Fauci Warns Coronavirus Could Disrupt Life Well Into New Year


The United States should not expect a return to normal until “well into 2021, maybe even towards the end of 2021,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said on Friday.

In an interview with “Andrea Mitchell Reports” on MSNBC, Dr. Fauci addressed when people would most likely be able to do things again that they had done before the pandemic, such as going to an indoor movie theater “with impunity.” While a vaccine may be available by the end of the year, he said, “by the time you mobilize the distribution of the vaccinations, and you get the majority or more of the population vaccinated and protected, that’s likely not going to happen till the mid or end of 2021.”

Dr. Fauci was also asked about comments he had made on Thursday in a panel discussion at Harvard Medical School, where he said “we need to hunker down and get through this fall and winter because it’s not going to be easy.” Ms. Mitchell pointed out that this conflicted with what President Trump had said at the White House on the same day, that the country had “rounded the final turn” on the virus.

“I have to disagree,” Dr. Fauci said of Mr. Trump’s optimistic read on the situation.

“We’re plateauing at around 40,000 cases a day and the deaths are around 1,000.” He raised concerns that Labor Day could make that number rise again, as Memorial Day and the Fourth of July had done before.

But in any case, he said “what we don’t want to see is going into the fall season when people will be spending more time indoors — and that’s not good for a respiratory borne virus — you don’t want to start off already with a baseline that’s so high.”

As of Thursday, there had been an average of 35,629 cases per day over the previous week, a decrease of 16 percent from the average two weeks earlier, according to a Times database. Case numbers remain persistently high across much of the country, though reports of new cases have dropped considerably since late July, when the country averaged well over 60,000 per day.

But even as many of the country’s most populous states saw vast improvement — and as the Northeast kept case reports low — new infections were rising by late summer across parts of the Midwest and South.

Deaths, though still well below their peak levels in the spring, averaged around 700 per day in mid-September, more than were reported in early July.

China’s vaccine pledges, on top of earlier shipments of masks and ventilators around the world, help it project itself as a responsible player and could also help it push back against accusations that the ruling Communist Party should be held accountable for its initial missteps when the coronavirus first emerged in China in December.

The Trump administration has roundly attacked Beijing over its handling of the virus crisis, as well as over accusations that Chinese-directed hackers have tried to steal vaccine research to gain an edge. The Justice Department indicted two Chinese suspects accused of targeting pharmaceutical companies in July.

China is a leader in the global race for a Covid-19 vaccine, and four out of the eight late phase clinical trials are for Chinese vaccines. The country began testing experimental vaccines on soldiers and employees of state-owned companies in July, and the testing has quietly expanded to include health care and aviation workers. Chinese vaccine makers have built factories that can produce hundreds of thousands of doses.

The United States has three vaccine candidates in late-stage trials, with Pfizer saying it could apply for emergency approval as early as October and Moderna saying it hopes to have a vaccine by the end of the year. AstraZeneca, a British-Swedish company that received U.S. government funding to develop its vaccine, paused its late-stage global trials this week because of a serious suspected adverse reaction in a participant.

But Chinese vaccine companies that have gone abroad to conduct clinical trials have also generated controversy amid fears that local residents are being treated like guinea pigs. And some political experts worry about the leverage that China could wield over countries that accept vaccines.

“Should we be suspicious, or should we be grateful?” asked Muhammad Zulfikar Rakhmat, an academic at Universitas Islam Indonesia, who researches China’s foreign policy in Indonesia.

Long before the coronavirus swept into her village in the rugged southeast of Afghanistan, Halima Bibi knew the gnawing fear of hunger. It was a relentless source of anxiety as she struggled to nourish her four children.

Her husband earned about $5 a day, hauling produce by wheelbarrow from a local market to surrounding homes. Most days, he brought home a loaf of bread, potatoes and beans for an evening meal.

But when the virus arrived in March, taking the lives of her neighbors and shutting down the market, her husband’s earnings plunged to about $1 a day. Most evenings, he brought home only bread. Some nights, he returned with nothing.

“We hear our children screaming in hunger, but there is nothing that we can do,” said Ms. Bibi, speaking by telephone from a hospital in Kabul, where her 6-year-old daughter was being treated for severe malnutrition. “That is not just our situation, but the reality for most of the families where we live.”

As the global economy absorbs the most punishing reversal of fortunes since the Great Depression, hunger is on the rise. Those confronting potentially life-threatening levels of so-called food insecurity in the developing world are expected to nearly double this year to 265 million, according to the United Nations World Food Program.

The largest numbers of vulnerable communities are concentrated in South Asia and Africa, especially in countries that are already confronting trouble, including military conflict, extreme poverty and climate-related afflictions like drought, flooding and soil erosion.

As countries around the world struggle to safely reopen schools this fall, China’s Communist Party is harnessing the power of its authoritarian system to offer in-person learning for about 195 million students in kindergarten through 12th grade at public schools.

It has mobilized battalions of local officials and party cadres to inspect classrooms, deployed apps and other technology to monitor students and staff, and restricted their movements. It has even told parents to stay away for fear of spreading germs.

China’s leader, Xi Jinping, said in a speech on Tuesday that the country’s progress in fighting the virus, including the opening of schools, had “fully demonstrated the clear superiority of Communist Party leadership and our socialist system.”

In many ways, China is applying the same heavy-handed model to reopen schools that it has used to bring the virus under control. To stop the epidemic, the authorities imposed harsh lockdowns and deployed invasive technologies to track residents, raising public anger in some places and concerns about the erosion of privacy and civil liberties.

With schools, the government’s effort has in some places been met with similar frustrations. Teachers, who are at times doubling as medical workers, checking for fevers and isolating sick students, say they are exhausted by the new protocols. Students have complained that some policies, such as lockdowns on university campuses, are excessive.

“The Chinese system moves by itself,” said Yong Zhao, a scholar at the University of Kansas who has studied education in China. “The system is run like a military: it just goes for it, no matter what anyone thinks.”

A new study suggests that restaurant dining may have increased the risk of exposure to the virus for some patrons, but several researchers said that the links between contracting the virus and eating out should be viewed with caution, because the study did not distinguish between patrons who dined at indoor or outdoor facilities, and didn’t rely on contact tracing.

The study, released by the Centers for Disease Control and Prevention, analyzed 314 patients and found that those who tested positive for the virus were twice as likely to have eaten at a restaurant in the previous two weeks as those who tested negative.

“We want people to understand as society opens back up where the risks are for Covid-19,” said Dr. Wesley Self, a doctor and researcher at Vanderbilt University and an author of the study.

Dr. Self said he believed in retrospect that the researchers should have made the distinction between indoor and outdoor dining.

Gov. Andrew M. Cuomo announced on Wednesday that New York City would lift its prohibition on indoor dining on Sept. 30, allowing restaurants to operate at one-quarter indoor capacity. In July, the governor and Mayor Bill de Blasio halted a plan to resume indoor dining, citing concerns about a resurgence of the virus. (The conditions of outdoor dining are considered less risky.)

Last month, data from a number of states and cities showed that community outbreaks had centered on restaurants and bars. Contact tracers in Maryland found that 12 percent of new cases in July were traced to restaurants, and in Colorado, 9 percent of outbreaks were traced to bars and restaurants. The patients in the new study were treated at 11 hospitals in California, Colorado, Maryland, Massachusetts, Minnesota, North Carolina, Ohio, Tennessee, Utah and Washington.

Some researchers have urged caution in interpreting the findings of the new C.D.C. study.

“The way folks have interpreted this study is that going to a restaurant causes Covid,” said Zack Cooper, an associate professor of public health at the Yale School of Public Health. “That isn’t what this type of study is designed to show. What this shows is people who have Covid were more likely to have been in restaurants.”

Dr. Cooper said dining in restaurants was probably associated with increased risk because it puts people in proximity with others who are not exercising caution in limiting their exposure to the virus. He said researchers needed to be careful in studying the risks of common activities, given the challenges for the general public in interpreting statistical findings.

In an interview with CNN on Friday, Dr. Fauci was asked what the study’s findings meant for people who wanted to dine out. He said that he would not completely rule out going to a restaurant.

“But,” he said, “restaurant owners should be aware that, particularly if you’re in a zone where you have a significant degree of infection, you either do outdoor dining or if it’s indoor, you don’t do it at 100 percent capacity.”

Four Canadian provinces — Alberta, British Columbia, Ontario and Quebec — account for more than 4,000 of the 4,439 cases that the country has reported over the past week. Those provinces also accounted for all of the 23 deaths related to Covid-19 that were reported over the same period. This week, Ontario, Canada’s most populous province, said that it will take a four-week “pause” before it considers loosening restrictions or allowing further economic reopening.

Over all, at least 9,163 deaths in the country have been linked to Covid-19. Quebec accounts for more than half of them, with 5,774, followed by Ontario, with 2,813.

Canada has previously reported zero Covid-19 deaths in 24-hour periods, although measuring that can be imprecise because of delays in reporting. The average number of daily reported deaths over the past week is three.

By contrast, as of Thursday the average number of daily reported deaths over the past week in the United States was 702.

It began as a trickle of coronavirus infections as college students arrived for the fall semester. Soon that trickle became a stream, with campuses reporting dozens, and sometimes hundreds of new cases each day.

Now the stream feels like a flood. In just the past week, a New York Times survey has found, American colleges have recorded more than 36,000 additional infections, bringing the total of 88,000 cases since the pandemic began.

Not all those cases are new, and the increase is partly the result of more schools beginning to report the results of more testing. But The Times survey of 1,600 colleges also shows how widely the contagion has spread, with schools of every type and size, and in every state reporting infections.

France is facing a worrying surge in cases, the government said on Friday, warning that the new cases were rapidly increasing and that hospitals were seeing an uptick in admissions.

Many expected new restrictions, especially after the government’s scientific council said earlier this week that the authorities would have to take “difficult measures.”

But the authorities did not announce new rules, vowing instead to improve the country’s immense testing program — which has been plagued by delays in recent weeks — and urging the French to continue social distancing measures.

The country registered about 54,000 new cases over the past 7 days — less than Spain, but far more than other neighboring countries like Italy or Germany. Nearly 31,000 people in France have died of the virus.

On Thursday, there were nearly 10,000 new confirmed cases, a record since the beginning of the epidemic. The surge is due partly to widespread testing, but the positivity rate for those tests has also increased — it was at 5.4 percent this week, up from 1.5 in late July — meaning that the virus is picking up speed.

Jean Castex, the French prime minister, said in a televised address on Friday that authorities were particularly worried about a renewed increase in the number of hospitalizations, especially of elderly people.

“This shows there is no Maginot line,” said Mr. Castex, referring to national fortifications built in the 1930s. Even if the virus is still mostly spreading among younger people, he said, it “inevitably” ends up reaching more vulnerable segments of the population.

In other developments around the world:

  • Myanmar has locked down half of its largest city, Yangon, and halted travel between regions in an effort to halt the spread of the virus. Myanmar’s leader, Daw Aung San Suu Kyi, urged the public to follow health protocols in a nationally televised address on Thursday. The number of confirmed cases has gone up fivefold in less than three weeks, reaching 2,422 on Friday, with 14 deaths, according to a Times database.

  • India again broke a record for daily new cases, reporting 97,750 on Saturday, according to a Times database. The previous record, set Friday, was 96,551.

  • North Korea has deployed crack troops along its border with a shoot-to-kill order to prevent smugglers from introducing the coronavirus into its isolated and malnourished population, the United States’ top general in South Korea, Gen. Robert B. Abrams, said on Thursday. North Korea insists that it has not confirmed a single case of Covid-19. But outside experts are skeptical, citing the country’s decrepit public health capabilities and the long border it shares with China, where the epidemic first erupted.

A series of studies released on Friday offered the strongest evidence yet that the coronavirus is surging again in Britain, suggesting that the country may be following other European nations in seeing significant new spikes of the virus.

Scientists from Imperial College London said that the prevalence of coronavirus infections doubled every eight days from late August to early September in England, a significant quickening of the spread.

The scientists tested a random sample of 150,000 people and estimated that the so-called reproduction number — a measure of how many people on average a single patient will infect — was 1.7, indicating a growing outbreak. An R number below 1 would indicate a dwindling outbreak.

The government’s own scientific advisory group offered a more conservative estimate of the virus’s spread — it said the R number was between 1 and 1.2 in Britain — but still said that “the epidemic is growing.”

The British government reported 3,539 new daily cases on Friday, lifting its seven-day average well over 2,500, a level last seen in May. Its total caseload has surpassed 361,000, with more than 41,600 deaths.

Heeding the surge, Prime Minister Boris Johnson announced this week that the government would ban gatherings of more than six people. But with students now returning to school and Britons socializing inside more as the weather cools, scientists said that might not be enough.

“This is a massive blow to the government’s strategy to contain the spread of Covid-19,” Simon Clarke, an associate professor at the University of Reading, said of the Imperial College London study.

The mayor of Miami-Dade County, Carlos Gimenez, and the county’s schools superintendent, Alberto Carvalho, appeared with the governor at the news conference on Friday. Mr. Carvalho said he expects to make an announcement about physically opening schools before the end of the month; he had previously established a timeline to bring students back by Oct. 5.

About 51 percent of parents of public school students have told the district they want to send their children back, he said, adding that “six feet of distance is probably not going to be possible in many schools.”

Mr. Gimenez, whose county was hit hardest in the state, said that his administration would begin to look at businesses that could now reopen under certain restrictions, including movie theaters and bowling alleys, though he reiterated it would not include bars and nightclubs. On Wednesday, he said he did not foresee reopening them “until we get a vaccine.”

“We’re still not out of the woods yet, but we’re getting close,” he said Friday.

In Puerto Rico, Gov. Wanda Vázquez eased some of the island’s tight restrictions on Thursday, citing a recent drop in cases. Ms. Vázquez lifted a lockdown that had forced people to stay home on Sundays, and reopened beaches to everyone. She also authorized the reopening of gyms, movie theaters and casinos at 25 percent capacity.

Bars and nightclubs remain closed, and a nightly curfew will remain in effect.

It was a nearly party-line vote whose outcome was never in doubt. The proposal amounted to a fraction of the $1 trillion plan Republicans had offered in negotiations with Democrats, who in turn are demanding more than twice as much.

A failure to compromise would leave millions of jobless Americans in potentially dire straits, as they exhaust jobless benefits and states run out of additional funds that Mr. Trump steered to the unemployed by executive order last month. It would also strand a wide swath of small business owners who have endured steep drops in revenue, with little prospect of a return to normal levels for months to come.

“Along with a pandemic of Covid-19, we have a pandemic of politics,” Senator Pat Roberts, Republican of Kansas, said. “Looking to the House — and for that matter, our colleagues across the aisle — it’s a sort of a dead-end street.”

He spoke after the measure failed on a 52-to-47 vote, falling short of the 60 it would have needed to advance.

The new application will allow people to scan QR codes when they visit hospitality venues and will use Apple and Google’s technology for detecting other smartphones in the vicinity.

Matt Hancock, Britain’s health secretary, said in a statement on Friday that the app would be a vital tool for containing the spread of the coronavirus.

“We need to use every tool at our disposal to control the spread of the virus including cutting-edge technology,” he said. “The launch of the app later this month across England and Wales is a defining moment and will aid our ability to contain the virus at a critical time.”

What’s the fairest expectation of how bad the pandemic should have been in the United States?

In his Morning newsletter, David Leonhardt spoke with Donald McNeil, the New York Times reporter who has frequently appeared on “The Daily” podcast to talk about the coronavirus.

Mr. Leonhardt writes:

Donald makes a fascinating point: Don’t look only at snapshots, like a country’s per capita death toll. “It’s not fair to pick one point in time and say, ‘How are we doing?’” he writes. “You can only judge how well countries are doing when you add in the time factor” — that is, when the virus first exploded in a given place and what has happened since.

The pandemic, he adds, is like a marathon with staggered start times.

The virus began spreading widely in Europe earlier than in North America. Much of Europe failed to contain it at first and suffered terrible death tolls. The per capita toll in a few countries, like Britain, Italy and Spain, remains somewhat higher than in the U.S. But those countries managed to get the virus under control by the late spring. Their caseloads plummeted.

In the U.S., the virus erupted later — yet caseloads never plummeted. Almost every day for the past six months, at least 20,000 Americans have been diagnosed with the virus. “Europe learned the hard lesson and applied remedies,” as Donald says. “We did not, even though we had more warning.”

This chart makes the point:

The data, drawn from millions of health insurance claims, shows a consistent pattern, whether it was prostate screenings or contraceptives: Preventive care declined drastically this spring and, as of late June, had not yet recovered to normal levels. Many types of such care were still down by a third at the start of this summer, the most recent data available shows, as Americans remained wary of visiting hospitals and medical offices.

Americans continued seeking care they couldn’t avoid — hospital admissions for childbirth, for example, held steady — but avoided care they could put off. More invasive preventive procedures, such as mammograms and colonoscopies, showed the greatest decline.

Colonoscopies, which are generally used to screen for colon cancer, declined by 88 percent in mid-April and were still 33 percent lower than normal at the end of June. Mammograms, which fell 77 percent at the height of the pandemic, are still down 23 percent.

Critical childhood vaccinations for hepatitis, measles, whooping cough and other diseases also declined significantly, a trend that had already begun to worry pediatricians earlier in the pandemic. Of particular concern, measles vaccinations fell 73 percent in mid-April and were still down 36 percent at the end of June.

But one preventive service stayed relatively steady through the pandemic: pregnancy-related ultrasounds. Those declined slightly in March and April but never fell more than 20 percent below 2019 levels. Insertions of IUDs, one of the most effective birth control methods, declined like other preventive care — raising the possibility of an increase in pregnancies in coming months.

Reporting was contributed by Sarah Almukhtar, Aurelien Breeden, Kenneth Chang, Choe Sang-Hun, Emily Cochrane, Abdi Latif Dahir, Marie Fazio, Emma G. Fitzsimmons, Michael Gold, Emma Goldberg, Peter S. Goodman, Sophie Hardach, Javier C. Hernández, Jonathan Huang, Mike Ives, Sarah Kliff, David Leonhardt, Dan Levin, Patricia Mazzei, Benjamin Mueller, Saw Nang, Richard C. Paddock, Roni Caryn Rabin, Campbell Robertson, Dana Rubinstein, Karan Deep Singh, Megan Specia, Jim Tankersley, Kate Taylor, Sui-Lee Wee and Noah Weiland.


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