Wednesday, December 2, 2020
Tuesday, December 1, 2020
Trump’s real reason for not accepting election results?
Report: Trump has raised more than $150 million since Election Day
Catherine Garcia
Mon, November 30, 2020, 10:44 PM CST
Since Election Day, President Trump's political operation has raised more than $150 million, with much of the money coming from small-time donors who tend to get fired up when they believe Trump is under attack, people with knowledge of the matter told The Washington Post.
In the wake of the election, the Trump campaign has sent roughly 500 pitches to donors, the Post reports, with the messages including demands to end voter fraud and a plea from Vice President Mike Pence to join the "Election Defense Task Force." The Trump campaign's website states that the Official Election Defense Fund is soliciting the money, but this account doesn't exist, the Post says, and the fundraising requests are actually coming from the Trump Make America Great Again Committee, a joint fundraising committee benefiting the Trump campaign and Republican National Committee.
As of Nov. 18, a third entity is also receiving money from the joint fundraising committee: Save America, Trump's new leadership PAC. In the fine print of the most recent fundraising letters, it says 75 percent of every contribution will go to Save America, with the remaining 25 percent going to help with the RNC's operating expenses. Trump set up Save America in early November, and will be able to tap into its funds when he is out of office, the Post reports. There aren't many limitations as to how leadership PAC money can be spent, and Trump could use it for events at his properties or to pay for travel and personal expenses, the Post says.
The Trump machine is raising more money now than ever before — the Trump Make America Great Again Committee's previous best month was September, when it brought in $81 million — and that's too much for some GOP donors, like Dan Eberhart. "Trump is making hay while the sun is shining," Eberhart told the Post. "He's taking advantage of all the free media coverage to pay off his campaign debt and fill his coffers for whatever comes next. I would rather give to Romney 2012 than Trump 2020 at this point."
Above is from: https://www.yahoo.com/news/report-trump-raised-more-150-044424719.html
December 1: Johns Hopkins COVID 19 Report
COVID-19
Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.
Additional resources are available on our website.
The Johns Hopkins Center for Health Security also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.
Giving Tuesday
Today is #GivingTuesday, the global day of giving. We hope you will consider supporting causes that are meaningful to you, including the many organizations providing on-the-ground support for the COVID-19 response. If you are able to make a donation, please consider supporting these response efforts.
The COVID-19 Situation Report is produced by the Johns Hopkins Center for Health Security, and the support of our donors helps us continue to provide analysis and resources. Please consider making a gift to the Center’s COVID-19 Response Fund.
EPI UPDATE The WHO COVID-19 Dashboard reports 62.66 million cases and 1.46 million deaths as of 5:15am EST on December 1. The WHO surpassed 60 million cumulative cases on November 26. From the first COVID-19 case, it took 90 days for the global total to reach 1 million cases. From there:
1 million to 10 million- 86 days
10 to 20 million- 44 days
20 to 30 million- 37 days
30 to 40 million- 31 days
40 to 50 million- 21 days
50 to 60 million- 17 days
UNITED STATES
The US CDC reported 13.30 million total cases and 266,051 deaths. The US surpassed 13 million cumulative cases on November 28. From the first case reported in the US on January 22, it took 96 days to reach 1 million cases. From there:
1 to 2 million- 44 days
2 to 3 million- 27 days
3 to 4 million- 15 days
4 to 5 million- 17 days
5 to 6 million- 22 days
6 to 7 million- 25 days
7 to 8 million- 21 days
8 to 9 million- 14 days
9 to 10 million- 10 days
10 to 11 million- 7 days
11 to 12 million- 5 days
12 to 13 million- 7 days
The US reported 12,999,624 cases on November 27, and it is likely that the US would have surpassed 13 million cases a day earlier, if not for delayed reporting over the Thanksgiving holiday.
The US COVID-19 average daily incidence and mortality both reached a peak over the Thanksgiving holiday weekend. On November 25, the US reported 173,518 new cases per day, a new record, and 1,658 deaths per day, the highest average since May 11. Both the daily incidence and mortality fell sharply since then, which is likely an artifact of reporting delays over the holiday weekend. Some of the direct effects of the Thanksgiving holiday are readily evident in the CDC’s COVID-19 incidence reporting. As expected during a normal week, the daily incidence increased for data collected November 23-25, corresponding to Monday through Wednesday (the final workday before Thanksgiving, which falls on a Thursday). The reported incidence fell sharply on Thursday, November 26 (Thanksgiving Day); jumped back up on Friday, November 27; and then fell again for the weekend reports on November 28-29.
It appears as though the national daily incidence may have passed an inflection point in mid-November. Prior to Thanksgiving, the daily incidence in a number of states—including Illinois, Iowa, North and South Dakota, and Wisconsin, all of which exhibited very high incidence during the current surge—began to taper off. However, with the interruptions to COVID-19 reporting and the varying trends at the state level, it could be a little more difficult to anticipate daily incidence trends over the next week or so. Regardless of what the daily incidence trend looks like in the wake of Thanksgiving, COVID-19 mortality in the US will likely continue to increase due to consistent and sharp increases in daily incidence over the past several weeks.
It will be critical to monitor these trends over the coming weeks to determine the impact of Thanksgiving travel and gatherings. Any spikes in cases this week are likely attributable to disruptions in reporting over the holiday. It will likely take 2-3 weeks before we begin to see any actual effects from Thanksgiving in cases and hospitalizations and several weeks after that before we could observe early signs in terms of mortality. We have observed this timing following several other US holidays or major events in 2020, including Memorial Day (May 23-25) and Labor Day (September 5-7)/the return of students to college and university campuses (early September). If the US epidemic follows a similar timeline after Thanksgiving, we could potentially start to see increasing daily incidence in the US the week of Christmas and surging mortality early in 2021. With that in mind, however, reporting over the weeks of Christmas and New Year’s are also expected to be inconsistent, so the effect of the holiday season on the US epidemic may not be apparent until well into January.
The Johns Hopkins CSSE dashboard reported 13.58 million US cases and 268,880 deaths as of 12:30pm EST on December 1.
US ISOLATION & QUARANTINE DURATION Last week, White House Coronavirus Task Force member ADM Brett Giroir commented that senior health officials are reevaluating the recommended time that individuals should quarantine after a known exposure to SARS-CoV-2 with an eye toward shortening the quarantine period. A recent study published in TheLancet found that the length of time that individuals can shed viable SARS-CoV-2 is shorter than previously believed. The US CDC currently recommends that exposed individuals quarantine for 2 weeks after their last close contact with a COVID-19 case and that infected individuals should isolate for at least 10 days after the onset of symptoms and at least 24 hours after the fever resolves. Updated CDC guidance could potentially include a provision to shorten quarantine or isolation if accompanied by negative results for a diagnostic test administered after a certain amount of time. This story was initially covered by news media outlets this time last week; however, no formal announcement has been made regarding changes to the official CDC guidance.
Reducing the quarantine or isolation period could potentially increase compliance by individuals who are not willing or able to isolate or quarantine for the full period currently recommended by the CDC. It could also reduce the impacts on employers and the US economy that result from workers being unavailable to perform in-person duties. There are concerns, however, that removing individuals from quarantine or isolation earlier could result in transmission by individuals who become or remain infectious after that point.
US LONG-TERM CARE FACILITIES As we have covered previously, residents of nursing homes and other long-term care facilities remain at high risk for severe COVID-19 disease and death. A report published on November 25 by the Kaiser Family Foundation finds that more than 100,000 COVID-19 deaths have been reported in the US among long-term care facility residents and staff. Notably, the cumulative total jumped from 84,136 in October to 100,033 in November, the highest 1-month increase since May. The report notes that these figures are likely an underestimate of COVID-19 deaths at these facilities, including due to delays in reporting—and no reporting at all by Alaska. Long-term care facilities account for 40% of all US COVID-19 deaths.
The ongoing COVID-19 surge in the Midwest region, and across most of the US, is fueling outbreaks in nursing homes and other long-term care facilities. In South Dakota, for example, the number of cases reported at these facilities tripled over the past month. Additionally, the total number of facilities reporting COVID-19 cases is approximately 30% higher than previous peaks, with more than 1,300 facilities nationwide reporting cases in the first week of November alone. In one long-term care facility for military veterans in Illinois, 4 cases identified in early November grew to nearly 200 cases within 3 weeks, resulting in at least 28 deaths. Health officials and experts as well as representatives for long-term care facilities across the country continue to call on the federal government to provide additional funding and support to help these facilities prepare for, prevent, and respond to COVID-19 outbreaks.
US VACCINE ALLOCATION As vaccine candidates get closer to receiving Emergency Use Authorizations (EUAs) under the US FDA, officials and health experts are working diligently to determine how the first doses should be allocated. Officials from the White House’s Operation Warp Speed announced that the initial doses purchased by the US government will be allocated to states based on population. From there, the current plan is for states to determine how best to allocate their allotted vaccines to individuals.
Prioritizing the initial limited supply of vaccine doses is a major challenge, with a number of competing factors with respect to determining which individuals are the highest priority. Last week, the CDC’s Advisory Committee on Immunization Practices (ACIP), which issues recommendations for a variety of vaccines used in the US, presented its preliminary guidelines regarding “phased allocation” of SARS-CoV-2 vaccines. The preliminary guidance indicates that the highest priority (Phase 1a) should include frontline healthcare workers and residents in long-term care facilities. Phase 1b would expand access to other essential workers, including in the education, food and agriculture, public utility, law enforcement and corrections, emergency response (e.g., firefighters), and transportation sectors. And Phase 1c would include those at elevated risk for severe COVID-19 disease, including those with underlying health conditions and those aged 65 and older. The Phase 1 plan received general agreement from the ACIP members, but additional data and discussion were needed.
The CDC announced an emergency meeting of ACIP, held today from 2-5pm EST, with the aim of finalizing the initial allocation guidance. Considering that the US FDA’s Vaccines and Related Biological Products Advisory Committee is scheduled to meet on December 10 to discuss the EUA application for Pfizer’s candidate SARS-CoV-2 vaccine and that US states are supposed to submit vaccination plans this week, the CDC wants to finalize the allocation plans in order to mitigate any delays in initiating mass vaccination efforts. ACIP is expected to formally approve Phase 1a, but further analysis and discussion may be needed before developing and approving the guidance beyond that. The meeting is scheduled for 2-5pm EST today, and the proceedings will be streamed live.
EUROPE As a whole, Europe has passed the peak of its current COVID-19 wave, and while a number of European countries have not yet turned the corner, some are beginning to announce plans to relax social distancing restrictions. The UK recently unveiled its COVID-19 Winter Plan, which outlines steps to return England to a “regional, tiered approach” to COVID-19 restrictions as opposed to a nationwide “stay at home” order. Retail stores, gyms and fitness centers, and other businesses will be permitted to reopen, and highly restrictive limits on attendance at religious services, weddings and funerals, and outdoor gatherings will be relaxed. The regional restrictions are scheduled to resume on December 2.
The UK government also announced COVID-19 policies specifically for the upcoming Christmas holiday, which will apply to all 4 countries in the UK—England, Northern Ireland, Scotland, and Wales. The Christmas plan “will allow some increased social contact for everyone,” including through the use of a “Christmas bubble.” The Christmas bubble can consist of individuals from up to 3 different households, and individuals in the bubble can gather in private homes, places or worship, and other locations without being limited by regional tiered restrictions. The Christmas bubble announcement comes at the end of a year in which holidays, ceremonies, and festivals across all religions have been muted by COVID-19 restrictions. The relaxation of COVID-19 gathering and travel restrictions specifically tied to Christmas, in the UK and other European countries, has generated frustration among some members of non-Christian religions, particularly those who faced restrictions earlier in the year during their own religious holidays. There is also concern that the temporary relaxation of COVID-19 restrictions that would permit increased travel and larger gatherings could result in another surge early in 2021. European governments are attempting to balance COVID-19 health risks against religious practices, social gatherings, and broad economic impact associated with Christmas.
France is also scaling back its COVID-19 restrictions. On November 24, French President Emmanuel Macron announced a timeline and epidemiological metrics for easing some social distancing restrictions over the coming weeks. Beginning on November 28, France eased travel restrictions and permitted outdoor activities to resume and some retail businesses and home services to reopen. If France is able to reduce daily incidence to fewer than 5,000 new cases per day and intensive care hospitalizations to fewer than 3,000 patients, it could enter the next phase, which will further reduce travel restrictions; allow theaters, cinemas, and museums to reopen; and permit indoor recreational activities. And if the epidemiological conditions are satisfactory on January 20 (not specified explicitly), restaurants and indoor sports facilities can reopen and high school students can resume in-person classes.
While some European countries are beginning to remove restrictions, others are extending current COVID-19 measures. For example, Greece is reportedly extending its current “lockdown” period by a week, through December 7, following a record high 121 deaths on November 28. Greece’s daily COVID-19 incidence peaked in mid-November, but the government has been fairly aggressive in terms of implementing COVID-19 restrictions. One of Greece’s principal concerns is that long-term economic struggles have negatively impacted national health system capacity, and implementing restrictions earlier and longer than other European countries could curb transmission before hospitals are overwhelmed. The current lockdown began in early November, with highly restrictive measures, including a requirement for individuals to notify the government via text/SMS message before leaving their homes. Reportedly, Greece recently issued more than €500,000 in fines and ordered a 15-day closure of multiple businesses in a single day following violations of national COVID-19 restrictions.
ASTRAZENECA VACCINE TRIAL DATA Following the release of interim Phase 3 clinical trial data for its candidate SARS-CoV-2 vaccine, AstraZeneca and the University of Oxford (UK) are facing criticism regarding the circumstances surrounding findings that indicated 90% efficacy in participants who received a half-dose in the first of their 2 injections, which was considerably higher than in participants who received 2 full doses. Beyond the unexpected results—i.e., higher efficacy among participants receiving smaller doses—the fact that the researchers inadvertently administered the wrong dose to a portion of the study group raised serious concerns, particularly because this was omitted from the press release announcing the interim results.
A number of factors could be influencing the higher efficacy reported among the subset of participants who received the initial half-dose, and further investigation is needed. Perhaps most notably, the participants who received the half-dose were reportedly all aged 55 years and younger, who would be at lower risk for severe disease and death than older individuals (e.g., age 65 years and older). Experts from around the world, including at the University of Oxford and the WHO, have called on AstraZeneca to publish more detailed trial data. Reportedly, AstraZeneca aims to publish the full data and analysis in a peer-reviewed journal “within the next week or so.” A senior executive for AstraZeneca dismissed concerns about the accidental half-dose and emphasized that the overall 70% efficacy still exceeds the minimum threshold of 50% set by multiple national-level regulatory agencies. While 70% would be sufficient for a novel SARS-CoV-2 vaccine, it is still below the 90-95% reported by Pfizer and Moderna.
MODERNA VACCINE EUA APPLICATION Moderna Therapeutics announced that the Phase 3 clinical trials for its candidate SARS-CoV-2 vaccine reached the primary efficacy endpoints. In total, the trials detected 196 cases of COVID-19 among 30,000 total participants, including 185 cases among the placebo group. This corresponds to an overall efficacy of 94.1%, nearly identical to the 94.5% efficacy based on preliminary Phase 3 trial data announced on November 16. The most recent press release also indicates that the vaccine demonstrated similar efficacy across all “age, race and ethnicity, and gender demographics.” Additionally, Moderna reported that all 30 severe cases of COVID-19, including 1 death, were among participants in the placebo group, demonstrating that the vaccine is capable of substantially mitigating risk of severe COVID-19 disease.
Yesterday, Moderna submitted requests for Emergency Use Authorization to the US FDA and Conditional Marketing Authorization to the European Medicines Agency. Moderna expects the US CDC’s Vaccines and Related Biological Products Advisory Committee to meet to review its vaccine clinical trial data on December 17, one week after the committee meets to review the Pfizer vaccine. If the vaccine receives an EUA, Moderna’s CEO, Stéphane Bancel, indicated that vaccinations could begin as early as December 21. Evaluation of the vaccine is already underway in multiple other countries, including Canada, Israel, Singapore, Switzerland, and the UK. While limited data are presented in the press release, Moderna committed to publish more detailed data and analysis in a peer-reviewed publication.
In addition to the clinical trial data, Moderna announced that it finalized an agreement to provide an additional 2 million doses of the vaccine to the UK government, bringing the UK’s purchase from Moderna to 7 million total doses.
UK VACCINE AUTHORIZATION The UK is on track to be the first country to authorize the Pfizer COVID-19 vaccine for use among its citizens. The UK’s Medicines and Healthcare Products Regulatory Agency is currently conducting an expedited review of Pfizer’s vaccine candidate, under a special government rule to bypass certain EU regulatory processes. Sources indicate that the authorization could be announced as early as December 7, with distribution beginning that same day. It has been reported that British hospitals were told on Sunday to prepare for vaccine rollout within the next 10 days. The UK has ordered 40 million doses of the Pfizer vaccine, which corresponds to 20 million individuals at 2 doses per person. According to a report from the UK’s Joint Committee on Vaccination and Immunisation, long-term care facility and nursing home residents and associated healthcare workers are the first priority group for vaccination, with adults aged 80 years and older and NHS healthcare workers following in the next tier.
While the Pfizer vaccine would be the first to be distributed in the UK, it is unlikely to be the only candidate that will eventually be used in the country. The UK has invested in 7 different vaccine candidates from various companies, with the majority of the UK’s investment going to vaccine developed by UK-based AstraZeneca and the University of Oxford. Out of a total of 350 million doses purchased across all seven candidates, 100 million of those doses are expected to come from AstraZeneca. The UK government directed MHRA last week to begin evaluating the AstraZeneca data for safety, quality, and efficacy. If authorized for use, this vaccine could be rolled-out not long after the Pfizer product.
NORTH KOREA While North Korea has yet to officially report a single case of COVID-19, intelligence sources suggest that government officials are taking extreme measures against the pandemic. It is difficult to understand exactly what the North Korean approach is to COVID-19, but recent intelligence updates can provide some insight. While North Korea typically maintains highly restrictive limitations on international travel, travel to and from the country has stopped almost completely. Additionally, North Korea is believed to have drastically decreased trade with China, its only major trading partner, likely in an effort to prevent COVID-19 from entering the country. China accounts for at least 90% of all trade with North Korea, so the reduction in imports and exports will have significant impacts on the North Korean economy and the North Korean people. In addition to stricter border controls, sources believe that large-scale lockdowns have also been put into place.
TRAVEL The travel sector, particularly the airline industry, has been among the hardest hit during the COVID-19 pandemic, largely due to a combination of travel restrictions and traveler concerns about exposures in other countries or during travel. Air travel has steadily started to increase compared to earlier in 2020, and many airlines have made major changes to their normal operations and requirements for passengers, including enhanced cleaning and hygiene practices, increased physical distancing, and mask mandates. Now, more airlines are considering testing requirements and, with potential vaccines on the horizon, vaccination requirements for passengers. Delta Airlines recently announced a “COVID-free” route from Atlanta to Rome that would require passengers to take 3 separate tests: 2 leading up to departure and 1 upon arrival. The first test would be a PCR-based test taken no later than 72 hours before departure. The second test would be a rapid antigen test at the gate before boarding. A third test, also a rapid antigen test, would be administered upon landing in Rome and before clearing through customs. Travelers will also be required to undergo another rapid antigen test prior to boarding their return flight to the US. Epidemiological models, developed in conjunction with experts at the Mayo Clinic (Minnesota, US), estimate that the new protocols will significantly decrease transmission risk on Delta’s flights, potentially as low as “one in a million.”
With the prospect of a SARS-CoV-2 vaccine in the near future, some airlines are considering mandating vaccination for travelers. The CEO of Australia-based airline Qantas stated that customers will be required to provide proof of vaccination before taking international flights. He also indicated medical issues “should be the only basis” for exemptions to the vaccination policy, which suggests that personal belief or religious exemptions may not be accepted by the airline. The International Air Transport Association (IATA) is preparing for these types of mandates by developing its IATA Travel Pass smartphone application, which will allow travelers to input and present their vaccination and testing information to relevant travel authorities. The application will be free for travelers and will include information on their destination’s travel restrictions and requirements and will provide digital security for personal medical information related to COVID-19.
COVID 19: No end in sight?
The Long Darkness Before Dawn
Donald G. McNeil Jr.
Tue, December 1, 2020, 7:27 AM CST·7 min read
A double exposure shows a highway informational sign in Albuquerque, N.M., on Tuesday, Nov. 24, 2020. (Adria Malcolm/The New York Times)
Each week, good news about vaccines or antibody treatments surfaces, offering hope that an end to the pandemic is at hand.
And yet this holiday season presents a grim reckoning. The United States has reached an appalling milestone: more than 1 million new coronavirus cases every week. Hospitals in some states are full to bursting. The number of deaths is rising and seems on track to easily surpass the 2,200-a-day average in the spring, when the pandemic was concentrated in the New York metropolitan area.
Our failure to protect ourselves has caught up to us.
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The nation now must endure a critical period of transition, one that threatens to last far too long, as we set aside justifiable optimism about next spring and confront the dark winter ahead. Some public health researchers predict that the death toll by March could be close to twice the 250,000 figure that the nation surpassed only last week.
“The next three months are going to be just horrible,” said Dr. Ashish Jha, dean of Brown University’s School of Public Health and one of two dozen experts interviewed by The New York Times about the near future.
This juncture, perhaps more than any to date, exposes the deep political divisions that have allowed the pandemic to take root and bloom, and that will determine the depth of the winter ahead. Even as the Centers for Disease Control and Prevention urged Americans to avoid holiday travel and many health officials asked families to cancel big gatherings, more than 6 million Americans took flights during Thanksgiving week, which is about 40% of last year’s air traffic. And President Donald Trump, the one person most capable of altering the trajectory between now and spring, seems unwilling to help his successor do what must be done to save the lives of tens of thousands of Americans.
President-elect Joe Biden has assembled excellent advisers and a sensible plan for tackling the pandemic, public health experts said. But Mitchell Warren, the founder of AVAC, an AIDS advocacy group that focuses on several diseases, said Biden’s hands appear tied until Inauguration Day on Jan. 20: “There’s not a ton of power in being president-elect.”
By late December, the first doses of vaccine may be available to Americans, federal officials have said. Priorities are still being set, but vaccinations are expected to go first to health care workers, nursing home residents and others at highest risk. How long it will take to reach younger Americans depends on many factors, including how many vaccines are approved and how fast they can be made.
But even as the medical response to the virus is improving, the politics of public health remain a deeply vexing challenge.
The regions of the country now among those hit hardest by the virus — Midwestern and Mountain States and rural counties, including in the Dakotas, Iowa, Nebraska and Wyoming — are the ones that voted heavily for Trump in the recent election. The president could help save his millions of supporters by urging them to wear masks, avoid crowds and skip holiday gatherings this year. But that seemed unlikely to occur, many health experts said.
“That is outside of his DNA,” said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University medical school. “It would mean admitting he was wrong and Tony Fauci was right.”
The antidote to hopelessness is agency, and Americans can protect themselves by wearing masks and keeping their distance from others.
“There is pretty broad support for mask mandates even among Republicans,” said Martha Louise Lincoln, a medical historian at San Francisco State University. “But among extreme right-wing voters there’s still a perception that they’re a sign of weakness or a symbol of being duped.”
A study by the Institute for Health Metrics and Evaluation at the University of Washington estimated that 130,000 lives could be saved by February if mask use became universal in the United States immediately. Masks can also preserve the economy: A study by Goldman Sachs estimated that universal use would save $1 trillion that may be lost to business shutdowns and medical bills.
Biden has said that he intends to tackle the pandemic from his first full day in office, on Jan. 21. But because coronavirus deaths follow new cases by some weeks, any results of his actions may not be apparent before early spring.
The experts generally praised the panel of advisers chosen by Biden, depicting them as reputable scientists who could credibly reach out to many groups hard-hit by the pandemic, including Black and Hispanic Americans.
But several experts, some of whom spoke anonymously to avoid offending friends and colleagues, said the panel needed different skills and a different kind of balance.
Some felt that it should have more scientific expertise, and suggested recruiting more vaccinologists, such as Dr. Paul A. Offit of Children’s Hospital of Philadelphia, and more public health researchers, such as Harvard’s Marc Lipsitch and Natalie E. Dean of the University of Florida.
Others said the panel needed more behavioral scientists adept at fighting rumors, which have been a major obstacle.
“We’re facing extremely complex and poorly understood dynamics around disinformation, conspiratorial theories, paranoia and mistrust,” Lincoln noted.
Among the suggested names with those skills were Heidi J. Larson of the Vaccine Confidence Project in London, Carl T. Bergstrom of the University of Washington and Zeynep Tufekci of the University of North Carolina.
Warren suggested consulting marketing experts and recruiting “everyone from Santa Claus to LeBron James” as trusted spokespersons.
Another expert suggested adding Dr. Mehmet Oz, a heart surgeon and television personality who was criticized for promoting hydroxychloroquine on Fox News (he later relented), and possibly even asking Sean Hannity and Tucker Carlson to join, because they are popular with Trump’s base and might be persuaded to accept science that would save the lives of their own viewers.
Biden’s plan for tackling the pandemic is outlined on his website. It calls for far more widespread testing, delivered free; a ban on out-of-pocket costs for medical care for the virus; having the military build temporary hospitals if necessary; cooperation with American businesses to create more personal protective gear and ventilators; more food relief for the poor, and other measures.
All the experts interviewed by the Times praised the plan, but several felt it was not aggressive enough. The pandemic is raging so far beyond control, they argued, that it can be contained only with deeply unpopular but necessary measures, such as rigorously enforced mask laws, closing bars and restaurants, requiring regular testing in schools and workplaces, isolating the infected away from their families, prohibiting travel from high-prevalence areas to low ones, and imposing quarantines that are enforced rather than merely requested.
Many other countries have imposed such measures despite fierce opposition from some citizens, they said, and they have helped.
Biden will inherit the fruits of Operation Warp Speed and oversee their distribution. Members of his transition team, speaking anonymously because they were not authorized to reveal its deliberations, said they were already discussing two sensitive topics: whether to create a secure way for vaccinated individuals to prove they have received both shots, and whether COVID vaccines should ultimately be made mandatory — either by the federal government, or by state governments, employers, school systems or the like.
The next dozen weeks will be long and painful. But spring is likely to bring highly effective vaccines and a renewed commitment to medical leadership, something that has been missing under Trump.
“The CDC will have to be rebuilt, and its guidelines and the FDA’s have to be promptly reevaluated,” said Dr. Robert L. Murphy, director of the Institute for Global Health at Northwestern University’s medical school. “The Biden team will move quickly. It’s not like they don’t know what to do.”
This article originally appeared in The New York Times.
© 2020 The New York Times Company
Science Magazine questions Trump’s numbers for COVID-19
Across the United States, COVID-19 wards like this one at University of Wisconsin Health in Madison are filling up fast, but federal data on their patient numbers and available beds are suspect, which could hinder getting personal protective equipment, other supplies, or medicines to where they are needed most.
JOHN HART/WISCONSIN STATE JOURNAL VIA AP
Federal system for tracking hospital beds and COVID-19 patients provides questionable data
By Charles PillerNov. 29, 2020 , 4:30 PM
This story was supported by the Science Fund for Investigative Reporting. Please help Science pursue ambitious journalism projects.
In mid-November, as the United States set records for newly diagnosed COVID-19 cases day after day, the hospital situation in one hard-hit state, Wisconsin, looked concerning but not yet urgent by one crucial measure. The main pandemic data tracking system run by the Department of Health and Human Services (HHS), dubbed HHS Protect, reported that on 16 November, 71% of the state’s hospital beds were filled. Wisconsin officials who rely on the data to support and advise their increasingly strained hospitals might have concluded they had some margin left.
Yet a different federal COVID-19 data system painted a much more dire picture for the same day, reporting 91% of Wisconsin’s hospital beds were filled. That day was no outlier. A Science examination of HHS Protect and confidential federal documents found the HHS data for three important values in Wisconsin hospitals—beds filled, intensive care unit (ICU) beds filled, and inpatients with COVID-19—often diverge dramatically from those collected by the other federal source, from state-supplied data, and from the apparent reality on the ground.
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“Our hospitals are struggling,” says Jeffrey Pothof, a physician and chief quality officer for the health system of the University of Wisconsin (UW), Madison. During recent weeks, patients filled the system’s COVID-19 ward and ICU. The university’s main hospital converted other ICUs to treat the pandemic disease and may soon have to turn away patients referred to the hospital for specialized care. Inpatient beds—including those in ICUs—are nearly full across the state. “That’s the reality staring us down,” Pothof says, adding: The HHS Protect numbers “are not real.”
HHS Protect’s problems are a national issue, an internal analysis completed this month by the Centers for Disease Control and Prevention (CDC) shows. That analysis, other federal reports, and emails obtained by Science suggest HHS Protect’s data do not correspond with alternative hospital data sources in many states (see tables, below). “The HHS Protect data are poor quality, inconsistent with state reports, and the analysis is slipshod,” says one CDC source who had read the agency’s analysis and requested anonymity because of fear of retaliation from the Trump administration. “And the pressure on hospitals [from COVID-19] is through the roof.”
Both federal and state officials use HHS Protect’s data to assess the burden of disease across the country and allocate scarce resources, from limited stocks of COVID-19 medicines to personal protective equipment (PPE). Untrustworthy numbers could lead to supply and support problems in the months ahead, as U.S. cases continue to rise during an expected winter surge, according to current and former CDC officials. HHS Protect leaders vigorously defend the system and blame some disparities on inconsistent state and federal definitions of COVID-19 hospitalization. “We have made drastic improvements in the consistency of our data … even from September to now,” says one senior HHS official. (Three officials from the department spoke with Science on the condition that they not be named.)
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CDC had a long-running, if imperfect, hospital data tracking system in place when the pandemic started, but the Trump administration and White House Coronavirus Task Force Coordinator Deborah Birx angered many in the agency when they shifted much of the responsibility for COVID-19 hospital data in July to private contractors. TeleTracking Technologies Inc., a small Pittsburgh-based company, now collects most of the data, while Palantir, based in Denver, helps manage the database. At the time, hundreds of public health organizations and experts warned the change could gravely disrupt the government’s ability to understand the pandemic and mount a response.
The feared data chaos now seems a reality, evident when recent HHS Protect figures are compared with public information from states or data documented by another hospital tracking system run by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR). ASPR manages the Strategic National Stockpile of medicines, PPE—in perilously short supply in many areas—and other pandemic necessities. ASPR collects data nationwide, although it is more limited than what HHS Protect compiles, to help states and hospitals respond to the pandemic.
In Alabama, HHS Protect figures differ by 15% to 30% from daily state COVID-19 inpatient totals. Karen Landers, assistant state health officer, said nearly all of the state’s hospitals report data to HHS via the Alabama Department of Public Health. Although reporting delays sometimes prevent the systems from syncing precisely, Landers says, she cannot account for the sharp differences.
(GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) HHS PROTECT; ASPR
Many state health officials contacted by Science were reluctant to directly criticize HHS Protect or attribute supply or support problems to its data. Landers notes that Alabama relies on its own collected data, rather than HHS Protect’s, for its COVID-19 response. “We are very confident in our data,” she says, because the state reporting system was developed over several years and required little adjustment to add COVID-19. HHS, she adds, has generally been responsive to state requests for medicines and supplies, although Alabama has not always gotten all the PPE it has requested.
Other states, however, say they do rely on HHS Protect. A spokesperson for the Wisconsin Department of Health Services wrote in a response to questions, “When making decisions at the state level we use the HHS Protect data,” but declined to comment about its accuracy. HHS informed Wisconsin officials it distributes scarce supplies based on need indicated by HHS Protect data, the spokesperson wrote.
Pothof says UW’s hospital system has its own sophisticated data dashboard that draws on state, local, and internal sources to plan and cooperate on pandemic response with other hospitals. But small hospitals in Wisconsin—now experiencing shortages of some medicines, PPE, and other supplies—are more dependent on federal support largely based on HHS Protect data. Help might not arrive, Pothof says, if the data show “things look better than they are.”
If the HHS Protect data are suspect, “that’s a very large problem,” says Nancy Cox, former director of CDC’s influenza division and now an affiliated retiree of the agency. If HHS officials use bad data, they will not distribute medicines and supplies equitably, Cox notes, adding: “Undercounting in the hardest hit states means a lower level of care and will result in more severe infections and ultimately in more deaths.”
Birx and the other managers of HHS Protect “really had no idea what they were doing,” says Tom Frieden, CDC director under former President Barack Obama. (Birx declined to comment for this article.) Frieden cautions that ASPR data might also be erroneous—pointing to the need for an authoritative and clear federal source of hospital data. The original CDC system, called the National Healthcare Safety Network (NHSN), should be improved, he said, but it handles nursing home COVID-19 data skillfully and could do the same with hospitals. NHSN is “not just a computer program. It’s a public health program” built over 15 years and based on relationships with individual health facilities, Frieden says. (CDC insiders say HHS officials recently interfered with publication of an analysis showing that NHSN performed well early in the pandemic [see sidebar, below]).
An HHS official says HHS Protect’s data are complex and the department can’t verify any findings in the reports reviewed by Science without conducting its own analysis, which it did not do. But the official says HHS Protect has improved dramatically in the past 2 months and provides consistent and reliable results.
As for the difference between state and HHS Protect data, an HHS official contends state numbers “are always going to be lower” by up to 20%. That’s because hospitals could lose Medicare funding if they do not report to HHS, the official says, but face no penalty for failing to report to the state. So rather than expect identical numbers, HHS looks for state and federal data to reflect the same trajectory—which they do in all cases for COVID-19 inpatient data, according to another confidential CDC analysis of HHS Protect, covering all 50 states.
Yet the same analysis found 27 states recently alternated between showing more or fewer COVID-19 inpatients than HHS Protect—not always just fewer, as HHS says should be the case. Thirty states also showed differences between state and HHS Protect figures that were frequently well above the 20% threshold cited by HHS, and HHS Protect data fluctuated erratically in 21 states (see chart, below).
“Hospital capacity metrics can and should be a national bellwether,” the CDC data expert says. “One important question raised by the discordant data reported by HHS Protect and the states is whether HHS Protect is systematically checking data validity.” HHS has not provided its methodology for HHS Protect data estimates for review by independent experts. But an HHS official says a team of data troubleshooters, including CDC and ASPR field staff, work to resolve anomalies and respond to spikes in cases in a state or hospital.
Out of sync
Tracking hospital inpatients who have COVID-19 has become a crucial measure of the pandemic’s severity. Department of Health and Human Services (HHS) data from the HHS Protect system often diverge sharply from state-supplied data. This chart, drawn from a data analysis from the Centers for Disease Control and Prevention, summarizes some of the similarities and differences for COVID-19 inpatient totals over the past 2 months.
<?XML:NAMESPACE PREFIX = "[default] http://www.w3.org/2000/svg" NS = "http://www.w3.org/2000/svg" />HHS Protect’s COVID-19 inpatient data erratic in past 2 monthsRecent differences between HHS Protect and state data >20%State COVID-19 inpatient tally consistently lower than HHS Protect’sState tally alternately lower/higher than HHS Protect’sState and HHS Protect tallies became closer recentlyState COVID-19 inpatient trajectory tracks with HHS Protect’s213014271650Number of states
(GRAPHIC) J. TRAVIS/SCIENCE; (DATA) COVID TRACKING PROJECT; HHS PROTECT VIA CDC
Along with improving trust in its data, HHS Protect needs to make it more accessible, CDC data scientists say. The publicly accessible HHS Protect data are far less complete than the figures in its password-protected database. This effectively hides from public view key pandemic information, such as local supplies of protective equipment.
The site also does not provide graphics highlighting patterns and trends. This might explain, in part, why most media organizations—as well as President-elect Joe Biden’s transition team—instead have relied on state or county websites that vary widely in completeness and quality, or on aggregations such as The Atlantic magazine’s COVID Tracking Project, which collects, organizes, and standardizes state data. (In comparing state and federal data, CDC also used the COVID Tracking Project.)
Frieden and other public health specialists call reliable, clear federal data essential for an effective pandemic response. “The big picture is that we’re coming up to 100,000 hospitalizations within the next few weeks. Hospital systems all over the country are going to be stressed,” Frieden says. “There’s not going to be any cavalry coming over the hill from somewhere else in the country, because most of the country is going to be overwhelmed. We’re heading into a very hard time with not very accurate information systems. And the government basically undermined the existing system.”
*Update, 30 November, 1:10 p.m.: This story has been updated to link to a PDF of a CDC evaluation of the HHS Protect hospital data collection system.
RELATED STORY
More MMWR tampering?
In September, the public health community expressed outrage at reports that Health and Human Services (HHS) Assistant Secretary for Public Affairs Michael Caputo and others in the Trump administration tried to force politically motivated edits on papers in the Morbidity and Mortality Weekly Report (MMWR), the well-regarded weekly journal published by the Centers for Disease Control and Prevention (CDC). Even though Caputo went on extended leave for health reasons, such interference may be continuing.
Science has learned that soon after HHS halted use of CDC’s own National Healthcare Safety Network (NHSN) for COVID-19 tracking, leaders of the system prepared an analysis of its effectiveness in tracking the pandemic in hospitals from March through mid-July. The paper found that NHSN provided “rapid, accurate data reporting and information sharing among public health partners and the general public” on hospital occupancy, and staffing and supply shortages, “which can continue to guide the pandemic response.” In August, they submitted the paper to MMWR. According to two CDC data experts directly familiar with the circumstances, MMWR editors finally said in in early November that HHS expressed concerns about the paper. MMWR’s editor subsequently decided to reject it as out of date, those CDC officials say.
HHS and MMWR’s editor-in-chief declined to comment about the rejected paper. “There was no discussion with HHS,” a CDC spokesperson wrote in an email, calling it “a routine editorial decision made based on the timeliness of the data.”
Yet on 13 November, the journal published a different paper on COVID-19 hospital data based on a private company data set covering a nearly identical time frame. One of the authors of the NHSN paper calls its rejection “censorship plain and simple, and a clear-cut effort to silence NHSN.”
Above is from: https://www.sciencemag.org/news/2020/11/federal-system-tracking-hospital-beds-and-covid-19-patients-provides-questionable-data
Monday, November 30, 2020
November 30: 6190 New COVID 19 Cases in Illinois
Public Health Officials Announce 6,190 New Cases of Coronavirus Disease
30th Nov, 2020
SPRINGFIELD – The Illinois Department of Public Health (IDPH) today reported 6,190 new confirmed and probable cases of coronavirus disease (COVID-19) in Illinois, including 85 additional deaths.
- Cook County: 1 female 30s, 1 female 50s, 1 male 50s, 5 females 60s, 6 males 60s, 12 females 70s, 11 males 70s, 10 females 80s, 13 males 80s, 3 females 90s, 2 males 90s
- DeKalb County: 1 male 60s
- DuPage County: 1 female 70s, 1 male 70s
- Kane County: 1 female 70s, 1 female 80s
- Lake County: 1 male 70s
- LaSalle County: 1 male 50s, 1 male 90s
- Madison County: 1 male 60s, 1 male 90s
- Mason County: 1 male 80s, 1 female 90s
- McDonough County: 1 male 60s
- Monroe County: 1 female 80s
- Ogle County: 1 female 90s
- Peoria County: 1 female 50s
- Tazewell County: 1 male 70s, 1 male 80s
- Will County: 2 females 90s
Currently, IDPH is reporting a total of 726,304 cases, including 12,278 deaths, in 102 counties in Illinois. The age of cases ranges from younger than one to older than 100 years. Within the past 24 hours, laboratories have reported 66,980 specimens for a total 10,497,998. As of last night, 5,849 in Illinois were reported to be in the hospital with COVID-19. Of those, 1,217 patients were in the ICU and 715 patients with COVID-19 were on ventilators.
The preliminary seven-day statewide positivity for cases as a percent of total test from November 23 – November 29, 2020 is 10.2%. The preliminary seven-day statewide test positivity from November 23 – November 29, 2020 is 12.2%.
*All data are provisional and will change. In order to rapidly report COVID-19 information to the public, data are being reported in real-time. Information is constantly being entered into an electronic system and the number of cases and deaths can change as additional information is gathered. Information for a death previously reported has changed, therefore, today’s numbers have been adjusted. For health questions about COVID-19, call the hotline at 1-800-889-3931 or email dph.sick@illinois.gov.
Pope Francis: A Crisis Reveals What Is in Our Hearts
Pope Francis: A Crisis Reveals What Is in Our Hearts
This oped by Pope Francis appeared the day after the Supreme Court’s new conservative majority late Wednesday night sided with religious organizations in New York that said they were illegally targeted by pandemic-related restrictions.
November 29, 2020 Pope Francis: Pope Francis NEW YORK TIMES
, Illustration by Najeebah Al-Ghadban; photographs by Getty Images
In this past year of change, my mind and heart have overflowed with people. People I think of and pray for, and sometimes cry with, people with names and faces, people who died without saying goodbye to those they loved, families in difficulty, even going hungry, because there’s no work.
Sometimes, when you think globally, you can be paralyzed: There are so many places of apparently ceaseless conflict; there’s so much suffering and need. I find it helps to focus on concrete situations: You see faces looking for life and love in the reality of each person, of each people. You see hope written in the story of every nation, glorious because it’s a story of daily struggle, of lives broken in self-sacrifice. So rather than overwhelm you, it invites you to ponder and to respond with hope.
These are moments in life that can be ripe for change and conversion. Each of us has had our own “stoppage,” or if we haven’t yet, we will someday: illness, the failure of a marriage or a business, some great disappointment or betrayal. As in the Covid-19 lockdown, those moments generate a tension, a crisis that reveals what is in our hearts.
In every personal “Covid,” so to speak, in every “stoppage,” what is revealed is what needs to change: our lack of internal freedom, the idols we have been serving, the ideologies we have tried to live by, the relationships we have neglected.
When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness. It changed the way I saw life. For months, I didn’t know who I was or whether I would live or die. The doctors had no idea whether I’d make it either. I remember hugging my mother and saying, “Just tell me if I’m going to die.” I was in the second year of training for the priesthood in the diocesan seminary of Buenos Aires.
I remember the date: Aug. 13, 1957. I got taken to a hospital by a prefect who realized mine was not the kind of flu you treat with aspirin. Straightaway they took a liter and a half of water out of my lungs, and I remained there fighting for my life. The following November they operated to take out the upper right lobe of one of the lungs. I have some sense of how people with Covid-19 feel as they struggle to breathe on a ventilator.
I remember especially two nurses from this time. One was the senior ward matron, a Dominican sister who had been a teacher in Athens before being sent to Buenos Aires. I learned later that following the first examination by the doctor, after he left she told the nurses to double the dose of medication he had prescribed — basically penicillin and streptomycin — because she knew from experience I was dying. Sister Cornelia Caraglio saved my life. Because of her regular contact with sick people, she understood better than the doctor what they needed, and she had the courage to act on her knowledge.
Another nurse, Micaela, did the same when I was in intense pain, secretly prescribing me extra doses of painkillers outside my due times. Cornelia and Micaela are in heaven now, but I’ll always owe them so much. They fought for me to the end, until my eventual recovery. They taught me what it is to use science but also to know when to go beyond it to meet particular needs. And the serious illness I lived through taught me to depend on the goodness and wisdom of others.
This theme of helping others has stayed with me these past months. In lockdown I’ve often gone in prayer to those who sought all means to save the lives of others. So many of the nurses, doctors and caregivers paid that price of love, together with priests, and religious and ordinary people whose vocations were service. We return their love by grieving for them and honoring them.
Whether or not they were conscious of it, their choice testified to a belief: that it is better to live a shorter life serving others than a longer one resisting that call. That’s why, in many countries, people stood at their windows or on their doorsteps to applaud them in gratitude and awe. They are the saints next door, who have awakened something important in our hearts, making credible once more what we desire to instill by our preaching.
They are the antibodies to the virus of indifference. They remind us that our lives are a gift and we grow by giving of ourselves, not preserving ourselves but losing ourselves in service.
With some exceptions, governments have made great efforts to put the well-being of their people first, acting decisively to protect health and to save lives. The exceptions have been some governments that shrugged off the painful evidence of mounting deaths, with inevitable, grievous consequences. But most governments acted responsibly, imposing strict measures to contain the outbreak.
Yet some groups protested, refusing to keep their distance, marching against travel restrictions — as if measures that governments must impose for the good of their people constitute some kind of political assault on autonomy or personal freedom! Looking to the common good is much more than the sum of what is good for individuals. It means having a regard for all citizens and seeking to respond effectively to the needs of the least fortunate.
It is all too easy for some to take an idea — in this case, for example, personal freedom — and turn it into an ideology, creating a prism through which they judge everything.
The coronavirus crisis may seem special because it affects most of humankind. But it is special only in how visible it is. There are a thousand other crises that are just as dire, but are just far enough from some of us that we can act as if they don’t exist. Think, for example, of the wars scattered across different parts of the world; of the production and trade in weapons; of the hundreds of thousands of refugees fleeing poverty, hunger and lack of opportunity; of climate change. These tragedies may seem distant from us, as part of the daily news that, sadly, fails to move us to change our agendas and priorities. But like the Covid-19 crisis, they affect the whole of humanity.
Look at us now: We put on face masks to protect ourselves and others from a virus we can’t see. But what about all those other unseen viruses we need to protect ourselves from? How will we deal with the hidden pandemics of this world, the pandemics of hunger and violence and climate change?
If we are to come out of this crisis less selfish than when we went in, we have to let ourselves be touched by others’ pain. There’s a line in Friedrich Hölderlin’s “Hyperion” that speaks to me, about how the danger that threatens in a crisis is never total; there’s always a way out: “Where the danger is, also grows the saving power.” That’s the genius in the human story: There’s always a way to escape destruction. Where humankind has to act is precisely there, in the threat itself; that’s where the door opens.
This is a moment to dream big, to rethink our priorities — what we value, what we want, what we seek — and to commit to act in our daily life on what we have dreamed of.
God asks us to dare to create something new. We cannot return to the false securities of the political and economic systems we had before the crisis. We need economies that give to all access to the fruits of creation, to the basic needs of life: to land, lodging and labor. We need a politics that can integrate and dialogue with the poor, the excluded and the vulnerable, that gives people a say in the decisions that affect their lives. We need to slow down, take stock and design better ways of living together on this earth.
The pandemic has exposed the paradox that while we are more connected, we are also more divided. Feverish consumerism breaks the bonds of belonging. It causes us to focus on our self-preservation and makes us anxious. Our fears are exacerbated and exploited by a certain kind of populist politics that seeks power over society. It is hard to build a culture of encounter, in which we meet as people with a shared dignity, within a throwaway culture that regards the well-being of the elderly, the unemployed, the disabled and the unborn as peripheral to our own well-being.
To come out of this crisis better, we have to recover the knowledge that as a people we have a shared destination. The pandemic has reminded us that no one is saved alone. What ties us to one another is what we commonly call solidarity. Solidarity is more than acts of generosity, important as they are; it is the call to embrace the reality that we are bound by bonds of reciprocity. On this solid foundation we can build a better, different, human future.
Pope Francis is the head of the Catholic Church and the bishop of Rome. This essay has been adapted from his new book “Let Us Dream: The Path to a Better Future,” written with Austen Ivereigh.
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