BNEI BRAK, Israel—Israel’s attempt to suppress a roiling pandemic has collided with a hard-hit ultraorthodox community that has proven resistant to lockdowns and suspicious of the nation’s mass vaccination campaign.
On Sunday, thousands of ultraorthodox mourners attended two funerals of famous rabbis who died from the coronavirus. The mourners flouted bans on public gatherings of no more than 10 people on the same day that Israel’s cabinet extended a strict lockdown that includes barring all international flights. Thousands of men dressed in black wool hats and suits crowded together, many without masks, images of the event show. Fearing violence, police steered away from arrests while some top Israeli politicians seethed.
“This is how unequal enforcement looks,” said
Benny Gantz,
the defense minister and head of the Blue and White party. “Millions of families and children are locked in their homes and abide by the rules while thousands of haredim crowd the funeral, most of them even without masks,” he said, using the Hebrew word for ultraorthodox.
The funerals followed anti-lockdown protests in Bnei Brak and other ultraorthodox cities the week before, in which ultraorthodox men threw rocks at police, lit dumpsters on fire and knocked down street signs and light poles.
Many of the mourners crowding together for a rabbi’s funeral on Sunday in Jerusalem weren’t wearing face masks.
Photo:
Ariel Schalit/Associated Press
Israel’s health officials have also struggled to coax ultraorthodox to take a Covid-19 vaccine. While much of Israel has lined up for vaccinations, the ultraorthodox population has been slower to get on board, with some doubting the safety of the vaccine and others suggesting the country’s citizens are being used to test its efficacy.
“This isn’t a vaccine. It’s an experiment,” said
Izhar Mahpud,
a 57-year-old resident from Bnei Brak, an ultraorthodox city just east of Tel Aviv that has been one of the hardest hit by Covid-19 in the country. “I’m not ready to be a rat in a laboratory.”
Israel aims to vaccinate much of its population by March and get the economy going again, allowing the tiny nation beside the Mediterranean sea to serve as a global showcase for how to beat back the deadly virus. But the ultraorthodox have undermined those lofty goals, largely by bucking lockdowns and shying from vaccines.
Israel’s ultraorthodox make up about 12% of the population but account for nearly one-third of the country’s coronavirus infections. Israel currently has 68,331 active coronavirus cases with new infections hovering at about 7,000 a day.
Officials are scrambling to get the latest surge under control. A British variant of the virus accounts for about 70% of current coronavirus infections, even as almost one-third of Israelis have received the first dose of a vaccination. Prime Minister
Benjamin Netanyahu
last month banned all international flights and lawmakers passed a bill Sunday doubling fines for lockdown violations.
Ultraorthodox Jews argued with Israeli police officers during a protest over coronavirus lockdown restrictions in Ashdod last month.
Photo:
Oded Balilty/Associated Press
Public health officials say the ultra-Orthodox community is particularly vulnerable to the fast-moving virus. Their large families typically live in crowded apartments and traditionally shun electronic communication that helps get information out about the vaccines.
Data from Israel’s health ministry shows Israel’s ultraorthodox are getting vaccinated at a lower rate than other groups. Among those over 60, to whom the campaign has been open the longest, 85% of all Israelis have taken the vaccine, compared with 78% of Israel’s ultraorthodox.
Ultraorthodox and Arab towns are lagging behind in overall immunity to the virus due to the lower vaccination rates, according to
Eran Segal,
a computational biologist at the Weizmann Institute of Science who presented his findings to Israel’s government on Sunday evening. “It’s going to slow down the decline of the pandemic,” said Mr. Segal.
Health officials say that infections in ultraorthodox communities have gone down in recent days, as some leading rabbis have endorsed vaccinations. There are also efforts under way to combat misinformation and get residents to take the vaccine.
In the large ultraorthodox city of Bnei Brak, local officials have set up a war room. In the oval-shaped, wood-paneled room on the top floor of city hall, with portraits of important religious figures lining the walls, young ultraorthodox sit around a large circular table with large jugs of hand sanitizer and work the phones. They stare at spreadsheets with information about everyone who has or hasn’t been vaccinated.
Officials had called nearly 10,000 people who hadn’t been vaccinated—and spoken with nearly 7,000 of them. About 5,000 said they wanted a vaccine but hadn’t been able to get one yet. Another 1,500 or so didn’t want to be vaccinated. The city officials work to overcome any obstacles raised on the calls.
For those who don’t have a ride to a vaccination center, they arrange one. If would-be vaccine recipients can’t get in touch with their health insurance providers, they also help. And if anyone they reach doesn’t want to take the vaccine, they note why.
Avi Blumenthal, who leads the health ministry’s outreach to the ultraorthodox, said he and his staff are combing through lists of Israel’s ultraorthodox towns to find the rabbis who are against vaccination, and seeking answers. In one instance, an ultraorthodox community in Jerusalem had low vaccine rates that many attributed to its rabbi’s alleged antivaccine stance. But when health officials interviewed the rabbi, they learned he was actually pro-vaccine—someone had spread a rumor attributed to him that the vaccine is dangerous.
An ultraorthodox Jewish man received a coronavirus vaccine in Jerusalem last month.
Photo:
abir sultan/epa/Shutterstock
Yehuda Shaish,
63, who runs four ultra-Orthodox schools in Bnei Brak and nearby towns, said he waited until the rabbis blessed the vaccines. “After the rabbis authorized it, I went happily,” he said.
Even with rabbis’ blessings, many ultraorthodox remain skeptical about vaccines. Yedidya Hasson, 28, who manages a network of WhatsApp groups with 30,000 people in which some members have questioned the wisdom of vaccines and coronavirus restrictions, says he won’t take the vaccine at least for now because he fears possible health risks.
“When it comes to vaccines,” he said, “I think that the media in Israel is hiding the truth.”
Some ultraorthodox leaders say that while community mistrust may help to explain resistance to vaccines and recent displays of civil disobedience, that distrust doesn’t justify violating rules that endanger public health. “You expect from religious men to be more moral,” said Rabbi
Dov Halbertal,
a prominent ultraorthodox lawyer and commentator. “But when it comes to the biggest test of saving lives, we are failing.”
Israel says it’s on track to vaccinate everyone over 16 by the end of March. To understand how the small country has vaccinated more of its population than any other so quickly, WSJ visited clinics that are giving shots to young and middle-aged citizens. Photo: Tamir Elterman for The Wall Street Journal
Write to Felicia Schwartz at Felicia.Schwartz@wsj.com
Officials from Ohio said recently that 60% of nursing-home staff so far haven’t elected to take the vaccine. In New York,
Gov. Andrew Cuomo
said this month that state officials expect 30% of health-care workers offered the vaccine will ultimately turn it down. Two-thirds of the staff at a Florida hospital refused the vaccine this month, leaving so many unused doses that the facility started giving away shots to the general public.
The hesitancy among health-care workers concerns public-health officials who expected America’s front-line workers to serve as a model for others.
“Please get vaccinated,”
Anthony Fauci,
who is serving as President Biden’s chief medical adviser for the Covid-19 pandemic, said in a video message to health-care providers. “It’s important to protect yourselves, to protect your family, but as important, symbolically, as health-care providers, to show confidence in the vaccine so that other people in this country follow suit.”
In a survey of 1,563 respondents conducted in January by researchers at the Kaiser Family Foundation, 79% of U.S. adults who haven’t yet been vaccinated say they would be likely to turn to a doctor, nurse or other health-care provider when deciding whether to get a vaccination.
Meanwhile, 28% of 128 health-care workers in the Kaiser survey said they want to wait and see how the vaccine is working for other people before getting it themselves. While they weren’t the most resistant group the foundation studied, their outsize influence over whether members of the general public would choose to get the vaccine concerns public-health officials.
Surveys of vaccine skepticism of broader populations have shown that people have become less hesitant as they see others vaccinated.
Some health-care workers say they’ve passed up the shot for altruistic reasons, believing that others should get it first. Several health-care systems said they have struggled to persuade female employees to get vaccinated due to a lack of data about the vaccines’ impact on pregnancy. Other health-care workers say while they want to encourage others to get vaccinated, when it comes to their own health, they are still wary.
“As I was getting my first shot, I asked the two nurses who were administering it to me how they felt when they got the shot. And they were on the side of waiting. That scared me a little bit, but I went through with it,” said
Charles Smith II,
chief financial officer at Vibrant Health in Kansas City, Kan.
At the system of clinics where Mr. Smith works, about 30% of the staff have decided against getting the vaccine to this point, according to Vibrant Health’s chief executive,
Patrick Sallee.
Mr. Smith said he felt uncomfortable with the speed of the process and the lack of long-term data, but news that a more highly transmissible virus variant was spreading made him take the leap. “There is an expectation for the health industry to lead other industries to say this thing is safe and lead by example,” he said. “I feel like I’m shaking the dice, really.”
Mr. Smith, CFO at a health-clinic system, and Dr. Jackson-Smith, a dentist, felt reluctant about a Covid-19 vaccine but decided to lead by example and get the shot.
Photo:
Katie Currid for The Wall Street Journal
Mr. Smith’s wife, Aniika Jackson-Smith, a dentist, said she also hesitated to get a vaccine because she doesn’t feel enough is known about their long-term effects. She said she finally decided to make an appointment to get the first shot in late January because she feels a responsibility as a health-care provider not to discourage others from getting it.
“My mind isn’t really changed,” she said. “But I guess in order for us to get past this, people are just going to have to take the vaccine or we’ll just be here forever.”
Heidi Arthur,
chief campaign development officer at the Ad Council, which has been running a large-scale public-service education effort about the Covid-19 vaccines, said getting health-care workers on board wasn’t originally part of the plan.
“It was surprising, the level of hesitancy,” she said.
Covid-19 Vaccine’s Last Mile
Instead of health-care workers lining up, the Ad Council found themselves pulling together a diverse group of leaders within the industry, including Dr. Fauci, to educate other health-care workers about the vaccines and address their concerns.
For Susan Izzo, an adult nurse practitioner in Connecticut, her initial hesitancy was because she felt her patients deserved the vaccine before her. Ultimately, her patients persuaded her to get the shots, she said, so that she could be healthy to protect them.
“I didn’t feel like it was my turn, even though as a health-care worker it is my turn. I would have gladly given up my vaccine to my 55-year-old patient who just had a lung transplant,” she said.
Deborah Burger,
a president at National Nurses United, the largest nurses’ union in the U.S., said many nurses felt information about vaccines that came out during the Trump administration was politicized and wanted to learn more so they could decide for themselves whether it was safe. Education and more information, she said, is increasing uptake among nurses.
Dawn Allen,
vice president of patient services at Huron Regional Medical Center in South Dakota, said at first less than 50% of their workforce chose to be vaccinated. After sitting down with staff to answer their questions, particularly around concerns of infertility, she said they are up to 76% of staff choosing to be vaccinated over a two-week period.
Still, some nurses say they have no intention of getting vaccinated.
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Cleon Charles,
a traveling nurse who has been working in Covid-19 hot spots throughout the pandemic, said she would never get the vaccine and has discouraged her daughters and parents from getting it, despite having had Covid-19 herself.
She cited a general mistrust of the pharmaceutical industry, among other concerns, and the death of baseball legend Hank Aaron, who publicly received the Covid-19 vaccine in early January. Medical officials say the baseball legend died of natural causes, but his death has been taken up by antivaccination leaders, including
Robert F. Kennedy Jr.
, who called the death “part of a wave of suspicious deaths among elderly closely following administration of #COVID #vaccines,” on Twitter.
“I don’t want it,” Ms. Charles said. “I’ll take my chances and my vitamins.”
New Hampshire health officials announced Tuesday there were no new outbreaks of COVID-19 this week at long-term care and other congregate living facilities, and a dozen outbreaks, including one at the state Veterans Home, have closed.The decreasing number of outbreaks follows other trends that show that while COVID-19 is still spreading widely in New Hampshire, the rate of spread is slowing some, with active cases, test positivity and hospitalizations all trending lower.>> Latest coronavirus coverage from WMUR”I am very pleased to announce we are closing the New Hampshire Veterans Home outbreak effective Jan. 26,” said Health Commissioner Lori Shibinette. “So, we’re very happy that that’s closed.”Gov. Chris Sununu said the state’s efforts to vaccinate staff members and residents at the facilities may be helping to prevent or shut down outbreaks. “It’s working,” Sununu said. “Yeah, there’s no doubt it’s having some effect.”>> COVID-19 in New Hampshire: Important informationAccording to Dr. Beth Daly, chief of the state’s Bureau of Infectious Disease Control, 18,000 people in long-term care facilities have received the first dose of the vaccine, and about 5,000 have received the second dose. She said the total population of residents and staff members in those facilities is about 33,000, so there is more work to be done to get most of them vaccinated.Health officials said more outbreaks are still likely until the virus is no longer spreading widely in the community. There are still 32 active outbreaks in congregate living facilities in the state.This story will be updated.** Town-by-town COVID-19 case data **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
CONCORD, N.H. —
New Hampshire health officials announced Tuesday there were no new outbreaks of COVID-19 this week at long-term care and other congregate living facilities, and a dozen outbreaks, including one at the state Veterans Home, have closed.
The decreasing number of outbreaks follows other trends that show that while COVID-19 is still spreading widely in New Hampshire, the rate of spread is slowing some, with active cases, test positivity and hospitalizations all trending lower.
>> Latest coronavirus coverage from WMUR
“I am very pleased to announce we are closing the New Hampshire Veterans Home outbreak effective Jan. 26,” said Health Commissioner Lori Shibinette. “So, we’re very happy that that’s closed.”
Gov. Chris Sununu said the state’s efforts to vaccinate staff members and residents at the facilities may be helping to prevent or shut down outbreaks.
“It’s working,” Sununu said. “Yeah, there’s no doubt it’s having some effect.”
>> COVID-19 in New Hampshire: Important information
According to Dr. Beth Daly, chief of the state’s Bureau of Infectious Disease Control, 18,000 people in long-term care facilities have received the first dose of the vaccine, and about 5,000 have received the second dose. She said the total population of residents and staff members in those facilities is about 33,000, so there is more work to be done to get most of them vaccinated.
Health officials said more outbreaks are still likely until the virus is no longer spreading widely in the community. There are still 32 active outbreaks in congregate living facilities in the state.
Scientists are settling on a road map that can help critical sectors of the economy safely conduct business, from meatpacking plants to financial services, despite the pandemic’s continued spread.
After nearly a year of study, the lessons include: Mask-wearing, worker pods and good air flow are much more important than surface cleaning, temperature checks and plexiglass barriers in places like offices and restaurants. And more public-health experts now advocate wide use of cheap, rapid tests to detect cases quickly, in part because many scientists now think more than 50% of infections are transmitted by people without symptoms.
The playbook comes after months of investigations on how the coronavirus spreads and affects the body. Scientists combined that with knowledge gained from years of experience managing occupational-health hazards in high-risk workplaces, such as factories and chemical plants, where tiny airborne pollutants can build up and cause harm. They say different types of workplaces—taking into account the types of interactions workers have—need slightly different protocols.
The safety measures have taken on new urgency in recent weeks as new infections, hospitalizations and deaths rise across the U.S. and Europe, and potentially more-transmissible variants of the virus spread around the globe. This phase of the pandemic is prompting a new wave of stay-at-home orders, closures and travel restrictions, important first steps to curbing contagion. Infection-prevention specialists say known strategies for stemming spread should continue to work against the new variants, but that increased adherence is even more important.
Vaccines are rolling out, but slowly, and access will be limited mostly to high-priority groups for some time.
“We have to still deal with ‘the right now.’ We’ve zeroed in on this set of controls that we know work,” said
Joseph Allen,
director of the Healthy Buildings Program at the Harvard T.H. Chan School of Public Health.
Over the past year, the lack of consistent and cohesive messaging among scientists and lawmakers has seeded confusion over what makes up risky behavior, what activities should be avoided and why. That is beginning to change as consensus builds and scientists better understand the virus.
In the U.S., scientists at first advised people against wearing masks, in part because of shortages, while the idea of stay-at-home orders received severe pushback from some lawmakers. Early in the pandemic, testing was limited to people with symptoms, also partly due to shortages. That advice has shifted, but a year later, sufficient testing remains a critical issue.
London’s Regent Street was nearly empty last week.
Photo:
May James/SOPA Images /Zuma Press
Countries such as New Zealand and others in Asia adhered to a combination of basic mitigation strategies from the start—particularly masking, large-scale testing and lockdowns that broke transmission chains. They have tended to fare better than those that didn’t.
In one of his first moves, President
Biden
signed executive orders to require masks be worn on federal property and at airports and other transportation hubs. The administration said it is focusing on increasing the availability of vaccines, and also stressed the importance of widely available testing, which still lags in low-income and minority communities.
The current scientific playbook follows from two of the biggest research insights since the start of the pandemic. First, individuals who aren’t showing symptoms can transmit the virus. Infectious-disease experts worry most about this silent spread and say it is the reason the pandemic has been so hard to contain. While visibly sick people can pass on the virus, data cited by the Centers for Disease Control and Prevention estimate that 40% to 45% of those infected never develop symptoms at all. With the new viral variants that can transmit more readily, the potential for silent spread is even higher, infectious-disease experts said.
Secondly, researchers now know that tiny airborne particles known as aerosols play a role in the spread of Covid-19. These can linger in the air and travel beyond 6 feet.
An early hallmark of the pandemic response focused on the risk of transmission through large respiratory droplets that typically travel a few feet and then fall to the ground. Businesses rushed to buy plexiglass barriers, creating shortages.
The barriers can be good at preventing larger virus-containing droplets from landing on and infecting healthy individuals. They may offer some protection in shielding workers who have brief face-to-face interactions with many people throughout the workday, such as cashiers and receptionists, some occupational-health experts said.
Yet in settings like offices, restaurants or gyms, the role of the barriers is murkier, because activities like talking loudly and breathing deeply create aerosols that can waft on air currents and get around shields.
A Los Angeles Apparel employee added plexiglass to sewing stations in July.
Photo:
Sarah Reingewirtz/Orange County Register/Zuma Press
Outdoor diners at Eat At Joe’s restaurant in Redondo Beach, Calif., in December.
Photo:
patrick t. fallon/Agence France-Presse/Getty Images
A gym in Milan in October.
Photo:
DANIEL DAL ZENNARO/EPA-EFE/Shutterstock
Also, installing such barriers could affect airflow throughout the space, environmental-health experts said. It is possible they could limit proper ventilation, making things worse, they said.
“There seems to be an assumption that particles are going to get stopped by the barriers, which is simply not true,” said
Lisa Brosseau,
an industrial hygienist and research consultant for the University of Minnesota’s Center for Infectious Disease Research and Policy. Airborne particles ferrying the virus “really distribute all over the place.”
The emphasis on intense surface cleaning has diminished as scientists have come to understand that indirect transmission through contaminated surfaces doesn’t play as critical a role in the spread of Covid-19 as they thought in the early days of the pandemic. In September, the CDC published sanitation guidelines for offices, workplaces, homes and schools that said that, for most surfaces, normal, routine cleaning should suffice, and that frequently touched objects, such as light switches and doorknobs, should be cleaned and disinfected.
“Sanitation is important in general always,” said
Deborah Roy,
president of the American Society of Safety Professionals. “The idea is we went overboard at the beginning because of the amount of unknowns. Now, we’re in a situation where we have more information.”
Temperature checks have become less popular among some employers because scientists now know that not all Covid-19 patients get fevers. One large study published online in November in the New England Journal of Medicine showed only 13% of Covid-19 patients reported a fever during the course of their illness.
Scientists now understand that brief encounters with an infected person can lead to spread, according to an October case study—an advance from earlier, when the rule of thumb was to avoid close contact for 15 consecutive minutes or longer. The report urged people to consider not just time and proximity in defining close contact with a Covid case, but also ventilation, crowding and a person’s likelihood of generating aerosols. Following the report, the CDC changed its definition of close contact to a total of 15 minutes or more over a 24-hour period.
A flight attendant showed an air filter on LATAM airlines in Bogota in August.
Photo:
juan barreto/Agence France-Presse/Getty Images
Fresh air and effective filters indoors are important because they can remove virus particles before they have time to infect.
Masks offer a similar benefit, by lowering the amount of particles that infected individuals emit. Some scientists say there could be a benefit to doubling up on masks, as a second layer may improve both filtration and fit, so long as the masks are worn correctly.
A study published in October found that in countries where mask wearing was the norm or where governments put in place mask mandates, coronavirus mortality rates grew much more slowly than in countries without such measures. This fall, the CDC said that masks also offer some personal protection by reducing a wearer’s exposure to infected particles.
As the weather gets colder and people head indoors, the risk of catching Covid-19 is rising. WSJ explains why air ventilation and filtration are one of our biggest defenses against the coronavirus this winter. Illustration: Nick Collingwood/WSJ
The combination of airborne particles and personal interactions, even among people who don’t feel ill, can turn wedding receptions, plane rides and choir practices into superspreading, potentially deadly events.
“For Covid, those two factors—asymptomatic spread and aerosolization—is what made mask-wearing so essential,” said
Megan Ranney,
emergency physician and assistant dean at Brown University.
Lessons can be gleaned from an outbreak at a Canadian spin studio last fall. The operators of the SPINCO studio in Hamilton, Ontario, had many public-health measures in place, including limiting the number of bikes in each class and screening staff and attendees with a questionnaire about topics including symptoms and travel. Rooms were sanitized within 30 minutes of a completed class, and towels were laundered, according to a statement provided last fall by
Elizabeth Richardson,
medical officer of health for the city of Hamilton.
Masks were also required before and after workout classes, Dr. Richardson said.
In total, 54 people who attended workouts over a span of several classes became infected. Another 31 cases were tied to the outbreak after spin-class attendees who contracted the virus then passed it on. The spin studio temporarily shut down following the outbreak and later reopened. It is currently not offering classes due to local regulations that mandated the closure of all gyms and fitness centers amid rising Covid-19 cases in the area.
In a November statement following the outbreak,
Michelle August,
founder of SPINCO, said that the company has “always put safety first and [has] exceeded all recommended guidelines from public health throughout” the pandemic. She said SPINCO has also strengthened and heightened its Covid-19 mitigation measures. SPINCO’s website currently says face masks are mandated throughout workouts in the company’s Hamilton location.
It also says that SPINCO is installing air purifiers in all of its studios that filter air in the rooms every 17 to 21 minutes. Airborne transmission experts recommend that building managers pump in clean, fresh air between three to six times an hour and that they install filters that are proven to effectively trap and remove a substantial number of virus-carrying particles.
To film a stage play of “A Christmas Carol” in November, the Guthrie Theater in Minneapolis upgraded its air filters and increased the rate at which the ventilation system pumps in outside air, said
Brooke Hajinian,
the Guthrie’s general manager. Management staggered arrival times, and a compliance officer made sure everyone socially distanced, wore their masks properly and washed their hands.
The theater divided staff into pods depending on how close they must get to the lone actor on stage, who portrayed Charles Dickens and didn’t wear a mask while performing, according to Ms. Hajinian. Those working nearest the stage underwent testing three times a week and wore N95 masks at all times, she said, while cleaning and security crews, who didn’t interact with the stage crews, wore cloth masks and didn’t undergo testing.
Actor Nathaniel Fuller performed in ‘A Christmas Carol’ at the Guthrie Theater in Minneapolis.
Photo:
Kaitlin Schlick
Ms. Hajinian said she monitored the staff’s testing results and symptoms. “Any symptom is not a failure of this plan,” she said. Catching a case “and isolating it—that’s what success looks like for us,” she said. There were no cases, she said.
Scientists say multilayered safety efforts are needed because no single prevention method is 100% effective.
One of the largest studies of asymptomatic transmission to date showed that frequent testing was essential in identifying infections among a group of nearly 2,000 Marine recruits required to socially distance and wear masks except while eating and sleeping.
The study looked at cases identified with lab-based tests that search out and amplify the genetic material of the virus, but those tests aren’t as easily scaled as so-called rapid antigen tests, which search for viral proteins.
Results from lab-based tests can sometimes take days, while results from rapid tests are usually available in less than an hour. As a result, some epidemiologists have been advocating for widespread use of antigen tests to prevent outbreaks, because they are cheaper and don’t require high-tech laboratory equipment to run, meaning they can be deployed in a broader range of settings.
The shift toward using frequent, inexpensive and rapid tests on the same people multiple times a week to screen entire populations—instead of one-time tests on individuals who have symptoms—will be important to efficiently break transmission chains, epidemiologists said.
“Unless we’re doing really broad, frequent screening of the people at large, we’re completely missing the vast majority” of infections, said
Michael Mina,
an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health. “We have to change how we’re doing this.”
A Covid-19 testing site at the Alemany Farmers Market in San Francisco in November.
Photo:
David Paul Morris/Bloomberg News
While rapid tests tend to be less sensitive than lab-based tests, Dr. Mina said the data suggest they have high sensitivity when people are most likely to be infectious.
Other infectious-disease experts have touted contact tracing to identify and bust clusters of infection. But they say the strategy works best when cases aren’t surging, as they are now. When transmission rates are too high, limiting gatherings, travel and crowding are more effective at denting spread, said
Abraar Karan,
a global-health physician at Brigham and Women’s Hospital and Harvard Medical School.
In places without big surges, a high-tech approach is becoming increasingly useful: genetic epidemiology, or tracking tiny changes in viral genomes to map out transmission chains. As the coronavirus replicates and moves from person to person, its genes change slightly. Sometimes, those tiny changes are unusual, and they can be particularly useful in mapping transmission events, according to
Justin O’Grady,
an infectious disease expert at the Quadram Institute in the U.K.
By sifting through the differences among more than 1,000 viral genomes, Dr. O’Grady and his collaborators found that a particular viral variant was moving through multiple nursing homes in the U.K., among patients and staff, but not among the wider community. The unpublished data suggested that transmission was facilitated by the movement of staff from one facility to another, Dr. O’Grady said. The team relayed the findings to government authorities and advised them to restrict staff moving among facilities during the pandemic.
“Sometimes genomic epidemiology is able to find hidden transmission links that traditional epidemiology would struggle to find,” Dr. O’Grady said. “We can’t stop transmission, but when we find a superspreader event…we can bring in the right prevention methods to stop it from spreading further.”
A London ad urged safety measures last week.
Photo:
Dinendra Haria/London News Pictures /Zuma Press
—Betsy McKay contributed to this article.
Write to Daniela Hernandez at daniela.hernandez@wsj.com, Sarah Toy at sarah.toy@wsj.com and Caitlin McCabe at caitlin.mccabe@wsj.com
LONDON—Doctors began noticing the change last month as the U.K.’s new coronavirus variant spread. In hospital critical-care units, they were seeing more younger people and women with serious cases of Covid-19, a disease that previously inflicted its worst symptoms largely on older patients and men.
The shift—backed up now by statistical studies—is part of an urgent puzzle preoccupying British public-health officials as they race to understand a strain of the virus that is more transmissible and, some studies indicate, could be deadlier than earlier versions.
One early hypothesis, scientists say, is that one of the virus’s genetic mutations makes it better at invading a greater number of cells inside the body, leading to serious sickness in people who with previous Covid-19 variants would only have had mild or no symptoms.
David Strain, a physician and instructor at the University of Exeter’s medical school who is also treating Covid-19 patients, said initial research paints a picture of a virus variant that is like a burglar that has become better and breaking and entering—into vulnerable cells in this case, not houses.
“We think that’s why it’s making people sicker as well as being more transmissible,” Dr. Strain said.
Virologists suspect that it is a particular mutation known as N501Y on the new variant’s spike protein that has enhanced its ability to enter and infect human cells and to move more efficiently through the human body.
Some doctors, such as Dr. Strain, think that is behind the rise in younger people and women—who for most of the pandemic have become ill at lower rates—ending up in the hospital.
Some things, doctors and scientists say, don’t seem to have changed with the new variant. Once hospitalized, patients seem to have the same chance of survival as before and doctors can’t tell from symptoms which variant a patient has.
In London, the southeast and east of England, where the new variant was first identified in a test sample from Sept. 20, the mean age of patients admitted to intensive-care units fell from 61.4 years between September and the end of November to 58.9 years from Dec. 1 to Jan. 21.
The proportion of women admitted into ICUs rose from 30.1% to 35.1% in the same period. Data from the rest of the country show a similar pattern.
As new coronavirus variants sweep across the world, scientists are racing to understand how dangerous they could be. WSJ explains. Illustration: Alex Kuzoian/WSJ
Through December, the proportion of 18- to 54-year-olds admitted to English hospitals with Covid-19 also began to trend up, before a national lockdown was imposed on Jan. 4.
Not all doctors are convinced this is explained by mutations in the new variant. Some think it could also be a matter of behavior changes, with more people, especially younger ones, mixing during the holiday season and becoming infected.
Luke Allen, a local doctor in Oxford, for instance, said he has been treating more younger patients but that he is seeing more Covid-19 patients in general, and the ratio of people seems to be the same as in the first peak.
Parts of London have been hit particularly hard by the new virus variant.
Photo:
May James/Zuma Press
He attributes the increased numbers to the greater transmissibility of the new variant and increased socializing over the holidays. “That increases the chances of their contact with us,” Dr. Allen said.
There is still considerable debate around whether the new variant is in fact deadlier, as some research suggests.
The new variant, which has become the dominant version across the U.K., is estimated to be 30% to 70% more infectious than earlier varieties. Last week, a government health advisory panel said studies suggest there was a realistic possibility that it also could be 30% to 40% deadlier than the previous variant.
The advisers say their conclusions are tentative. “Although there’s uncertainty, we can’t always wait for certainty,” said
Peter Horby,
chairman of the panel, the New and Emerging Respiratory Virus Threats Advisory Group, or Nervtag.
Julian Tang, a clinical virologist and professor of respiratory medicine at the University of Leicester, said more evidence was needed to prove that the new variant was deadlier, given that social mixing was allowed during the winter months, greatly accelerating hospitalization rates.
“Viruses generally mutate to be more transmissible and less lethal,” he said.
The new variant’s spread has coincided with huge increases in the number of people hospitalized with Covid-19 and a rise in the number of people dying from the disease in the U.K., placing the state-run health service under unprecedented strain. Covid-19-related deaths in the U.K. are close to 100,000 since the start of the pandemic.
The disease caused by the variant so far doesn’t appear any different from that provoked by its ancestors, but because the virus itself is able to move around a patient’s system more easily, it can outpace the body’s immune response, doctors suspect.
“If you are getting much stronger binding you may need a lower infectious dose to become infected, which would increase the risk of transmission,” Dr. Horby said. “Then, if it’s been able to spread between cells much quicker within the lungs, then that may increase the rate of disease and the rate of inflammation which may then progress quicker than your body can respond to.”
To determine whether the new variant was deadlier, scientists looked at data from around 850,000 cases of the coronavirus tested in the community where they knew which variant of the virus each person had, including between 1,400 and 1,900 people who died.
“You have to compare people who are as similar as possible to each other,” said
John Edmunds,
an author of one of the studies by the London School of Hygiene & Tropical Medicine.
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The researchers matched groups of people based on age, sex and ethnicity as well as income and where they lived, to reduce the effect that pressure on hospitals might have had on death rates.
Dr. Edmunds’s group found that if two similar people had the coronavirus, the one who had the new variant was around 30% more likely to have died from the disease it causes. A group from Imperial College London found a similar likelihood of mortality with the new variant compared with its ancestor. University of Exeter researchers found a 91% increase in the risk of mortality from the new variant, though that could be because the population it examined skews older, Dr. Strain said.
Another study by Public Health England put the chances of dying after infection with the new variant around 65% higher than with the old version.
The results are preliminary and because only in around 10% of all the cases in the U.K. is the virus variant known, may not be representative of the population as a whole.
Write to Joanna Sugden at joanna.sugden@wsj.com and Max Colchester at max.colchester@wsj.com
The U.K.’s economy shrank more last year than any of the G-7, in what the Bank of England says will be the country’s biggest economic slump in more than 300 years.
What went wrong? Shutdowns caused greater pain for the U.K. than other members of the Group of Seven advanced economies in part because it is especially dependent on consumer spending, which evaporated amid one of Europe’s deadliest Covid-19 outbreaks. The economy was already weak after the four years of negotiations over Britain’s exit from the European Union, during which business investment sagged and households held back on spending.
This is the starting point for Britain’s new relationship with the EU, which began Jan. 1 with a loose free-trade agreement. Earlier this month, Prime Minister Boris Johnson announced another nationwide lockdown to fight a new, more-contagious variant of the coronavirus. That puts the U.K. economy on course to shrink again in the first quarter of the year, when businesses must also get to grips with new European trading arrangements.
Growth in the U.K. was already weak going into the pandemic because of feeble business investment, poor productivity and scant growth in incomes. Once the coronavirus set in, the British economy shrank by more than its peers in the G-7 in the first nine months of the year. Figures for the final quarter, due Feb. 12, are expected to show the economy contracted again.
The U.K. took a bigger hit because around 13% of its annual gross domestic product comes from spending on recreation and culture and in restaurants and hotels, a higher share than any other G-7 country. Businesses that depend on direct contact with consumers—bars and restaurants, sports events, hotels and theaters, cinemas and museums—were hobbled when social distancing became the norm and when the spread of the virus forced them to close. The current lockdown, in place through mid-February, closes schools and nonessential shops, and people have been told to leave home only if necessary.
China overtook the U.S. as the world’s top destination for new foreign direct investment last year, as the Covid-19 pandemic amplifies an eastward shift in the center of gravity of the global economy.
New investments by overseas businesses into the U.S., which for decades held the No. 1 spot, fell 49% in 2020, according to U.N. figures released Sunday, as the country struggled to curb the spread of the new coronavirus and economic output slumped.
China, long ranked No. 2, saw direct investments by foreign companies climb 4%, the United Nations Conference on Trade and Development said. Beijing used strict lockdowns to largely contain Covid-19 after the disease first emerged in a central Chinese city, and China’s gross domestic product grew even as most other major economies contracted last year.
The 2020 investment numbers underline China’s move toward the center of a global economy long dominated by the U.S.—a shift accelerated during the pandemic as China has cemented its position as the world’s factory floor and expanded its share of global trade.
While China attracted more new inflows last year, the total stock of foreign investment in the U.S. remains much larger, reflecting the decades it has spent as the most attractive location for foreign businesses looking to expand outside their home markets.
LONDON—British officials warned Friday that a coronavirus variant first identified in the U.K. might be more lethal as well as more transmissible than previous versions of the pathogen.
The conclusions of scientists advising the British government are still highly uncertain. But British Prime Minister Boris Johnson said in a televised address that the variant—which has caused Covid-19 infections across the U.K. to spike and is spreading rapidly in the U.S.—could result in higher death rates.
U.S. federal health authorities have said it is likely to become the dominant variant in the U.S. by March.
“We have been informed today that, in addition to spreading more quickly, it also now appears that there is some evidence that the new variant—the variant that was first identified in London and the South East—may be associated with a higher degree of mortality,” said Mr. Johnson.
The tentative conclusions come as British hospitals cope with more Covid-19 patients than at any time during the pandemic. The Covid-19 death toll in the U.K. is expected to pass 100,000 in the coming week.
JOHANNESBURG—Three new laboratory studies are raising concerns that the immune response triggered by a Covid-19 infection or vaccination may be less effective at protecting against the new strain of the coronavirus that first emerged in South Africa.
The findings come from experiments done in the laboratory and only look at certain elements of a body’s immune response. Still, they reinforce the possibility that vaccine makers and regulators will need to update Covid-19 vaccines as the virus evolves.
A fourth study, conducted by scientists at BioNTech SE and Pfizer Inc. and published by the companies, showed that their vaccine successfully neutralized a variant that was initially detected in the U.K. That study didn’t include the South African strain.
The U.K. variant has already spread to many other countries, including the U.S.
More than a year into the pandemic, the discovery of new variants that appear to have made the virus more contagious is forcing researchers to adapt their understanding of the coronavirus that causes Covid-19. One concern, researchers said, is that the new strains are emerging in countries where a significant percentage of people have already built up an immune response to earlier variants after getting Covid-19.
