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Sweden warns of first lockdown amid surge in COVID-19 cases


Swedish officials have warned that the country may need to implement its first lockdown amid the pandemic as the number of COVID-19 infections surged 100% in Stockholm over the past three weeks.

“We have a third wave of transmissions — it’s here now,” Johan Bratt, the acting health and medical care director for the Stockholm region, said Wednesday, Bloomberg reported.

The capital city recorded 6,336 new cases last week, compared with 3,225 for the week beginning Feb. 1, according to data.

“Even though vaccinations have started, it will take a long time before enough people are inoculated for us to go back to a more normal way of life,” Bratt said.

The country, which refrained from implementing a nationwide lockdown during the first wave of the pandemic, has been tightening restrictions over the past few weeks.

But Prime Minister Stefan Lofven said last week that the measures might not be enough.

“We are seeing an increase in cases again, we need to take new measures,” Lofven said, Bloomberg reported. “If the situation gets worse, the government is prepared to enforce a possible lockdown in parts of Sweden.”

The country, which refrained from implementing a nationwide lockdown during the first wave of the pandemic, has been tightening restrictions over the past few weeks.
AP



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Health

Pfizer and Moderna pledge a massive vaccine surge



“Because of the dire need to vaccinate more people, we have ramped up production of doses,” John Young, Pfizer’s chief business officer, told the House Energy and Commerce oversight and investigations subcommittee in prepared testimony.

But achieving a surge on that scale remains daunting. Pfizer and Moderna, the companies with the only authorized vaccines so far, will need to increase their combined deliveries to date of 75 million doses to reach their promised target of 220 million shots by March 31.

That’s a goal of 28 million doses each week on average, far greater than their performance so far. The Biden administration said last week that doses allotted to states would grow from 11 million to 13.5 million per week, and it also directed 2 million doses to pharmacies, part of allocations that are expected to increase modestly again this week.

If the companies are able to meet their projections, it would signal the beginning of the end of a period of deep frustration and mark faster progress against a pandemic that has claimed 500,000 lives in the United States. The slower-than-anticipated vaccine rollout has hampered progress toward vaccinating the 70 or 80 percent of the U.S. population of 330 million people required to achieve herd immunity against the coronavirus.

Pfizer and Moderna, which both make mRNA vaccines, fell far short of the delivery schedules set by the Trump administration in December, when their vaccines received emergency authorization from the Food and Drug Administration. But both companies are expressing confidence in their latest promises after continuing to invest in manufacturing and steadily advancing production. Combined, the two companies have contracts to provide 600 million doses, which they say will be ready by the end of July.

Pfizer, which is partnered with Germany’s BioNTech in production of its vaccine, has laid out an aggressive timeline for boosting deliveries in coming weeks, according to Young’s advance testimony. The company has been pouring money into doubling batch sizes and adding manufacturing suites, as well as making its own supply of crucial raw materials called lipids and creating its own finish-fill capacity to put batches of vaccine into vials for shipment.

Pfizer reported last week during President Biden’s visit to its Kalamazoo, Mich., manufacturing plant that it had reduced manufacturing time from 110 days to about 60 days.

Pfizer also benefited from an FDA decision that recognized “overfill” in its vials as a sixth dose, creating a 20 percent increase in its deliveries.

Uneven weekly production is among the reasons the Biden administration has not issued new promises beyond its initial goal of delivering 100 million shots within the president’s first 100 days, despite drugmakers’ more ambitious promises, according to a senior administration official who, like other officials addressing production schedules, spoke on the condition of anonymity because of the matter’s sensitivity.

The administration is aiming to hold the companies to their commitments, the official said, while maintaining “collaborative enough relationships where they will share risks, as opposed to putting a gun to their head and saying, ‘You have to do X or Y and we don’t want to hear anything about it.’ ”

Two other Biden administration officials said it was unlikely that 220 million vaccine doses would be distributed by the end of March, even if a quantity approaching that total was allocated to states and other jurisdictions without being shipped by then. One official said just shy of 200 million doses was a more realistic estimate.

The potential for a supply pinch as the first quarter draws to a close late next month could represent a smaller-scale reprise of problems that bedeviled the Trump administration at the end of last year. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, estimated Dec. 20 at a meeting of a CDC advisory panel that there would be 40 million doses delivered in December, 60 million in January and 100 million in February — projections that proved much higher than reality.

Publicly posted CDC data indicates that about 75 million doses had been delivered as of Monday — about 10 million fewer doses than the companies said in their prepared testimony that they have provided.

Federal officials said delivered doses were split about evenly between the two companies. About 44 million people have received shots, with nearly 20 million of those people having received both required injections, for a total of about 64 million shots.

Pfizer’s promise is to provide 120 million doses by the end of March, while Moderna has said it will supply 100 million doses by then. To meet its target, Pfizer would have to release more than 2 million doses a day, or more than 14 million a week, for the next five weeks. The company currently is providing about 9 million doses a week, according to one of the federal officials involved in the vaccine effort, with the expectation that it can climb steadily to about 13 million doses per week by the beginning of April. Moderna is expected to level out at about 10 million per week, the official said.

Moderna said in its prepared testimony that it had produced 45 million doses as of this week, which leaves 55 million, or more than 10 million per week, to reach its goal of 100 million by March 31.

“As we work to meet these goals, we are continually learning and working closely with our partners and the federal government to identify ways to address bottlenecks and accelerate our production,” Moderna President Stephen Hoge said in prepared remarks.

The single-shot Johnson & Johnson vaccine, which is expected to be authorized for emergency use as soon as this weekend, also will provide a significant boost, though federal officials say only a few million doses will immediately be available.

After that slow start, the company will deliver 20 million doses by the end of March, Johnson & Johnson said in its prepared testimony. By the end of April, the company is projected to have delivered nearly 60 million doses to the United States, officials said — well on its way to meet its promise of supplying 100 million doses by the end of June.

“The production of our vaccine is a highly complex process that requires very particular capabilities and experiences,” Richard Nettles, vice president of U.S. medical affairs for Johnson & Johnson’s Janssen division, said in his prepared testimony. “As a result, there are significant challenges inherent in scaling manufacturing output and accelerating the timeline needed for a coronavirus vaccine.”

To prepare for an expected surge of vaccine, federal officials are organizing mass vaccination sites in stadiums and parks throughout the country. They are directing more vaccine supply directly to retail pharmacies. And they are telling states that, within a few months, supply of the shots could begin to outpace demand, requiring a redoubled effort to persuade reluctant people to be immunized.

Andy Slavitt, a White House senior adviser on the coronavirus response, said he spends as much time on demand-side models as on those addressing supply shortages. Behavioral factors influencing vaccine hesitancy, he said, present a “different but no less critical challenge than getting a factory to produce more supply.”

Prepared testimony for the House hearing provided a more detailed public look inside the production of vaccines by companies that are traditionally secretive about their production procedures and data. Lack of visibility into production schedules for Pfizer, in particular, has been a source of frustration for federal officials, although senior Biden administration officials maintain they have stronger communication lines into the manufacturing process than did the Trump administration. That includes in-person monitoring of manufacturing “as needed,” according to a senior Biden administration official who spoke on the condition of anonymity because of the sensitivity of the matter.

One of the central aims of Biden’s team was to provide states with better supply forecasting so they could prepare the needed workforce, determine eligibility groups and set public expectations. In the first several weeks of the rollout, state officials complained of being caught off guard by last-minute changes to their allocations. Less than a week after Biden took office, the administration increased weekly allocations by 16 percent and pledged to provide estimates of anticipated supply three weeks in advance.

That has proved more challenging than the president’s team expected, in large part because production increases have been uneven. Biden’s advisers have been able to notify states of increased supply each week — typically on calls with governors led by Jeff Zients, the White House’s coronavirus coordinator — but the three-week estimates have become less reliable.

Much of the difficulty in supply forecasting owes to fill-finish bottlenecks, which federal officials describe as the most important obstacle to increasing manufacturing.

Last week, Moderna disclosed what it described as “short-term delays in the final stages of production and release of filled vials” encountered by its production partner, New Jersey-based Catalent. The same company is performing fill-finish functions for Johnson & Johnson. Moderna stressed that it would be able to meet monthly targets, and federal officials said there was no decrease in supply available to states. Moderna has asked the FDA to permit it to add up to five more doses in each of its vials, which currently hold 10 doses, which would improve finish-fill capacity by 50 percent.

Officials in states throughout the country maintain they have the ability to administer as much as five times the amount of vaccine they are receiving. The promise of a flood of shots, they say, could help them end the pandemic.

“We have the capacity and infrastructure in place to drastically ramp up how fast we can get shots in arms in Connecticut if we have the supply to make it happen,” said Connecticut Gov. Ned Lamont (D). “The Biden administration has provided predictability and increased numbers of doses, supporting our efforts at the state level, and so long as that continues, the light at the end of the tunnel gets closer and closer.”



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Christmas coronavirus surge better than some projections, but grim toll continues



Cases skyrocketed at the start of 2021, approaching a seven-day daily average of 250,000 around Jan. 10 before declining. But the toll on the health-care system was softer than expected.

Hospitals had braced for enormous spikes in patients that could have forced rationing care, exhausted already limited beds and sparked a nationwide shortage of health-care workers. But officials across the country said those dire predictions — a wave of severe Christmas cases weeks after a rapid increase from Thanksgiving — did not materialize in most places.

“The surge on top of a surge that could have happened didn’t really happen,” said Erin Bromage, a biology professor at the University of Massachusetts at Dartmouth. “We dodged a bullet, and we’ve done better than we could have, but we are still in a pretty terrible spot.”

Anthony S. Fauci, the nation’s top infectious-disease expert, said at a White House briefing Thursday that cases appeared to be plateauing, but he warned that it could be a temporary slowdown.

On Jan. 20, Anthony S. Fauci, the nation’s top infectious disease expert, reflected on his time under former president Donald Trump. (The Washington Post)

Hospital leaders and experts are still on edge. Variants of the coronavirus, including the B.1.1.7 strain, which originated in the United Kingdom and is believed to be 50 to 70 percent more contagious, could result in further case spikes in cold-weather months, when people are more likely to be indoors. And the availability of the coronavirus vaccines, while offering lifesaving protection to millions, could also lead to a false sense of complacency, particularly as they can be difficult to obtain.

“It’s like a pot of boiling water, so the temperature may have been turned down some, but it’s still dangerously hot,” said Carmela Coyle, chief executive of the California Hospital Association. “Plateauing is not a good thing.”

Infections soared in the aftermath of Thanksgiving, leading some to fear an even greater surge after back-to-back Christmas and New Year’s celebrations, where people would gather with family and friends, then travel back home, potentially spreading the virus with each step. The Transportation Security Administration recorded its highest number of airline travelers since the pandemic began around Christmas, exceeding 1 million daily.

Experts have floated several theories for why the holiday season dealt less damage than expected. Some people may have changed their behavior after seeing the Thanksgiving spike, such as by celebrating outdoors, limiting gatherings to immediate family or quarantining before Christmas. More people who have contracted the virus could be receiving treatment at home while the sickest patients are hospitalized.

Robert Kaplan, a medical professor at Stanford University who was among those raising alarms about a holiday surge, said hospitalizations appear to be dipping in states that already had high caseloads and rising in those that had lower caseloads.

“There may be some places in the country where there are fewer people eligible to get sick, because they’ve already been infected,” Kaplan said.

Los Angeles County faces one of the worst crises, with officials taking steps to conserve oxygen needed to treat covid-19 patients struggling to breathe and 11 percent of intensive care beds still available.

Researchers and county health officials released new projections Wednesday offering some good news: Hospitalizations have leveled off with enough ventilators to treat patients, and declines in admissions are projected, even under conservative estimates.

The bad news: Even with declining caseloads, the stress on hospitals will be so high that bed shortages will continue. Those who have been admitted are coming in with more severe cases of covid-19 and are more likely to die.

About 1 in 8 hospitalized covid-19 patients in Los Angeles died from September to November — a figure that doubled to 1 in 4 after Nov. 3.

Roger Lewis, who leads the Los Angeles County Department of Health Services modeling team, said the figures suggest hospitals are being more selective in whom they admit.

“With that level of hospital demand, clinicians are forced to be very careful to reserve hospital resources for patients who clearly need it to ensure that resource is available to those whose life depends on it,” Lewis said. “Decisions are being made now to send people home with instructions to come back rather than admitting as a precaution.”

Nicholas Testa, chief physician executive of Dignity Health, which operates four hospitals in Los Angeles County and two in neighboring San Bernardino County, said the hospitals experienced a Christmas surge, with admissions peaking 15 days after the holiday. He said the health system managed the increase in part because the lengths of stays have been shorter, and county and state officials have offered additional resources. Still, hospitals teetered on the brink of rationing care.

“We got as close to the edge of care as I ever want to be,” Testa said. “When you get to what’s called crisis care is when you have to start making decisions about [who gets] ICU beds and ventilators. We did not get to that point, thank God. It came pretty darn close.”

The American Hospital Association says others reported similar experiences.

“No one should be fooled that we are in an easy period right now,” said Nancy Foster, the group’s vice president for quality and patient safety policy. “The cold, hard data says we were on the brink in many places, many communities across the country.”

California appears to be in a stronger position statewide as Northern California avoids the brunt of crisis. Mark Ghaly, the state’s top health official, on Tuesday hailed an 8.5 percent decline in hospitalizations and 2.8 percent decline in ICU admissions over two weeks as a sign that the post-holiday surge was “not as bad” as projected.

President-elect Joe Biden attended a vigil for coronavirus victims the evening before his inauguration on Jan. 19. (The Washington Post)

Arizona has been another major coronavirus hot spot, reporting the nation’s highest per capita rates of new cases, hospitalizations and deaths through January. The hospitalization rate now stands at 65 per 100,000 residents, a slight decline from the start of the month.

Marjorie Bessel, chief clinical officer for Banner Health, Arizona’s largest health system, said the Jan. 11 peak, even if lower than expected, left hospital workers toiling in crowded conditions under enormous stress. Hospitals forced patients to share their rooms and repurposed labs and other areas, while corporate office staff were redeployed to the front lines.

“Yes, it could have been worse, and yes, it could have been better if there was more mitigation and more enforcement of mitigation,” said Bessel, who has criticized Gov. Doug Ducey (R) for declining to implement new restrictions to slow the virus’s spread. “Let’s just hope the worst is truly behind us, and we can continue to spend the next many, many months recovering from what we just went through.”

Parts of the country that weren’t as hard hit as the southwest heading into the Christmas season avoided a new crisis.

“We’re past the surge that could have come from Christmas and New Year’s,” Illinois Gov. J.B. Pritzker (D) said recently after lifting restrictions. “I say that with some trepidation, because you know, there’s always the possibility that we’ll see an upsurge from that. But I think with one incubation period past New Year’s Day, New Year’s Eve, our numbers look like good news.”

Louisville Mayor Greg Fischer (D) told residents at a recent town hall that hospitals avoided “extreme stress” in the holiday aftermath. In an interview, he said weekly cases hit 4,100 last week, a slight increase from a previous high, but the newly infected were disproportionately young and less likely to be hospitalized.

“We are seeing case counts spike, but we are not seeing a massive run to the hospitals,” Fischer said.

In Pennsylvania, the University of Pittsburgh Medical Center system prepared for hospitalizations across all of its facilities to approach 3,000 in January, more than twice the 1,200 mid-December peak. Instead, they have been declining to about 600 this week — a potential sign that residents learned lessons after a Thanksgiving spike.

“We prepared for the worst, but we deal with what exactly the realities are today,” said Donald Yealy, senior medical director at the system. “I would not be surprised if there was one final increase left. I don’t expect covid-19 infection and illness to just evaporate.”

About 3,900 deaths were reported Friday in the United States, suggesting Wednesday’s peak may not be an anomaly. The seven-day average of deaths in the weeks after Thanksgiving hovered around 2,500.

“We are getting, in some way, numb to the numbers,” said John Brownstein, chief innovation officer at Boston Children’s Hospital. “The numbers of hospitalizations, cases and death are still incredibly high. Even if we see a pullback, those numbers are still incredibly scary.”



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Celebrity

‘This Is Us’ Delayed ‘a Few Weeks’ Amid COVID Surge in Los Angeles


No need to set the DVR. This Is Us will air a repeat on Tuesday, January 19, following a delay in production due to the coronavirus pandemic.

“No new episode of #ThisIsUs tonight – Covid-related production delays in LA have forced us to delay a few weeks,” creator Dan Fogelman tweeted on Tuesday. “But the next few are big ones, and we are close, so we hope you’ll hang in there with us. Sorry!”

Us Weekly confirms the show will also air a repeat episode on Tuesday, January 26.

Following the holiday hiatus, This Is Us and many other series pushed their return to work from Monday, January 11, to Monday, January 18, after an unprecedented surge in coronavirus cases in Los Angeles. On December 28, the L.A. County Department of Public Health released a statement asking productions to consider closing.

Justin Hartley as Kevin and Caitlin Thompson as Madison on This Is Us NBC

“Although music, TV and film productions are allowed to operate, we ask you to strongly consider pausing work for a few weeks during this catastrophic surge in Covid cases,” the statement read. “Identify and delay higher risk activities, and focus on lower-risk work for now, if at all possible.”

Ahead of season 5, This Is Us Milo Ventimiglia opened up to Us exclusively about the show making changes amid the coronavirus, mostly behind the scenes. For example, the cast isn’t allowed on set while they’re not filming and can’t spend much time around the crew. That said, the show still has intimate scenes and the actors trust that everyone is being safe when not filming.

“I trust Mandy [Moore] and how she goes about her life away from work, and I think Mandy trusts me for how I go about my life away from work,” the Heroes alum, 43, told Us in October. “We’re always mindful of that. But no, you’re not going to see a Jack dummy or a Rebecca dummy — or Mandy kissing the Jack dummy or Milo kissing them Mandy dummy. It’s not gonna be that!”

Chrissy Metz also noted that filming is very different amid the pandemic.

“We have different zones, and we have all these protocols that we adhere to because we want to do the show,” the Breakthrough star, 40, told Us earlier this month. “The cast has decided to just be as careful as possible and we’re all staying home. Being on set is very strange — with a mask or in our pods or with face shields on — but you make the best of it and you just are grateful. I know there are shows that aren’t able to come back, which is such a shame and people are missing them desperately. So we just feel very grateful.”

This Is Us will return with new episodes on NBC Tuesday, February 2, at 8 p.m. ET.

Listen to Watch With Us to hear more about your favorite shows and for the latest TV news!





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CBS Studios delays production for five shows in LA amid COVID surge



CBS Studios is reportedly postponing the production of several of its popular shows in Los Angeles because of a coronavirus surge in the city

Five of the studios’ programs — including two from the hit “NCIS” series — will be affected by the pause, which pushes back the return of post-holiday production from Jan. 4 to Jan. 11, USA Today reported. 

In addition to “NCIS” and “NCIS: Los Angeles,” the shows include: “Seal Team,” “Why Women Kill,” and “Diary of a Future President.”

The programs air on CBS, streaming devices and other networks,

It’s unclear if other Hollywood studios plan to also delay production. 

But, SAG-AFTRA — the labor union representing film and TV actors — posted a message to its website indicating more pauses are likely. 

“Most entertainment productions will remain on hiatus until the second or third week of January if not later,” the group wrote in a Tuesday notice. 

“This means that the number of our member performers working on sets right now is reduced. Our safety protocols ensure appropriate precautions for the holiday hiatus period including additional time for testing prior to the resumption of production,” the message continued. 

Data from Los Angeles County health department showed on Wednesday 7,415 people were hospitalized with COVID-19 — a reported increase of over 1,000 percent from two months ago.

There were also 10,393 cases of the virus Wednesday, along with 274 deaths linked to the illness.



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Politics

Surge of gun violence added to the traumas of 2020


March for Our Lives in protest of gun violence in New York City in March 2018.

Night Owls, a themed open thread, appears at Daily Kos seven days a week


22 DAYS UNTIL JOE BIDEN AND KAMALA HARRIS TAKE THE OATH OF OFFICE


Champe Barton, Brian Freskos, and Daniel Nass at The Trace write—A Historic Surge in Gun Violence Compounds the Traumas of 2020In over a dozen cities, homicides rose by 50 percent or more this year. “It’s very likely that these increases are larger than any on record,” said one criminologist:

 From Oakland to Chicago to New York City, homicides and shootings crept toward — and sometimes exceeded — all-time highs. The sudden upswing reversed decades of progress, and provides a prism for the intersecting crises that characterized 2020. While researchers are still picking over the causes, the consequences of the violence are plain: Thousands of communities, families, and parents like Foster forced to manage terrible voids — and saddled with the knowledge that at any moment, more gunfire could tear open new ones.

Meanwhile, other types of crime such as burglary, larceny, and drug offenses declined across the country.

While nearly every type of gun violence spiked this year, mass shootings showed a particularly steep increase. In spite of the social isolation imposed by the pandemic, the number of shootings with four or more victims exceeded any recent year by more than 50 percent. […]





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With hospitals nearly overwhelmed, officials say California ‘cannot afford’ another holiday surge



The country’s most populous state has emerged as the new coronavirus epicenter, setting nationwide records for cases. The number of Californians hospitalized jumped 65 percent over a two-week period, to nearly 19,000 on Tuesday, and deaths have been hovering at nearly 250 a day, according to Washington Post tracking.

Administrators at some of California’s largest health-care systems warned Tuesday that Christmas and New Year’s gatherings could worsen the already grim picture. Some of the current surge can be attributed to Thanksgiving celebrations, they said, and they fear that if infections continue to mount, their facilities will become so strained they won’t be able to properly care for everyone.

“What we’re seeing right now is the Thanksgiving Day celebration effect,” said Stephen Parodi, the associate executive director of the Permanente Medical Group. “It is related to the travel, it is related to the gathering. We understand why people have done it, but we are really making a clarion and desperate call to Californians to not repeat what happened during Thanksgiving.”

“Our hospital systems cannot afford to see another increase like we’ve seen after Thanksgiving,” Parodi said.

Dec. 16 was a day of relief at Temple University Hospital in Philadelphia. Health-care workers lined up and some even teared up when they received a vaccine. (The Washington Post)

The SOS from medical centers in California was sounded on the same day that hope emerged the nation may be gaining access to an additional trove of coronavirus vaccines.

The Trump administration and Pfizer are close to a deal for the pharmaceutical giant to provide tens of millions of additional vaccine doses through next spring and summer, according to people familiar with the negotiations. The deal could be announced as soon as Wednesday.

As part of the agreement, Pfizer would get help from the federal government in procuring supplies to make the vaccine, said the individuals, who spoke on the condition of anonymity because they were not authorized to talk publicly about the matter.

The race to provide more vaccines appears ever more urgent in places such as Southern California. Hospitals there have resorted to keeping patients in hallways and converted conference rooms, as capacity in intensive care units across the region plummeted in recent days. Some facilities are now operating additional pop-up intensive care units to meet the demand.

But it’s not capacity that medical leaders worry most about. It’s staffing. Doctors, nurses and respiratory therapists are exhausted. At some Kaiser Permanente locations, nurses who usually care for one patient are being asked to handle three, said the system’s CEO, Greg A. Adams.

And it’s only going to get worse.

“The crux of the matter is the exhausted workers on the front lines,” said Thomas G. McGinn, an executive vice president at CommonSpirit Health, an affiliate of Dignity Health, one of the largest health systems in the nation.

McGinn was in New York during its dire spring surge, and he said what’s happening in California today is “a very similar situation to what I saw in New York.”

Some hospitals have begun postponing elective surgery and the state is implementing a plan to set up “alternate care sites” — better known as field hospitals — that will divert patients struggling with other maladies away from facilities overwhelmed with coronavirus patients.

Vanessa Walker, a medical director at Sutter Health in Northern California, said the surge is evident not only at big urban hospitals such as those in Los Angeles. It’s affecting rural facilities, too. Hospitals that in the past could have transferred patients to larger facilities for specialized care must now handle those patients themselves, she said.

“It’s affecting us all, everywhere,” Walker said.

Kaiser Permanente has not had to implement the state’s crisis standards of care, Parodi said in a statement to The Post. But he said that if the rate of new infections doesn’t slow, “it’s only a matter of time.”

“We hope not to get to the place where we have to start making extraordinarily difficult decisions that most of us have never had to face before,” Parodi said. “But with resources spread so thin — especially staffing — the only way we can avoid reaching crisis levels is if everybody takes action to stop the current spread of the virus.”

The news out of California came as much of the world’s attention remained focused on a new variant of the virus that has proliferated in Britain. There’s no evidence that the variant, officially known as B.1.1.7, causes more severe illness or greater risk of death. But it appears to be more contagious, a revelation that spurred a whirlwind of travel restrictions.

More than 50 countries banned arrivals from the United Kingdom, despite some experts’ belief the new variant may not have originated there. Among them was France, which halted transit along a key European trade route in a particularly disruptive move. On Tuesday, a limited reopening was announced, but France and Britain continued to argue over how to unblock the ports late into the night.

Prime Minister Boris Johnson, who initially said canceling Christmas gatherings would be “inhumane,” is now advising increasingly isolated Britons to do exactly that. More than a quarter of residents are living under strict lockdown, with shops, pubs and restaurants closed.

The U.S. has not imposed restrictions on travel from the United Kingdom, though officials said health authorities have been considering the best course. The Centers for Disease Control and Prevention said Tuesday that B.1.1.7 may already be circulating in the country.

“Ongoing travel between the United Kingdom and the United States, as well as the high prevalence of this variant among current UK infections, increase the likelihood of importation,” the CDC said in a scientific brief. “Given the small fraction of US infections that have been sequenced, the variant could already be in the United States without having been detected.”

There has been no evidence of the new variant in California, where samples are regularly tested. With the state already under enormous strain, Ghaly said health officials would be watching closely, concerned about how it could impact current efforts to contain and mitigate the virus.

“The last thing we want to do,” he said, “is let a new strain of covid come and spread more rapidly or easily across the state.”

Top U.S. disease trackers and drugmakers have said they believe that recently authorized vaccines will be effective against the coronavirus variant identified in the United Kingdom.

The first of those vaccines was produced by Pfizer, in collaboration with the German company BioNTech.

The U.S. government has been seeking an agreement that would provide an additional 100 million vaccine doses of that vaccine for the second quarter of next year. Pfizer has indicated it could provide 70 million in the second quarter and another 30 million in the third quarter, but also that it might be able to get to 100 million doses more quickly if it gets additional manufacturing capability.

The New York Times first reported Tuesday that Pfizer and the administration were close to a deal.

Under an existing contract, Pfizer has committed to providing the government with 100 million doses by the end of March. Moderna, the maker of the second vaccine to be authorized by federal regulators, has agreed to provide the same amount by the end of the first quarter.

Pfizer as recently as October had been urging the government to lock down an additional 100 million doses of its vaccine. But that did not happen, and when administration officials recently said they wanted to buy another 100 million, Pfizer said it had already committed most of its supply to other countries.

One person familiar with the negotiations said a priority for Pfizer has been activation of the Defense Production Act to create better access to some of the ingredients needed to produce the vaccine. The drugmaker has been stressing this point for several months, the person said, because some of the materials it needed had been snapped up by companies given priority under Operation Warp Speed, the government’s vaccine initiative. Michael Pratt, a spokesman for Operation Warp Speed, declined to comment.

Pfizer was the only company that did not take government money for research and development of a vaccine, which meant U.S. officials have had less insight into aspects of its manufacturing process, federal officials have said, and less certainty about where the company’s doses would be sold.

It was expected, the person said, that Wednesday’s deal would resolve this sticking point.

William Booth, Jacqueline Dupree, Derek Hawkins and Rick Noack contributed to this report.



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Some States Saw Thanksgiving Surge In Coronavirus Cases : Shots


A traveler adjusts her mask while waiting to check in for her flight at the Los Angeles International Airport on Monday, Nov. 23, 2020.

AP Photo/Jae C. Hong


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AP Photo/Jae C. Hong

A traveler adjusts her mask while waiting to check in for her flight at the Los Angeles International Airport on Monday, Nov. 23, 2020.

AP Photo/Jae C. Hong

As Thanksgiving approached, Americans were bombarded with warnings that holiday travel and gatherings would bring a “surge on top of a surge” — setting the country on a precarious path as it entered the next round of holidays in late December.

Three weeks later, many places are now contending with a wave of infections that local health authorities say were fueled by the Thanksgiving holiday, although some regions appear to have evaded a dramatic rise, at least so far.

“We are seeing a tremendous surge in cases in many locations around the United States that are associated with the Thanksgiving dinners, family get-togethers and social events,” says Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Much of the evidence comes from health departments that are tracing clusters of cases, but Osterholm suspects that hospitalizations and deaths — “lagging indicators” — will reveal the full impact in a few more weeks.

In the Texas capital of Austin, public health authorities said that Thanksgiving drove a surge of new infections that risks overwhelming hospitals. Massachusetts Governor Charlie Baker has urged residents not to “have a repeat” of Thanksgiving in the next round of holidays. And California — where cases have shot up a staggering 150% over the past two weeks — appears to be in the throes of a surge that is at least partly linked to Thanksgiving.

But even though the nationwide picture is mixed, Osterholm urges caution for the Christmas and New Year’s holidays.

No one’s trying to take Christmas away from anyone,” says Osterholm, “but we don’t want our future Christmases eliminated because somebody became infected and died. And that is exactly the experience we’re seeing off of Thanksgiving. So please take that as a hard lesson.”

In Philadelphia, cases were falling before the holiday and about five days later daily case numbers jumped by about 50 percent, says Dr. Thomas Farley, health commissioner for the city of Philadelphia.

His department found many examples of families and friends getting infected after sharing a meal together, including the case of one woman who started to develop symptoms the day before having 10 people over to celebrate.

“By the time we caught up with her early next week, seven of those 10 guests were now testing positive,” Farley says, “Multiply that even a few hundred times across the city, that’s enough to drive an entire epidemic.”

With cases so widespread, the country is essentially a sea of small outbreaks, with each community on its own trajectory, says Ellie Murray, an assistant professor of epidemiology at the Boston University School of Public Health.

The U.S is breaking daily records and hospitals are fuller than they’ve ever been in the pandemic, but it’s too early to know exactly how much of that can be linked to Thanksgiving, says Murray.

“We’re reasonably in a position where we can say that the really massive tsunami of cases didn’t happen and that suggests the precautions people took, on average, were pretty good,” says Murray.

A month ago, before Thanksgiving, the U.S. averaged about 163,000 new cases a day. The U.S. is now averaging more than 215,000 new cases a day. Some states with dire outbreaks in November put mask mandates in place just before Thanksgiving and have seen the pandemic slow down since then. Iowa, for instance, started a mask mandate on Nov. 17. In mid-November, Iowa reached an average peak of nearly 5,000 new daily cases but that has now dropped to just under 1,600 new cases a day.

“It looks from the data that we’re in some middle place, it wasn’t as bad as it could have been, it wasn’t as good as it could have been,” Murray says.

Doctors see the frightening fallout from Thanksgiving first hand

It was about ten days after Thanksgiving when Vishnu Chundi, an infectious disease physician in Chicago, started to see the aftermath of the holiday in his hospital.

In one case, a retired nurse he knew, as well as her husband and two children, all got infected after a dinner gathering.

“She didn’t think this could happen to her and yet it did. And that’s the take-home point for all of this,” says Chundi, who chairs a COVID Task Force for the Chicago Medical Society. The nurse’s husband and children survived; his former colleague did not. “It just broke my heart when she died.”

Chundi says there are “innumerable examples” among his clinical colleagues of families who had visitors over for Thanksgiving dinner and ended up getting sick.

“This is unnecessary, and it’s sad to watch people who still have a lot of quality life left being taken away by this virus,” he says.

At his hospital in Washington state, Dr. Nathan Schlicher is also seeing patients who appear to have contracted the virus during a multigenerational Thanksgiving gathering.

“I took care of a 3-month-old last night that had been together with grandma, and grandma had COVID,” he says. “Unfortunately the 3-month-old now has COVID.”

Schlicher shares the temptation to see his parents and sisters over the Christmas holidays, but he won’t do it.

He actually got the first dose of the COVID-19 vaccine this week, but he has no plans to change his behavior.

“I could still get the disease and it doesn’t change the fact that the rest of my family isn’t vaccinated.”

One day can ‘change the entire course’

While it’s hard to draw conclusions nationally, some local and state health departments report that the Thanksgiving holiday clearly ushered in a new infection within their communities.

“There is no question in my mind that we now know from Thanksgiving that get-togethers on a single day can change the entire course of the epidemic,” says Farley, the Philadelphia health commissioner.

On Long Island, a surge emerged within a week of Thanksgiving — in much the same way it did after Halloween, says Dr. Gregson Pigott, Suffolk County Commissioner of Health.

“That’s the frustrating thing, we’re trying to do our best to control the pandemic, to keep a lid on it, but despite our best efforts the numbers are going up,” he says.

Daily cases jumped from around 600 to about 900 starting in early December and infections have not slowed down since, he says. The spike came even after public advisories and media coverage called on people to limit gatherings to immediate members of a household and to avoid travel.

“I see all these messages out there, but we can’t control human behavior,” Pigott says.

Not all states suffered the same fate. Some states believe they may have dodged a post-Thanksgiving surge.

Oregon and Colorado did not see a marked increase in cases after the holiday. It was a similar situation in the hard-hit upper Midwest, including Minnesota and Michigan.

In other places, it’s possible the holiday did not make a big difference because there are many other events driving infections.

Dr. Karen Landers, assistant state health officer for the Alabama Department of Public Health, says her state is finding some cases related to the holiday.

“But we were already in an upward trend, so it’s just another event on top of an upward trend,” she says.

This story is from NPR’s partnership with Kaiser Health News.



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Restaurants Scramble Amid Cold, COVID Surge


         Controlling the indoor environment        

As far as indoor dining, there are many environmental controls available that could reduce risk of transmission, said Oscar Alleyne, chief of programs and services for the National Association of County and City Health Officials.

Restaurants can increase the rate of ventilation in their buildings and install high-quality air filters that can filter viruses out of HVAC-circulated air, Alleyne said.

They also can invest in supplemental portable air cleaners with HEPA filters, cut down on occupancy, increase space between tables and strictly enforce social distancing, he said.

“If there’s an intense approach on addressing environmental controls, that in and of itself would make things safer,” Alleyne said.

Stepped-up environmental controls also won’t break the bank, Allen added.

“Upgrading the filters costs a couple extra dollars. A good portable cleaner with a HEPA filter could be a couple hundred dollars,” Allen said. “I’m not talking about million-dollar fixes.”

However, reducing the restaurant’s level of occupancy to acceptable levels will severely challenge its profitability, Allen said.

“If you got to the level of de-densification that would be necessary to lower risk, I don’t know if that is economically viable for a restaurant,” Allen said.

Restaurants have been making financial changes to deal with lower capacity, Lynch said. They’ve tightened their menus to reduce food waste, and have held off bringing back staff laid off during the first lockdown.

The industry continues to look for new ways to make indoor dining safer, Lynch said.

For example, the National Restaurant Association is working with a leading HVAC association about ways to further improve ventilation and air filtration in buildings, Lynch said. One idea being explored is retrofitting virus-killing UV light filters into a building’s existing HVAC system, so that air is further sanitized as it is circulated.

But even if all of these measures are successfully undertaken, the human element remains a significant impediment to safety, Allen said.

“The risk levels are many in a restaurant,” Allen said. “It’s not just that people aren’t wearing masks at their tables. It’s volume and loud talking, which increases emission rates. It’s alcohol consumption, which lowers inhibition. It’s mixing of multiple groups at tables, if you go out with friends you’re not normally quarantined with.





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U.S. Surgeon General Blames ‘Pandemic Fatigue’ For Recent COVID-19 Surge : Coronavirus Updates : NPR


Surgeon General Jerome Adams, pictured on Capitol Hill on Sept. 9, says the Trump administration coronavirus task force is sharing information with “everyone,” despite claims that they are not sharing information with the Biden transition team.

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Surgeon General Jerome Adams, pictured on Capitol Hill on Sept. 9, says the Trump administration coronavirus task force is sharing information with “everyone,” despite claims that they are not sharing information with the Biden transition team.

Michael Reynolds/AP

The COVID-19 crisis in the U.S. is getting worse by nearly every metric. On Friday alone, there were more than 184,000 new confirmed cases and 1,400 deaths, the Johns Hopkins Coronavirus Resource Center reported. Hospitals are reaching capacity. To date in the U.S., there have been more than 10 million confirmed cases of the virus and more than 240,000 have died — more than any other nation.

U.S. Surgeon General Jerome Adams says “pandemic fatigue” is largely to blame. People are tired and aren’t taking mitigation measures as seriously as before, he says.

“The virus hit different places of the country at different points,” Adams, who is also a member of the White House Coronavirus Task Force, tells NPR’s All Things Considered. “And so you’ve had people who’ve been doing these things since February, March, April, but they didn’t really start to see the wave until later on. And they’re just plain tired.”

As the winter months and holidays approach, people can be tempted to escape the cold and spend time indoors with friends and family. Adams is encouraging people to have a virtual dinner or celebrate Thanksgiving only with other people who live in their household.

“The three W’s are most important if you do come together around other people: wear a mask, wash your hands and frequently disinfect commonly touched surfaces, and watch your distance from other people,” Adams says. “And if you can’t do these things in this environment where you’re planning on coming together, then you should probably stay home because, again, this virus is incredibly unforgiving.”

Despite the national case spike, President Trump said Friday he won’t endorse any new lockdown measures while he’s in office.

And the White House Coronavirus Task Force reportedly still meets once a week, but no longer holds the daily briefings that it did in the spring.

Adams says it’s because the task force is shifting its attention toward regional outreach instead of national briefings for its messaging efforts, as cases go up aggressively in states such as North Dakota, South Dakota, Iowa, Wyoming and Wisconsin. He says they are going to states to give guidance “on the ground.”

“Because people in North Dakota or people in Arkansas or people in California may not feel that they have to take the same measures as someone in New York City,” Adams says. “So I’ve been in South Dakota. I’ve been in Wisconsin. I’ve been in Ohio just over the past two weeks, really speaking directly to people, helping them understand their surges that are going on and the measures that they need to take at their state level.”

While the Trump administration’s days are waning, Trump has still refused to concede and administration health officials have not started working with President-elect Biden’s team on coronavirus response.

Atul Gawande, a surgeon and professor at Harvard University who is part of the Biden coronavirus advisory group, told NPR on Friday that they have been “denied access to the agencies and to actually starting formally a transition with the Trump administration.” He said knowing more information now, weeks before Biden’s inauguration, “can make a big difference.”

“We do not have access to talking to the agencies, to Dr. Fauci, to people who have information about what the status is of mask supplies and glove supplies, what the threat assessments are, what the distribution plans for vaccines are,” Gawande said. “That will be important and very much in the national interest to be able to work together on that.”

Adams denies that is the case and says the task force is “sharing information with everyone.”

“There is no information that we have that we don’t share with the American public in general, and that is not available to the Biden task force,” Adams says. “And so I’m here and I’m willing to talk to anybody at any point. And that’s the most honest answer that I can give you, because I think we all need to have the information to make informed decisions and to really take measures to protect ourselves.”

Robert Baldwin III and Tinbete Ermyas produced and edited the audio version of this story.



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