borders and the emergence of risky virus variants, said
Michael Osterholm,
director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“New variants are a huge possibility, and they could have a tremendous impact on the rest of the world,” Dr. Osterholm said.
In his own comments marking the anniversary of the Patriotic Health Campaign, which evolved over the years to target infectious diseases such as malaria, China’s Premier
Li Keqiang
said adjustments to the country’s Covid-19 policies were being implemented in an orderly manner, but urged officials at every level of government to address public demands for medical care and supplies.
Covid-19 cases in China have surged after authorities scrapped most of its restrictions, prompting residents to self-isolate and stockpile medication. WSJ’s Jonathan Cheng reports from Beijing on the risks that come with the country’s rapid reopening. Photo: Xiaoyu Yin/Reuters
China’s health system, thinly resourced even before the pandemic, has struggled to contend with the fast-spreading Omicron variant. The growth in infections has sent people scrambling to buy up home test kits along with ibuprofen and other medications.
At Chaoyang Hospital’s emergency room on Monday, digital screens showed a long wait list for people seeking treatment at the internal-medicine department. In an interview last week with China’s state broadcaster, Mei Xue, deputy director of the hospital’s emergency department, said around 400 patients were coming seeking internal medicine treatment every day—roughly four times the normal number.
“These patients are all elderly people with underlying diseases. After the combination of fever and respiratory infection, they are all very seriously ill,” he said.
A staffer with Beijing’s emergency medical center, which coordinates requests for urgent medical care in the city, said he and his colleagues had been working nonstop to transfer patients to Chaoyang Hospital in recent weeks and he expected the current situation to last for a few more weeks.
To cope with the surge in patients, the hospital has opened a second fever clinic in a nearby sports stadium for Covid-19 patients with mild symptoms.
Peking Union Medical College Hospital and Peking University First Hospital, both located in the center of Beijing, were similarly overwhelmed.
A sign outside the Peking Union emergency room warned patients it could take more than four hours to see a doctor. A nurse at Peking Union’s fever clinic said that for weeks patients had been forced to wait in the hallways for beds to open up. One elderly patient, unable to secure a bed, was lying on a metal bench just inside the entrance of the fever clinic.
A nurse at Peking University First Hospital’s emergency room said beds there were all full and the wait time at the internal medicine department was roughly six hours. The hospital public address system announced that nearly 50 patients were waiting to be seen.
In recent weeks, doctors and nurses from around China have been dispatched to Beijing to support the capital. Shandong province sent a team of medical staff to Beijing, according to state media reports.
In the U.S., the State Department on Friday updated its travel advisory and is asking that people reconsider travel to China due to the surge in Covid-19 cases, arbitrary enforcement of local laws and Covid-19-related restrictions.
—Xiao Xiao and Dominique Mosbergen contributed to this article.
The nose knows why some people still can’t smell long after recovering from Covid-19.
A haywire immune response in the olfactory system was found to explain why some people still can’t smell long after symptoms of the disease have abated, according to a small, peer-reviewed study published Wednesday in the journal Science Translational Medicine. In some cases, the immune or inflammatory response was detected in patients with smell loss up to 16 months after recovery from Covid-19.
Compared with people who can smell normally, patients with long-term smell loss had fewer olfactory sensory neurons, cells in the nose responsible for detecting smells and sending that information to the brain. Patients with lingering loss of smell had an average of 75% fewer of the neurons compared with healthy people, said
Brad Goldstein,
a study co-author and sinus surgeon at Duke University.
“We think the reduction of sensory neurons is almost definitely related to the inflammation,” Dr. Goldstein said.
Loss of smell is a common Covid-19 symptom, though its prevalence varies widely depending on factors including which variant caused the infection, head and neck specialists said.
Most Covid-19 patients who experience smell loss regain the sense within weeks of infection. But the symptom can stick around for a year or longerfor up to 7% of patients, a February analysis said.
Dr. Goldstein said he and his colleagues sought to identify what was damaged or altered in people with long-term smell loss. “If we don’t know what’s broken, it’s hard to tell how to fix it,” he said.
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They took samples from the nose tissue of nine patients who couldn’t smell long after Covid-19 infections and compared them with cells from healthy people. Patients with persistent smell loss had more T-cells, a type of white blood cell that plays a critical part in immune response, in their noses, the study said. The T-cells were making interferon-gamma, a substance linked to inflammation, Dr. Goldstein said, and support cells appeared to be reacting to it.
The support cells protect and nourish olfactory sensory neurons. Without them, the olfactory sensory neurons can’t survive. Research has shown that the virus that causes Covid-19 doesn’t infect olfactory sensory neurons directly, but that it can attack such support cells.
Patients with smell loss also had fewer of a certain type of anti-inflammatory cell and more of a particular inflammatory cell than healthy people, said the study of 24 patients. The healthy group included two people who had recovered from Covid-19 but didn’t have long-term smell loss.
Covid-19 researchers said the study bolstered evidence that inflammation could be a culprit in long-Covid symptoms. An April study in the journal JAMA Neurology found inflammation among deceased Covid-19 patients in the olfactory bulb, the part of the brain responsible for receiving and processing information from olfactory sensory neurons in the nose.
Neuroinflammation could be a contributor to loss of smell and other neurological symptoms related to long-Covid such as brain fog, said
Cheng-Ying Ho,
a co-author of the April study and an associate professor of pathology at Johns Hopkins University School of Medicine.
Dr. Ho, who wasn’t involved in the new study, said inflammation that starts in the nasal cavity could extend to the brain. She said that the new study was compelling but that its small sample size necessitated further work in more patients. Because the vaccination status of participants wasn’t collected, she said it wasn’t clear whether getting the shots played a role in the olfactory system’s inflammatory response.
In a survey published last year of more than 400 patients with smell loss, more than 40% reported depressive symptoms and almost 90% reported enjoying food less.
“People might think smell loss is not really an important Covid symptom compared with severe symptoms such as pneumonia, but it can really bother some patients,” Dr. Ho said.
Researchers said regions of the brain linked to the sense of smell are closely associated with brain regions that control memory and emotion.
Sandeep Robert Datta,
a co-author of the new study and a professor of neurobiology at Harvard Medical School, said he and others are conducting more research into the reasons for smell loss following Covid-19 infection smell loss. The research could lead to potential targets for treatment. There are no effective treatments for long-term smell loss, Dr. Datta said.
“Smell gives you a sense of place. It can be very disorienting without it,” Dr. Datta said.
Write to Dominique Mosbergen at dominique.mosbergen@wsj.com
A/S flubbed the launch of its buzzy new weight-loss drug Wegovy, missing out on hundreds of millions of dollars in sales and squandering a head start before a rival could begin selling a competing product.
Wegovy is among a new class of drugs that health regulators have approved to cut the weight of people who are obese, a goal long sought by doctors and patients. Their weight-dropping potential became a viral sensation on social media. Elon Musk tweeted about Wegovy in October. And a related drug for diabetes, Ozempic, is a hot topic in Hollywood among celebrities seeking to stay thin, according to doctors.
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Yet Denmark-based Novo underestimated how big demand for the drug would be, and wasn’t ready to make enough to fill the prescriptions that flooded in after U.S. approval last year. Then a contract manufacturer halted production to address inspection issues.
“We should have forecasted better, which we did not,” Novo Chief Executive
Lars Fruergaard Jørgensen
said. “Had we forecasted that, we would have built a different supply chain.”
The missteps have proven costly for Novo, which was forced to ration Wegovy to patients who already had started taking it. The company has recorded around $700 million in sales to date, well short of the $2 billion in 2021 and 2022 sales that some analysts had projected before supply issues hit.
Novo Nordisk Chief Executive Lars Fruergaard Jørgensen admits the drug company misjudged how popular Wegovy would be.
Photo:
Carsten Snejbjerg/Bloomberg News
Amber Blaylock, a music teacher from Springfield, Mo., said she has been trying to get Wegovy to help her reduce weight since hearing about the drug on TikTok and YouTube. She asked her doctor in September to prescribe it, but hasn’t been able to find it.
“Frustrated and impatient for sure,” said Ms. Blaylock, 29 years old.
To turn things around, Mr. Jørgensen said Novo has increased its capacity to make Wegovy and plans a “relaunch” early next year, which should fulfill all orders.
Novo, however, lost valuable time establishing a beachhead in the lucrative obesity-drug market before rival
Eli Lilly
LLY 1.20%
& Co. can enter. Lilly is expected to launch a similar, competing drug named Mounjaro late next year or in early 2024.
The market for anti-obesity drugs, now worth $2.4 billion worldwide, could reach $50 billion in 2030, Morgan Stanley estimates.
“Novo has left the door open for Lilly,” said BMO Capital Markets analyst Evan David Seigerman.
Mr. Jørgensen said the company can regain lost ground because of high demand for Wegovy and the large potential for what is still a mostly untapped market. He said he was unconcerned with the looming competition with Lilly’s drug, because there is room for both products.
“We disappointed physicians and patients in the first round,” he said. “The company wants to be better prepared for the second round.” Novo lists Wegovy at $1,349 a month. Some commercial insurers cover the drug.
Wegovy works by imitating a hormone called GLP-1, which occurs naturally in the body and suppresses appetite, among other effects.
Novo developed GLP-1 drugs to treat diabetes. In 2017, the company began selling semaglutide, the active ingredient in Wegovy, under the brand name Ozempic to treat diabetes.
During the drug’s development, Novo found that weight loss was a side effect, prompting the company to probe using semaglutide to treat obesity. A key trial found that Wegovy helped people with a high body-mass index shed up to 15% of their weight, surpassing the results for older obesity drugs like Novo’s Saxenda.
Saxenda and other older weight-loss drugs had sold modestly, partly due to their limited weight loss, as well as some unpleasant side effects and the refusal of many health insurers to pay up.
Novo worked with Catalent to fill its Wegovy weight-loss drug into syringes.
Photo:
yara nardi/Reuters
Given the experience, Novo figured Wegovy sales would increase gradually. To augment its own production, Novo contracted with a single manufacturer,
Catalent Inc.,
to fill the drug into syringes. Novo said it thought it would have time to add manufacturing capacity to meet a gradual increase in demand.
Wegovy may be superior to older drugs, but “we thought it would still be a journey to open up the market,” Mr. Jørgensen said.
When Novo started selling Wegovy in the U.S. in June last year, however, demand took off. Doctors with large followings on social media touted Wegovy as groundbreaking, while users posted photos holding injection pens and shared their progress losing weight.
“Demand for these new agents has been unlike anything I’ve ever seen in my time in medicine,” said Dr. Michael Albert, a physician specializing in weight-loss treatment at telehealth provider Accomplish Health who has consulted for Novo. Many of his patients began asking about Wegovy, he said, after they heard about it in Facebook groups or on TikTok.
It took only five weeks for doctors to write new prescriptions for Wegovy at the same weekly volume that Saxenda took four years to reach, according to Mr. Jørgensen. “It’s a completely different ballgame that we’re in,” said Ambre Brown Morley, the company’s vice president of media and digital global communication.
Within weeks, supplies were strained. Novo warned that patients might experience delays in receiving their prescriptions. Then in December 2021, Catalent temporarily stopped deliveries and manufacturing at its plant after Food and Drug Administration inspections found faulty air filters and damaged equipment.
To date, Novo has recorded around $700 million in Wegovy sales compared with the $2 billion in 2021 and 2022 sales that some analysts had projected before supply issues emerged.
Photo:
JACOB GRONHOLT-PEDERSEN/REUTERS
Many people who couldn’t get Wegovy for weight loss have sought prescriptions for Novo’s Ozempic and Lilly’s Mounjaro, according to analysts, even though the FDA hasn’t approved the latter two drugs for such use. Ozempic sales increased so much that certain doses are in short supply through at least January, the FDA said.
Lilly is studying Mounjaro, its GLP-1-containing drug for diabetes, for weight loss.
Novo and Lilly said they don’t promote their diabetes drugs for the “off-label” use treating obesity.
A Catalent spokesman said the company is still making improvements to the plant and working with customers to limit the impact of supply constraints on patients. The company restarted filling Wegovy syringes at the facility in the spring.
Novo has been amassing a sufficient inventory before the Wegovy relaunch, Mr. Jørgensen said. When Wegovy relaunches, he said, insurance coverage will be broader than when the drug first went on sale.
Write to Peter Loftus at Peter.Loftus@wsj.com and Denise Roland at denise.roland@wsj.com
has accelerated plans to shift some of its production outside China, long the dominant country in the supply chain that built the world’s most valuable company, say people involved in the discussions. It is telling suppliers to plan more actively for assembling Apple products elsewhere in Asia, particularly India and Vietnam, they say, and looking to reduce dependence on Taiwanese assemblers led by
Foxconn
2354 4.05%
Technology Group.
Turmoil at a place called iPhone City helped propel Apple’s shift. At the giant city-within-a-city in Zhengzhou, China, as many as 300,000 workers work at a factory run by Foxconn to make iPhones and other Apple products. At one point, it alone made about 85% of the Pro lineup of iPhones, according to market-research firm Counterpoint Research.
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The Zhengzhou factory was convulsed in late November by violent protests. In videos posted online, workers upset about wages and Covid-19 restrictions could be seen throwing items and shouting “Stand up for your rights!” Riot police were present, the videos show. The location of one of the videos was verified by the news agency and video-verification service Storyful. The Wall Street Journal corroborated events shown in the videos with workers at the site.
Coming after a year of events that weakened China’s status as a stable manufacturing center, the upheaval means Apple no longer feels comfortable having so much of its business tied up in one place, according to analysts and people in the Apple supply chain.
“In the past, people didn’t pay attention to concentration risks,” said Alan Yeung, a former U.S. executive for Foxconn. “Free trade was the norm and things were very predictable. Now we’ve entered a new world.”
Footage shows police beating workers at Foxconn’s facility in Zhengzhou, China. The world’s biggest site making Apple smartphones had been under Covid-19 lockdowns in recent weeks. Screenshot: Associated Press
One response, say the people involved in Apple’s supply chain, is to draw from a bigger pool of assemblers—even if those companies are themselves based in China. Two Chinese companies that are in line to get more Apple business, they say, are Luxshare Precision Industry Co. and
Wingtech Technology Co.
On calls with investors earlier this year, Luxshare executives said some consumer-electronics clients, which they didn’t name, were worried about Chinese supply-chain snafus caused by Covid-19 prevention measures, power shortages and other issues. They said these clients wanted Luxshare to help them do more work outside China.
The executives referred to what is known as new product introduction, or NPI, when Apple assigns teams to work with contractors in translating its product blueprints and prototypes into a detailed manufacturing plan.
It is the guts of what it takes to actually build hundreds of millions of gadgets, and an area where China, with its concentration of production engineers and suppliers, has excelled.
Apple has told its manufacturing partners that it wants them to start trying to do more of this work outside of China, according to people involved in the discussions. Unless places such as India and Vietnam can do NPI too, they will remain stuck playing second fiddle, say supply-chain specialists. However, the slowing global economy and slowing hiring at Apple have made it hard for the tech giant to allocate personnel for NPI work with new suppliers and new countries, said some of the people in the discussions.
Apple and China have spent decades tying themselves together in a relationship that, until now, has mostly been mutually beneficial. Change won’t come overnight. Apple still puts out new iPhone models every year, alongside steady updates of its iPads, laptops and other products. It must keep flying the plane while replacing an engine.
“Finding all the pieces to build at the scale Apple needs is not easy,” said Kate Whitehead, a former Apple operations manager who now owns her own supply-chain consulting firm.
Yet the transition is under way, driven by two causes that are feeding on each other to threaten China’s historic economic strength. Some Chinese youth are no longer eager to work for modest wages assembling electronics for the affluent. They are seething in part because of Beijing’s heavy-handed Covid-19 approach, itself a concern for Apple and many other Western companies. Three years after Covid-19 started circulating, China is still trying to crush outbreaks with measures such as quarantines, as many other countries have returned to prepandemic norms.
Zhengzhou, China, is home to a giant Foxconn facility known as iPhone City.Shang Ji/Future Publishing/Getty Images
A worker is shown disinfecting equipment at iPhone City in Zhengzhou, China.VCG/Getty Images
Zhengzhou, left, is home to a giant Foxconn facility known as iPhone City, where a worker is shown at right disinfecting equipment.Shang Ji/Future Publishing/Getty Images; VCG/Getty Images
Protests in Chinese cities over the past week, during which some demonstrators called for the ouster of President
Xi Jinping,
suggested criticism over Covid-19 restrictions could build into a larger movement against the government.
All this comes on top of more than five years of heightened U.S.-China military and economic tensions under the Trump and Biden administrations over China’s rapidly expanding military footprint and U.S. tariffs on Chinese goods, among other disputes.
Apple’s longer-term goal is to ship 40% to 45% of iPhones from India, compared with a single-digit percentage currently, according to Ming-chi Kuo, an analyst at TF International Securities who follows the supply chain. Suppliers say Vietnam is expected to shoulder more of the manufacturing for other Apple products such as AirPods, smartwatches and laptops.
For now, consumers doing Christmas shopping are stuck with some of the longest wait timesfor high-end iPhones in the product’s 15-year history, stretching until after Christmas. Apple issued a rare midquarter warning in November that shipments of the Pro models would be hurt by Covid-19 restrictions at the Zhengzhou facility.
In November, as the worker protests in the facility grew, Apple issued a statement assuring it was on the ground looking to resolve the issue. “We are reviewing the situation and working closely with Foxconn to ensure their employees’ concerns are addressed,” a spokesman said at the time.
The risk of too much concentration in China has long been known to Apple executives, yet for years they did little to lessen it. China supplied a literate and diligent workforce, political stability and a huge local market for Apple’s products.
Taiwan-based Foxconn, under founder
Terry Gou,
became an essential link between Apple in California and the Chinese assembly plants where iPhones get put together. Foxconn managers share a language and cultural background with mainlandworkers.
Pegatron Corp.
, another Taiwan-based contractor, has played a smaller but similar role.
Apple is looking to manufacture more in Vietnam, where a facility of China-based Luxshare, an Apple supplier, is located.
Photo:
Linh Pham/Bloomberg News
And both the government in Beijing and local governments in places such as Henan province, home to the Zhengzhou plant, have enthusiastically supported Apple’s business, seeing it as an engine of jobs and growth.
Even now, when ever-harsher anti-American rhetoric flows each day from Beijing over issues such as Taiwan and human rights, that backing remains strong.
People’s Daily, the mouthpiece of the Chinese Communist Party, hailed the Apple production site in a Nov. 20 video, saying it accounted directly or indirectly for more than a million local jobs. Foxconn shipped about $32 billion in products overseas from Zhengzhou in 2019, according to a Chinese government-linked think tank. All told, the Foxconn group accounted for 3.9% of China’s exports in 2021, according to the company.
“The government’s timely assistance…continuously provides a sense of certainty for multinational companies like Apple, as well as for the world’s supply chain,” the People’s Daily video said.
Yet such words ring hollow to many U.S. businesses in light of stringent anti-Covid measures by the government that have hampered production and roused worker unrest. A survey by the U.S.-China Business Council this year found American companies’ confidence in China has fallen to a record low, with about a quarter of respondents saying they have at least temporarily moved parts of their supply chain out of China over the past year.
To keep operating during government Covid-19 measures, the Zhengzhou factory is among those compelled to adopt a system in which workers stay on-site and contact with the outside world is limited to the bare minimum to keep the goods flowing. Foxconn has sealed smoking areas, switched off vending machines and closed dining halls in favor of carryout meals that workers bring back to their dormitories, often a half-hour walk away, workers said.
Many have escaped, jumping fences and walking along empty highways to get back to their hometowns. In November, the pandemic policies and pay disputes further fueled workers’ grievances. Some clashed with police at the site and left smashed glass doors.
Many of those abandoning the factory were young people who said on social media that they decided wages equivalent to $5 or less an hour weren’t enough to compensate for tedious production work, exacerbated by Covid-19 restrictions.
People protested throughout China this past week against the country’s strict anti-Covid protocols.Kevin Frayer/Getty Images
Beijing residents waited in line last month to be tested for Covid-19.Kevin Frayer/Getty Images
People protested throughout China this past week, left, against the country’s strict anti-Covid protocols. Beijing residents, right, waited in line to be tested for the disease.Kevin Frayer/Getty Images (2)
“It’s better for us to skate by at home than to be sucked dry by capitalists,” one person who identified herself as a departed Foxconn worker posted on her social-media account after the protests.
Asked for comment, a Foxconn spokesman referred to earlier statements in which the company blamed a computer error for some of the pay issues raised by new hires. It said it guaranteed recruits would be paid what was promised in recruitment ads. The spokesman declined to comment further.
China’s Covid-19 policy “has been an absolute gut punch to Apple’s supply chain,” said Wedbush Securities analyst
Daniel Ives.
“This last month in China has been the straw that broke the camel’s back for Apple in China.”
Mr. Kuo, the supply-chain analyst, said iPhone shipments in the fourth quarter of this year were likely to reach around 70 million to 75 million units, which he said was around 10 million fewer than market projections before the Zhengzhou turmoil. The top-of-the-line iPhone 14 Pro and Pro Max models have been particularly hard-hit, he said.
Accounts vary about how many workers are missing from the Zhengzhou factory, with estimates ranging from the thousands to the tens of thousands. Mr. Kuo said it was running at about 20% capacity in November, a figure expected to improve to 30% to 40% in December. One positive sign came Wednesday, when the local government in Zhengzhou lifted lockdown restrictions.
One Foxconn manager said hundreds of workers were mobilized to move machinery and components by truck and plane nearly 1,000 miles from Zhengzhou in central China to Shenzhen in the south, where Foxconn has its other main factories in China. The Shenzhen factories have made up some, but not all, of the production gap.
Meanwhile, Foxconn is offering money to get workers to come back and stay for a while. One of its offers is a bonus of up to $1,800 for January to full-time workers in Zhengzhou who joined at the start of November or earlier. Those who wanted to quit have gotten $1,400.
India and Vietnam have their own challenges.
People in Beijing protested this past week against stringent anti-Covid measures.
Photo:
Kevin Frayer/Getty Images
Dan Panzica, a former Foxconn executive who now advises companies on supply-chain issues, said Vietnam’s manufacturing was growing quickly but was short of workers. The country has just under 100 million people, less than a 10th of China’s population. It can handle 60,000-person manufacturing sites but not places such as Zhengzhou that reach into the hundreds of thousands, he said.
“They’re not doing high-end phones in India and Vietnam,” said Mr. Panzica. “No other places can do them.”
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India has a population nearly the size of China’s but not the same level of governmental coordination. Apple has found it hard to navigate India because each state is run differently and regional governments saddle the company with obligations before letting it build products there.
“India is the Wild West in terms of consistent rules and getting stuff in and out,” said Mr. Panzica.
The U.S. embassies of India and Vietnam didn’t respond to requests for comment.
Nonetheless, “Apple is going to have to find multiple places to replace iPhone City,” Mr. Panzica said. “They’re going to have to spread it around and make more villages instead of big cities.”
—Selina Cheng contributed to this article.
Write to Yang Jie at jie.yang@wsj.com and Aaron Tilley at aaron.tilley@wsj.com
