COVID-19

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Japan’s northern island of Hokkaido offers a grim lesson in the next phase of the battle against COVID-19. It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.

A doctor who helped coordinate the government response says he wishes they’d done things differently. “Now I regret it, we should not have lifted the first state of emergency,” Dr. Kiyoshi Nagase, chairman of the Hokkaido Medical Association, tells TIME.

Hokkaido’s story is a sobering reality check for leaders across the world as they consider easing coronavirus lockdowns: Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate.

“Hokkaido shows, for example, that what’s happening in the U.S. with individual governors opening up is very dangerous; of course you can’t close interstate traffic but you need to put controls in place,” says Kazuto Suzuki, Vice Dean of International Politics at Hokkaido University. “That’s what we now know: Even if you control the first wave, you can’t relax.”

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An administrator for the Reopen NC Facebook page confirmed she tested positive for COVID-19 and recently finished up her quarantine.

Audrey Whitlock said she ended her 14-day quarantine on April 26. When asked by ABC11, she wouldn't say whether she had been tested to determine if she still has the virus. In a Facebook post on the ReOpen NC page, which has since been apparently deleted, Whitlock said she was asymptomatic.

Reopen NC held a protest outside the North Carolina General Assembly on April 21. ABC11 estimated a crowd size of about 300 people, and though many were not following social distancing guidelines required under Gov. Roy Cooper's stay-at-home order, no arrests were made.

It is unclear at this time whether Whitlock attended the April 21 protest or whether she was involved in organizing the event.

When ABC11 asked whether she attended, she said "no comment." Another administrator for the Facebook group told ABC11 Whitlock was not there.

In her Facebook post, she said she plans to attend another protest scheduled for Tuesday.

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U.S. intelligence agencies issued warnings about the novel coronavirus in more than a dozen classified briefings prepared for President Trump in January and February, months during which he continued to play down the threat, according to current and former U.S. officials.

The repeated warnings were conveyed in issues of the President’s Daily Brief, a sensitive report that is produced before dawn each day and designed to call the president’s attention to the most significant global developments and security threats.

For weeks, the PDB — as the report is known — traced the virus’s spread around the globe, made clear that China was suppressing information about the contagion’s transmissibility and lethal toll, and raised the prospect of dire political and economic consequences.

But the alarms appear to have failed to register with the president, who routinely skips reading the PDB and has at times shown little patience for even the oral summary he takes two or three times per week, according to the officials, who spoke on the condition of anonymity to discuss classified material.

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The Trump administration abruptly cut off funding for a project studying how coronaviruses spread from bats to people after reports linked the work to a lab in Wuhan, China, at the center of conspiracy theories about the Covid-19 pandemic’s origins.

The National Institutes of Health on Friday told EcoHealth Alliance, the study’s sponsor for the past five years, that all future funding was cut. The agency also demanded that the New York-based research nonprofit stop spending the $369,819 remaining from its 2020 grant, according to emails obtained by POLITICO.

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The group caught national attention a week ago after reports swirled that millions from its NIH grants had been sent to the Wuhan Institute of Virology, a research facility in the city where the coronavirus pandemic originated. In an email last week to NIH officials, EcoHealth Alliance President Pete Daszak denied giving any money this year to the Wuhan lab, although researchers from the facility have collaborated with EcoHealth Alliance scientists on research supported by an earlier grant.

The Wuhan lab is at the center of conspiracy theories alleging that the coronavirus outbreak began when the virus escaped the facility. U.S. intelligence agencies and scientists have not found any evidence to support the rumors.

Meanwhile, the NIH’s strategic plan for studying the novel coronavirus, released Thursday, lays out four key priorities — including understanding its origin and transmission, in line with the EcoHealth alliance’s broader investigation of bat coronaviruses. The agency did not respond to a request for comment on its decision to terminate the group’s funding.

Important study in @TheLancet Infectious Diseases concludes that "children are at a similar risk of infection to the general population, although less likely to have severe symptoms; hence they should be considered in analyses of transmission and control." https://t.co/U4Qhaaitom

— Christian Althaus (@C_Althaus) April 28, 2020

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The administration had been sharply criticized for not overseeing widespread testing, but Trump said no amount would ever be good enough for critics in the media.

The president dismissed suggestions that the administration was slow to respond to the threat of COVID-19, including reports that it was mentioned in his daily intelligence briefing in January and February. He stressed his decision to restrict flights from China — though more than 40,000 travelers from China still made it to the U.S. afterward — and said of the decision: “Whether it was luck, talent or something else, we saved many thousands of lives.”

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With crucial protective gear in short supply, federal authorities are saying health workers can wear lower-grade surgical masks while treating Covid-19 patients – but growing evidence suggests the practice is putting workers in jeopardy.

The Centers for Disease Control and Prevention (CDC) recently said surgical masks are “an acceptable alternative” to highly protective N95 respirators unless workers are performing intubations or other procedures on patients with Covid-19 that could unleash high volumes of virus particles.


But scholars, not-for-profit leaders and former regulators in the specialized field of occupational safety say relying on surgical masks – which are considerably less protective than N95 respirators – is almost certainly fueling illness among frontline health workers, who probably make up about 11% of all known Covid-19 cases.

“There’s no doubt in my mind that that’s one of the reasons that so many healthcare workers are getting sick and many are dying,” said Jonathan Rosen, a health and safety expert who advises unions, states and the federal government. As of 23 April, more than 21,800 healthcare workers had contracted the coronavirus and 71 have died, according to a House education and labor committee staffer briefed by the CDC.

Heretic wrote:

The death toll's at 19 9/11s or 14,410 Benghazis and climbing.

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President Donald Trump signed an executive order Tuesday that compels slaughterhouses to remain open, setting up a showdown between the giant companies that produce America’s meat and the unions and activists who want to protect workers in a pandemic.

Meat processing plants around the U.S. have shut down because of the coronavirus, but Trump said in the order that “such closures threaten the continued functioning of the national meat and poultry supply chain, undermining critical infrastructure during the national emergency.”

Using the Defense Production Act, Trump is ordering plants to stay open as part of the critical infrastructure needed to keep people fed amid growing supply disruptions from the coronavirus outbreak. The government will provide additional protective gear for employees as well as guidance.

The move came just days after Tyson Foods Inc., the biggest U.S. meat processor, ran paid ads in national newspapers stating that the food supply chain was “broken.”

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The county's top health official is urging the Marion community to be vigilant, as an outbreak of the novel coronavirus at a Marion prison spills into the general public.

More than 80% of Marion Correctional Institution's prison population has tested positive for COVID-19, the illness caused by the coronavirus, along with more than 160 corrections officers and other staff who live in Marion and surrounding counties, according to the Ohio Department of Rehabilitation and Correction.

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Marion Public Health has counted at least 112 cases of "community spread," or ones in Marion County residents who are members of the general public, including about 66 linked to the prisons outbreak, Marion Public Health Commissioner Traci Kinsler said Friday.

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US Vice President Mike Pence's office threatened to punish a reporter who exposed that it knew Pence was supposed to wear a face mask for his visit to the Mayo Clinic on Tuesday.

Pence, who leads the White House's coronavirus task force, has been widely criticized for flouting official guidance and not wearing a mask during his visit to the renowned clinic in Rochester, Minnesota.

Karen Pence, the vice president's wife, has defended her husband, saying in a Fox News interview on Thursday that he was unaware of the clinic's rule requiring visitors to wear a mask or face covering.

But in a tweet on Thursday, the Voice of America reporter Steve Herman said Pence's office knew all along about the face-mask rule.

"All of us who traveled with him were notified by the office of @VP the day before the trip that wearing of masks was required by the @MayoClinic and to prepare accordingly," he wrote.

Heretic wrote:

Pence threatened to punish the reporter who proved his office ignored the rule that he needed a mask to visit the Mayo Clinic

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US Vice President Mike Pence's office threatened to punish a reporter who exposed that it knew Pence was supposed to wear a face mask for his visit to the Mayo Clinic on Tuesday.

Pence, who leads the White House's coronavirus task force, has been widely criticized for flouting official guidance and not wearing a mask during his visit to the renowned clinic in Rochester, Minnesota.

Karen Pence, the vice president's wife, has defended her husband, saying in a Fox News interview on Thursday that he was unaware of the clinic's rule requiring visitors to wear a mask or face covering.

But in a tweet on Thursday, the Voice of America reporter Steve Herman said Pence's office knew all along about the face-mask rule.

"All of us who traveled with him were notified by the office of @VP the day before the trip that wearing of masks was required by the @MayoClinic and to prepare accordingly," he wrote.

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Maryland Gov. Larry Hogan (R) said Thursday that thousands of coronavirus tests obtained by the state from South Korea are currently protected in an undisclosed location by the Maryland National Guard.

Asked in a Washington Post Live interview whether he was concerned the federal government would seize the tests, Hogan acknowledged “it was a little bit of a concern.”

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Hogan said state officials ensured the plane landed at Baltimore/Washington International Thurgood Marshall Airport rather than Dulles International Airport in Virginia, noting that it was the first time a Korean Air passenger plane had landed at the airport.

“We landed it there with a large contingent of Maryland National Guard and Maryland State Police, because this was an enormously valuable payload. It was like Fort Knox to us, because it’s going to save the lives of thousands of our citizens,” Hogan continued.

Asked whether the National Guard was continuing to protect the tests from seizure, Hogan responded, “They are.”

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Nearly 900 workers at a Tyson Food plant in Indiana have reportedly tested positive for COVID-19.

The coronavirus infected 890 of the 2,200 people at the plant located in Logansport, Ind., local station WISH TV reported Wednesday.

The updated number is more than 700 additional confirmed cases at the plant than the Cass County Health Department reported last week, according to the Indianapolis Star.

Tyson announced last week that the company would voluntarily close its facility and work with county officials on a plan to reopen.

Cass County Commissioner Ryan Browning said he’s working with Tyson and the health department to develop a workable reopening plan, according to WISH.  

On Tuesday President Trump signed an executive order using the Defense Production Act (DPA) to order meat processing plants to stay open and designate them as critical infrastructure.

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The Trump administration is threatening to sue states and municipalities whose pandemic orders infringe on people's rights or cause "undue interference with the national economy."

"I am directing each of our United States Attorneys to also be on the lookout for state and local directives that could be violating the constitutional rights and civil liberties of individual citizens," US Attorney General William Barr wrote yesterday in a memo to all 94 US attorneys' offices. The Barr memo said that "even in times of emergency, when reasonable and temporary restrictions are placed on rights, the First Amendment and federal statutory law prohibit discrimination against religious institutions and religious believers." The memo is available at The Washington Post website.

Barr's memo is not just aimed at protecting members of religious groups. He continued:

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The legal restrictions on state and local authority are not limited to discrimination against religious institutions and religious believers. For example, the Constitution also forbids, in certain circumstances, discrimination against disfavored speech and undue interference with the national economy. If a state or local ordinance crosses the line from an appropriate exercise of authority to stop the spread of COVID-19 into an overbearing infringement of constitutional and statutory protections, the Department of Justice may have an obligation to address that overreach in federal court.

Barr wrote that he is "therefore directing the Assistant Attorney General for Civil Rights, Eric Dreiband, and Matthew Schneider, the US Attorney for the Eastern District of Michigan, to oversee and coordinate our efforts to monitor state and local policies and, if necessary, take action to correct them." While Barr said US officials "do not want to unduly interfere with the important efforts of state and local officials to protect the public," he noted that "the Constitution is not suspended in times of crisis."

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Update at 10:20pm ET: New York Attorney General Letitia James issued a statement saying she is prepared to take legal action to defend the state's authority. "Despite the Trump Administration's failure to do so, states are able to protect constitutional rights and enact policies to curb the spread of the coronavirus simultaneously," James said. "The Tenth Amendment of the US Constitution is clear that 'the powers not delegated to the' federal government shall be 'reserved to the States.' Make no mistake: US Attorney General Barr is not the only one prepared to take legal action to guard the Constitution. My office will fight every day to defend it and the rights it affords the great State of New York."

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AINSLEY EARHARDT (CO-HOST): Well, you know, that beach was open, and people could make the decisions. The problem is, though, Brian, they started to see more people going to the hospitals after that weekend — after all those images were released, in California, with corona. So, I think the governors have to make tough decisions because they don't want a relapse of all of this. That wouldn't make them look good. Their residents would be dying. And then you have, you know, people like — my mom is very sick. And as much as I want to go out, and I want — I still want everyone to play by the rules because when I finally do get to go home to visit her, I don't want —

BRIAN KILMEADE (CO-HOST): But is your mom going to the beach? But is your mom going to the beach?

EARHARDT: No, but Brian, you know, eventually she's going to be around family again. I understand both sides, I really do. I just don't want a resurgence of this. You know, I just don't want us to go through all of this. It's been — it's been hard for everyone at different levels.

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The crucial time for these states was the first three weeks of March. While the disease spread rapidly in New York, it grew slowly in Washington state so that by the time lock down really kicked in nationwide, Washington had kept the infection rate to 50 a day while New York struggled to stay below 500.

Once the disease gets going, it’s very hard to slow it down. Even though New York has done an excellent job, not just halting but actually slowing the disease, it has taken most of April to cut the new case rate in half, slow going indeed compared to early-to-mid March when it could double in only 3 or 4 days.

That’s why KEEPING LOCKDOWN is so important. Once the case load gets heavy, it takes a very long time to reduce it. If we relax our restrictions now and the disease takes off, we can’t put the genie back in the bottle. It’s a matter of life and death.

In case you’re wondering where the case load is growing right now, I estimate it’s where the upward-pointing black triangles are in this map.

The “corn belt” seems to be in the line of fire.

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[T]he premature promotion of hydroxychloroquine has had a number of deleterious effects on our nation. I’ve already discussed how Trump’s boosterism resulted in panic prescribing and hoarding, leading to shortages of the drug for patients with autoimmune diseases who need it. I’ve also speculated how the EUA and promotion of the drug will make it harder for scientists to complete the randomized clinical trials that our above cardiologist and I are waiting for. After all, if you are led to believe a drug works, why would you consent to be on a clinical trial where you might be randomized to receive a placebo? You wouldn’t, of course, and that’s what happened in France, with four out of five patients offered enrollment in Discovery, a randomized trial to study the efficacy of hydroxychloroquine and other treatments, refusing to be enrolled and refusing any treatment other than hydroxychloroquine.

It’s worse than that, though. Not only has the hydroxychloroquine craze made it harder to do the clinical trials necessary to determine if the drug benefits COVID-19 patients, but it’s derailing research into other drugs:

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People with COVID-19 who arrive at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City to search for treatment can choose from a menu of clinical trials, carefully presented by a worker trained to offer an unbiased portrait of the potential risks and benefits.

But neurologist Sergio Iván Valdés-Ferrer already knows which trial most will choose — and it’s not his. Instead, many people opt for one involving hydroxychloroquine, a malaria drug that has been touted by US President Donald Trump and other influential figures as an effective coronavirus treatment. High demand for the drug in Mexico has quickly depleted the country’s supply. Its use is now limited to hospitals, and patients are eager to ensure that they receive it.

“There’s a tremendous bias,” says Valdés-Ferrer, who is studying the effects of a dementia drug on COVID-19. “Studies of any other drug that are enrolling all ages and degrees of severity are in big trouble.”

And:

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Psychiatrist Eric Lenze of Washington University in St. Louis, Missouri, recently launched a trial of an antidepressant that he hopes could lessen the immune response linked to some severe COVID-19 cases. The trial has so far enrolled ten participants; three others declined to take part because they were already planning to take hydroxychloroquine. And Sauer says that she and her colleagues have encountered similar resistance while enrolling participants into a trial of the antiviral drug remdesivir.

So many people are taking hydroxychloroquine or insisting on being prescribed it that some doctors are compromising rigorous study design and allowing patients to take hydroxychloroquine anyway. Either way, the hype is making the interpretation of clinical trials for other drugs difficult:

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Data from clinical trials can also be skewed by excluding participants who refuse to give up chloroquine treatment. Chloroquine can cause heart arrhythmias, for example, and so may not be given to some people who have pre-existing heart problems. That means that a trial that excludes chloroquine-takers could end up enrolling a disproportionately large number of participants with heart conditions, says Malhotra.

But allowing participants to take chloroquine could muddle efforts to interpret data. Chloroquine’s effects, especially its effect on the immune system, could take days to fade, says Malhotra. This could make it difficult for trial investigators to distinguish the effect of the treatment they are testing from the effect of the chloroquine.

Exactly, and there are now over 100 clinical trials of hydroxychloroquine or chloroquine. Many are duplicative and the sheer number of clinical trials is not justified by the existing data concerning these drugs. One of the scientists in the article notes that the question of whether hydroxychloroquine is effective against COVID-19 could have been answered already if there had been a concerted effort to develop a handful of rigorous clinical trials, instead of the current situation. In the meantime, how many people have been harmed by what might well be an ineffective drug?

As the situation stands, CQ and HCQ, unproven drugs without clear evidence of benefit for COVID-19 but with evidence suggesting harm, became de facto standard of care before rigorous science supporting their use had been completed and remained so for nearly three months. Only now are doctors and government health authorities rethinking the situation and abandoning the drugs outside the auspices of clinical trials, thus coming into line with what I and others have been saying all along, that there was insufficient evidence that these drugs are effective against COVID-19 to justify using them indiscriminately. It turns out that, even during a pandemic, no good comes from abandoning science- and evidence-based medicine.

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The Capitol’s attending physician said Thursday that coronavirus tests will be available for staffers and senators who are ill, but not enough to proactively test all 100 senators as the chamber comes back in session, according to two people familiar with the matter.

In a conference call with top GOP officials, Dr. Brian Monahan said there is not sufficient capacity to quickly test senators for coronavirus — a contrast with the White House, where any people meeting with President Donald Trump and Vice President Mike Pence are tested for the disease. Monahan said test results in the Senate will take two or more days, while the White House has rapid testing.

The Senate is scheduled to reconvene on Monday after more than a month away, bringing as many as 100 senators from across the country. Roughly half the senators are 65 or older and at increased risk for the coronavirus, according to the Centers for Disease Control and Prevention.

Senate Majority Leader Mitch McConnell (R-Ky.) has repeatedly vowed that the Senate can operate safely amid the pandemic with proper social distancing and masks. Though House Democrats originally planned to come back next week, they decided against returning after consulting with Monahan. On Thursday, he did not address whether he thought it was safe for the Senate to return, one of the people familiar with the call said.

The Office of Attending Physician also sent out guidance late Thursday afternoon for committee meetings. The guidance recommends that senators and other attendees use a face covering and avoid getting out of their seats for the duration of the meeting. In addition, senators are advised to either attend meetings on their own or with at most one staffer per lawmaker.

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Nearly 5,000 coronavirus cases and 20 deaths have occurred in 115 meat and poultry processing facilities across the U.S., data from Centers for Disease Control and Prevention show.

Why it matters: The federal government has ordered meatpacking plants to remain open to keep America's food supply chain intact. But the data reveal worker safety is jeopardized when companies don't drastically change the work culture and provide protective equipment.

Many of the employees are low-income and are not offered paid sick leave or health benefits, which encourages employees to come to work sick.

The facilities with the largest outbreaks failed at providing adequate space for workers or had workers who found covering their faces difficult to adequately do their job.

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Senior Trump administration officials have pushed American spy agencies to hunt for evidence to support an unsubstantiated theory that a government laboratory in Wuhan, China, was the origin of the coronavirus outbreak, according to current and former American officials. The effort comes as President Trump escalates a public campaign to blame China for the pandemic.

Some intelligence analysts are concerned that the pressure from administration officials will distort assessments about the virus and that they could be used as a political weapon in an intensifying battle with China over a disease that has infected more than three million people across the globe.

Most intelligence agencies remain skeptical that conclusive evidence of a link to a lab can be found, and scientists who have studied the genetics of the coronavirus say that the overwhelming probability is that it leapt from animal to human in a nonlaboratory setting, as was the case with H.I.V., Ebola and SARS.

Mr. Trump’s aides and Republicans in Congress have sought to blame China for the pandemic in part to deflect criticism of the administration’s mismanagement of the crisis in the United States, which now has more coronavirus cases than any country. More than one million Americans have been infected, and more than 60,000 have died.

Secretary of State Mike Pompeo, a former C.I.A. director and the administration’s most vocal hard-liner on China, has taken the lead in pushing American intelligence agencies for more information, according to current and former officials.

Matthew Pottinger, the deputy national security adviser who reported on SARS outbreaks as a journalist in China, pressed intelligence agencies in January to gather information that might support any origin theory linked to a lab.

And Anthony Ruggiero, the head of the National Security Council’s bureau tracking weapons of mass destruction, expressed frustration during one videoconference in January that the C.I.A. was unable to get behind any theory of the outbreak’s origin. C.I.A. analysts responded that they simply did not have the evidence to support any one theory with high confidence at the time, according to people familiar with the conversation.

The C.I.A.’s judgment was based in part on the fact that no signs had emerged that the Chinese government believed the outbreak came from a lab. The Chinese government has vigorously denied that the virus leaked from a lab while pushing disinformation on its origins, including suggesting that the American military created it.

Any American intelligence report blaming a Chinese institution and officials for the outbreak could significantly harm relations with China for years to come. And Trump administration officials could use it to try to prod other nations to publicly hold China accountable for coronavirus deaths even when the pandemic’s exact origins cannot be determined.