Covid-19 Live Updates: Harrowing New Surge Rages Across America’s Heartland

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New reported cases by day in the United States

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Source: New York Times database of reports from state and local health agencies

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The latest coronavirus surge is raging across the American heartland, most acutely in the Midwest and Mountain West.

This harrowing third surge, which led to a U.S. single-day record of more than 85,000 new cases Friday, is happening less than two weeks from Election Day, which will mark the end of a campaign dominated by the pandemic and President Trump’s much-criticized response to it.

As of Friday evening, 15 states have added more cases in the past week than in any other seven-day stretch of the pandemic: Wisconsin, a battleground in the presidential election, Colorado, Kentucky, Illinois, Wyoming, Idaho, Utah, South Dakota, Montana, Arkansas, Alaska, Tennessee, Ohio, Indiana and North Dakota. And four states have added more deaths this week than in previous weeks: Wisconsin, Kentucky, South Dakota and Oklahoma.

North Dakota leads the nation in coronavirus cases per capita. Illinois is averaging more than 4,100 new cases per day, up 85 percent from the average two weeks ago. And Pennsylvania, another battleground state, on Friday reported a record of 2,258 cases.

The virus will be front of mind for voters in several key states: in Ohio, where more people are hospitalized than at any other time during the pandemic, and especially Wisconsin, home to seven of the country’s 10 metro areas with the highest numbers of recent cases. On Friday, the Wisconsin Supreme Court blocked Gov. Tony Evers’ emergency order restricting the size of indoor gatherings to 25 percent capacity on Friday.

Experts worry that the growing numbers in need of hospital care will only get worse if cases continue to mount, especially in rural areas where medical facilities could be quickly overwhelmed.

Credit…Hannah Mckay/Reuters

Citing a rise in hospitalizations across the state, the Colorado Department of Public Health and Environment announced a strengthening of coronavirus restrictions in certain counties, capping gatherings at 10 people from no more than two separate households. For the third straight day, Colorado announced a new single-day cases record on Friday.

Overnight, nearly 2,500 people were hospitalized in Illinois, the state’s top public health official, Dr. Ngozi Ezike, said in a news conference Friday afternoon. The mayor of Chicago, Lori E. Lightfoot, announced a curfew on nonessential businesses beginning at 10 p.m. on Friday.

In the latest presidential debate on Thursday night, President Trump asserted that the virus was “going away” as he defended his management of the pandemic. Former Vice President Joseph R. Biden Jr., the Democratic nominee, attacked Mr. Trump’s handling, calling for much more aggressive federal action for the “dark winter” ahead.

President Trump and many supporters blame restrictions on business activity, often imposed by Democratic governors and mayors, for prolonging the economic crisis initially caused by the virus. But the experience of states like Iowa, which recently set a record for patients hospitalized with Covid-19, shows the economy is far from back to normal even in Republican-led states that have imposed few business restrictions.

Iowa was one of only a handful of states that never imposed a full stay-at-home order. Restaurants, movie theaters, hair salons and bars were allowed to reopen starting in May, earlier than in most states. Many businesses worry they won’t be able to make it through the winter without more help from Congress. Others have already failed.

Defying the guidance of infectious disease experts, who say that universal masking and social distancing are essential to limiting the virus’s spread, has eroded support for both Mr. Trump and Gov. Kim Reynolds in Iowa, especially among voters over 65, normally a solid Republican constituency, according to public and private polls. Mr. Trump and Senator Joni Ernst — whose seat could play a decisive role in determining control of the Senate — are both in tight races in a state that the president easily won four years ago.

The high case count in part reflects increased testing. With about one million people tested on many days, the country is getting a far more accurate picture of how widely the virus has spread than it did in the spring.

But public health officials warn that Americans are heading into a dangerous phase, as cooler weather forces people indoors, where the virus spreads easily. It could make for a grueling winter that tests the discipline of the many people who have grown weary of masks and of turning down invitations to see family and friends.

Dr. Anthony S. Fauci, the nation’s leading expert on infectious diseases, again stressed the importance of wearing masks, socially distancing, avoiding crowds and regular hand washing Friday evening in an appearance on CNN.

“It’s not going to spontaneously turn around unless we do something about it,” he said, adding “I plead with the American public to please take these things seriously.”

Credit…Doug Mills/The New York Times

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said on Friday that the country should consider implementing a first-ever national mandate requiring masks, to help control a surge in coronavirus cases across the United States that has become the most severe to date.

Appearing on CNN, Dr. Fauci said that enforcing such a mandate would be difficult. But with conditions worsening across disparate regions of the country, he said he could be inclined to recommend the dramatic measure.

“There’s going to be a difficulty enforcing it,” he said, “but if everyone agrees that this is something that’s important and they mandate it and everybody pulls together and say, you know, we’re going to mandate it but let’s just do it, I think that would be a great idea to have everybody do it uniformly.”

Most states have imposed mask requirements to varying degrees, covering different spheres — such as indoor and outdoor spaces — at some point during the pandemic.

However, a minority of states, including Iowa, have resisted issuing directives on masks even as case counts have begun to climb to new highs. And even states and cities that have more restrictive orders in place tend to allow some exceptions, such as when people are exercising.

The White House has obstructed federal efforts that would have mandated masks in a more limited way, blocking an order drafted by the Centers for Disease Control and Prevention last month that would have required masks on public transportation.

But with more than a dozen states reporting more cases over the past week than in any other seven-day stretch during the pandemic, Dr. Fauci said that it may be necessary to have a more coordinated, national approach.

“I get the argument saying, ‘Well if you mandate a mask, then you’re going to have to enforce it and that’ll create more of a problem,’” he said. “Well, if people are not wearing masks then maybe we should be mandating it.”

Credit…Michael Probst/Associated Press

Warning signs flashed on Saturday that the pandemic has entered a dangerous phase across Europe, with several countries shattering daily infection records and uncertainty mounting about how the continent will battle its worst outbreak to date.

Deaths from the coronavirus in Germany surpassed 10,000 on Saturday, a disconcerting milestone in a country that has been widely admired for its ability to manage the pandemic. The number of new infections in a 24-hour period also reached a record level — 14,714 — although the country’s public health authority said that some of those cases should have been factored in earlier in the week but had not been because of technical issues.

Officials in Poland announced on Saturday that President Andrzej Duda had tested positive for the coronavirus at a time when the country’s de facto leader, Jaroslaw Kaczynski, was already in self-isolation after coming into contact with somebody earlier in the week who was infected.

The Belgian government, alarmed by the quickening pace of infections in the country of 11 million — the second-worst in Europe behind the Czech Republic — inched closer to a total lockdown with a spate of new restrictions on daily life. Officials moved up by two hours a curfew put in place last week, to 10 p.m. instead of midnight, for the next month, and required that all cultural and fitness venues such as gyms, pools, galleries and museums shut down. Commercial stores will be required to close at 8 p.m.

On Friday, several other countries, including France and Italy, recorded single-day records for new infections, according to data compiled by The New York Times. And the surge of new cases across the continent has pushed hospitalizations to alarming levels in countries such as Bulgaria, the Czech Republic and Hungary.

Local health authorities in Germany, who are responsible for the contact tracing of infected people, said they are increasingly overwhelmed, despite help from hundreds of soldiers who have been dispatched to communities across the country. In Frankfurt, a city of about 750,000 that serves as Germany’s banking capital, the number of new cases has quadrupled since the beginning of this month, and health officials there conceded that their ability to stop chains of infection had collapsed.

“It is no longer possible to trace each case,” the head of Frankfurt’s office of public health, René Gottschalk, told ZDF public television on Friday.

Credit…Bethany Baker/The Coloradoan, via Associated Press

As Colorado fights a spate of late-season wildfires, with residents hoping that a predicted blizzard on Sunday will finally bring things under control, the state’s governor is warning that the thick smoke spreading across mountain towns could hide coronavirus outbreaks.

“We do worry that the impact on respiratory conditions of the fires could mask the spread of Covid,” Gov. Jared Polis said at a news conference this week, asking residents to “please consider” getting tested if they have a cough or sore throat.

Crews in northern Colorado have spent several grueling days battling the East Troublesome fire amid 60-mile-an-hour wind gusts. Firefighters are struggling to control the 188,000-acre wildfire, which has destroyed an unknown number of homes while roaring through ranches, lakeside resorts and Rocky Mountain National Park.

Symptoms of smoke exposure such as wheezing, coughing and shortness of breath, are hard to distinguish from symptoms of the coronavirus, experts have said, making it difficult for many sufferers to know what is causing their discomfort.

“The early symptoms of Covid look a lot like breathing bad air for a period of hours,” Mr. Polis said.

Wildfire smoke can also make people more susceptible to catching the virus.

“When your immune system is overwhelmed by particles, it’s not going to do such a good job fighting other things, like viruses,” Sarah Henderson, a senior environmental health scientist at the British Columbia Centre for Disease Control, said this summer.

As of Saturday morning, there have been more than 92,000 confirmed coronavirus cases and 2,233 deaths in Colorado since the start of the pandemic, according to a New York Times database. Over the past week, the state has averaged almost 1,200 new cases per day, an increase of 81 percent from the average of two weeks earlier.

Credit…Jim Mone/Associated Press

With Covid-19 hospitalizations spiking again in many parts of the country, public health officials have expressed concerns about a perennial source of strain on the health care system: seasonal flu. As threats of a “twindemic” loom, health care workers have stressed the need for vaccination and other preventive measures to slow the spread of flu.

One insurance company is going further to try to mitigate the effects of flu season: UnitedHealthcare, the country’s largest health insurance company, plans to provide 200,000 at-risk patients with kits that include Tamiflu, the prescription antiviral treatment; a digital thermometer; and a coronavirus P.C.R. diagnostic test. People can take the test at home and mail it in for laboratory analysis, helping patients and doctors determine the cause of their symptoms. That’s important because the coronavirus and flu have similar symptoms but require different treatments.

“These viruses have proven themselves highly capable of putting strain on our health care system alone,” said Dr. Kelly Moore, an associate director of the Immunization Action Coalition. “Their combined impact is really worrisome.”

In late September, UnitedHealthcare began inviting its Medicare Advantage members to sign up for the kits either online or by phone, starting with a focus on those at highest risk for complications from Covid-19 and the flu, based on their age and health status. Since then, 120,000 people have enrolled, and the company has begun shipping the kits. The company has more than five million Medicare Advantage members.

Credit…Eve Edelheit for The New York Times

The United States is in the midst of one of the most severe surges of the coronavirus to date, with more new cases reported across the country on Friday than on any other single day since the pandemic began.

Since the start of October, the rise in cases has been steady and inexorable, with no plateau in sight. By Friday night, more than 85,000 new cases had been reported across the country, breaking a single-day record set on July 16 by more than 9,000 cases.

By that measure, Friday was the worst day of the pandemic, and health experts warned of a further surge as cold weather sets in.

For many, the soaring numbers brought back ragged memories of what it was like in mid-July, when the virus was raging through the Sun Belt.

Raymond Embry saw the worst of it up close. His small Arizona medical clinic had been giving about five coronavirus tests a day. That grew to dozens a day, and then came the surge on July 16, with 4,192 people lined up for tests to find out if they had the coronavirus.

That day, arguably the worst of the pandemic in the United States to that point, set records nationwide. By the end of that 24-hour period, a staggering 75,687 new cases had been reported around the country, and Arizona led the nation in deaths per capita.

On the Texas-Mexico border, mid-July was a nightmare. Johnny Salinas Jr., the owner of Salinas Funeral Home, was handling six to seven funerals a day, a number he would usually see over a week before the pandemic. Some of those included family members and relatives of employees.

But in some other parts of the country that day, the virus felt far away.

On July 16, towns in North Dakota were holding their annual summer festivals. People cheered the rodeos and danced together, maskless, in the streets.

Credit…Ting Shen for The New York Times

Late-stage coronavirus vaccine trials run by AstraZeneca and Johnson & Johnson have resumed in the United States after the companies said Friday that serious illnesses in a few volunteers appeared not to be related to the vaccines.

Federal health regulators gave AstraZeneca the green light after a six-week pause, concluding there was no evidence the experimental vaccine had directly caused neurological side effects reported in two participants. The AstraZeneca news was first reported by The Wall Street Journal.

Johnson & Johnson said that its trial, which had been on pause for 11 days, would restart after a company investigation determined that a “serious medical event” in one study volunteer had “no clear cause.” To maintain the integrity of the trial, the company said, it did not check whether the volunteer received the vaccine or the placebo.

Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration, welcomed the announcements, citing the urgent need for multiple vaccines to remain in the race for a product that could protect the global population from the coronavirus, which has already killed more than a million people worldwide.

“The demand for safe and effective Covid vaccines exceeds any single manufacturer’s production capacity,” Dr. Borio said. “We really need several in the field.”

An F.D.A. spokesperson declined to comment on Friday afternoon.

AstraZeneca and Johnson & Johnson are two of the four companies now in late-stage clinical trials in the U.S. for experimental coronavirus vaccines. Both companies are using adenoviruses, which typically cause harmless colds. The adenovirus is engineered so that it can chauffeur a coronavirus gene into human cells.

Their two high-profile competitors, Moderna and Pfizer, also in advanced trials, are instead using a technology based on genetic material known as mRNA. Delivered into human cells, the mRNA prompts the production of coronavirus proteins, triggering an immune response.

AstraZeneca moved swiftly into clinical trials, enrolling thousands of volunteers for its vaccine trials around the world in countries including Brazil, India, South Africa and Britain. A large, late-stage trial kicked off in the United States at the end of August. But all the trials were halted days later, on Sept. 6. A volunteer who had received the vaccine in the United Kingdom reportedly experienced symptoms of transverse myelitis, or inflammation of the spinal cord, triggering a global pause to the company’s efforts.

The incident sparked some concern among experts, who noted that a similar adverse neurological event, reported months ago, had occurred in another vaccinated volunteer. While this earlier event prompted its own pause in AstraZeneca’s trials, an independent safety board ultimately determined it was unrelated to the vaccine, allowing studies to resume.

Following the second AstraZeneca halt in September, trials abroad rapidly resumed in most countries. But the American hiatus persisted, with few details released as to why.

According to two vaccine experts familiar with the situation who were not authorized to discuss it publicly, the F.D.A. did not directly tie the vaccine to the two neurological illnesses, although it could not be ruled out. The agency has advised the company to alert study volunteers about related symptoms like weakness and numbness that might point to a milder case of transverse myelitis, the experts said.

Johnson & Johnson launched their Phase 3 trial on 60,000 volunteers in September. On October 12, the company announced its own trial pause, citing concerns that an illness had happened in one of its volunteers as well. The company has kept mostly quiet about the details of the incident.

“There are many possible factors that could have caused the event,” the company said. “Based on the information gathered to date and the input of independent experts, the Company has found no evidence that the vaccine candidate caused the event.”

Adverse events are not uncommon in large-scale vaccine trials. In some cases, they are caused by a vaccine. But investigations usually reveal that they’re coincidental — a simple matter of chance.

Before the pauses, both companies had indicated they would likely submit their vaccines for emergency authorization from the Food and Drug Administration within a few month’s time — perhaps even by year’s end. It remains unclear how much these plans have now been thrown into flux in the wake of trial delays. Results from AstraZeneca’s late-stage trials are still expected later this year, according to the statement. Johnson & Johnson did not provide an updated estimate in their statement.

Credit…Ethan Miller/Getty Images

With early voting underway and the election days away, many U.S. cities and states have imposed safety measures to protect voters and poll workers from exposure to the coronavirus.

But polling places could still become “mass gathering events,” the Centers for Disease Control and Prevention warned in an advisory released on Friday, adding that measures to prevent the spread of Covid-19 could be improved.

The C.D.C. based its latest advice on a survey of 522 poll workers in Delaware’s statewide primary in September. That survey did not indicate whether any cases of Covid-19 were linked to the voting centers.

Guidelines issued by the agency in June recommended various ways to minimize crowds at polling locations, including absentee voting, extended voting hours and the use of protective gear by poll workers assisting voters with coronavirus symptoms.

The C.D.C. also recommended putting up physical barriers between voting machines, spacing the machines apart from one another, indicating 6-foot distances with signs or floor markings for those waiting in line to vote and allowing curbside voting for people who are ill, among other measures.

The advisory published on Friday said that “a substantial proportion” of poll workers in the Delaware study saw incorrect mask use by voters, and said that “further messaging on proper mask use, including at polling locations, might be needed to strengthen the effectiveness of masks during upcoming elections.”

“Ensuring that ill voters can vote while maintaining poll worker and voter safety will be essential to minimizing transmission without restricting voting rights,” the advisory added.

But in Alabama, where curbside voting had been allowed, the state’s attorney general has ordered that it be stopped. On Wednesday, the U.S. Supreme Court upheld the ban.





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