CDC Guidance Shows Three-Month Window of Safety After Recovery: Live Updates

If you recover from the virus, you’re protected for up to three months, the C.D.C. says.

The Centers for Disease Control and Prevention updated their guidance recently to suggest that people who have recovered from the virus can safely mingle with others for three months.

It was a remarkable addition to the body of guidance from the agency, and the first acknowledgment that immunity to the virus may persist for three months.

In June, a study found that antibody levels could wane over a course of two to three months in people with confirmed infections who experienced mild symptoms or no symptoms. They drop off, but they may still be present at low levels, including below the limit of detection.

The latest C.D.C. guidance — which was tucked into public recommendations about who needs to quarantine — goes a bit further.

“People who have tested positive for Covid-19 do not need to quarantine or get tested again for up to three months as long as they do not develop symptoms again,” the guidance says. “People who develop symptoms again within three months of their first bout of Covid-19 may need to be tested again if there is no other cause identified for their symptoms.”

Other coronaviruses, including those that cause SARS and MERS, have antibodies that scientists believe last about a year. In the early days of the virus’s spread in the United States, scientists had hoped antibodies to the new virus would last at least that long.

A study published in May found that people who recovered from the infection could return to work safely, but it was still unclear how long they might be protected.

Doctors have reported some cases of people who seemed to be infected a second time after recovery, but experts have said those are more likely to represent a re-emergence of symptoms from the initial bout.

Clinical trials for some of the most promising experimental drugs are taking longer than expected, even as the pandemic continues to wreak havoc in the United States and treatments are needed more than ever.

Researchers at a dozen clinical trial sites said that testing delays, staffing shortages, space constraints and reluctant patients were complicating their efforts to test monoclonal antibodies — man-made drugs that mimic the molecular soldiers made by the human immune system.

As a result, once-ambitious deadlines are slipping. The drug maker Regeneron, which previously said it could have emergency doses of its antibody cocktail ready by the end of summer, has shifted to talking about how “initial data” could be available by the end of September.

And Eli Lilly’s chief scientific officer said in June that its antibody treatment might be ready in September, but in an interview this week, he said he now hopes for something before the end of the year.

“Of course, I wish we could go faster — there’s no question about that,” said the Eli Lilly executive, Dr. Daniel Skovronsky. “I guess in my hopes and dreams, we enroll the patients in a week or two, but it’s taking longer than that.”

One major hurdle has been testing. According to the rules of the Regeneron trial, a patient must be treated with the antibodies within seven days of the onset of symptoms. Both the Regeneron and Eli Lilly trials require giving the drug within three days of taking a test that comes back positive, but with turnaround times in some areas lagging for five days or more, keeping within those time frames has proved difficult.

Some researchers said finding the right location to give the experimental treatment to outpatients was complicated and some patients are reluctant to participate. Many people associate clinical trials with treatments that are given in life-or-death situations, and don’t want to risk taking an experimental drug for an illness they may overcome on their own. Others have the opposite rationale: They don’t want to go through the hassle of a trial only to receive a placebo.

The Senate formally adjourned on Thursday until early September, leaving undone any package of pandemic relief. House members had already left Washington.

Democrats and the Trump administration remain far apart on the stimulus, including how much to spend and where the money would go. The House, which is controlled by Democrats, passed a $3 trillion dollar aid package in May. Republicans, who control the Senate, want to stay in the $1 trillion range.

A major sticking point, aside from how much more to help unemployed Americans, was providing more aid to state and local governments. With tax revenues plummeting, states could face a cumulative budget gap of at least $555 billion through the 2022 fiscal year, according to one estimate. Economists warn that, unless Congress intervenes, the long-term financial damage might be greater than after the recession of 2007-9.

President Trump and top Republicans warn that providing more money to states could simply bail out fiscally irresponsible governments that did not manage their budgets and their public pension plans prudently in good times.

Democrats insist that states need more money and have proposed as much as $1 trillion, saying it would support needed services and help the economy recover more quickly.

Nearly all states are required to balance their budgets, meaning officials will need to plug shortfalls by tapping rainy-day funds, raising taxes or cutting costs, including by eliminating jobs.

That worries economists and Federal Reserve officials. Jerome H. Powell, the Fed chairman, regularly warns that state job cuts could hurt the economy’s ability to recover, and his colleagues say that public-sector budget trouble is one of the country’s primary vulnerabilities.

“It will hold back the economic recovery if they continue to lay people off and if they continue to cut essential services,” Mr. Powell said during congressional testimony in June. “In fact, that’s kind of what happened post the global financial crisis.”

With unemployment high and many businesses expected to close, states are bracing for more safety net costs on top of the public health expenses they are already incurring. They spend a large chunk of their budgets on Medicaid payments and services for low-income residents.

Yet the Trump administration and many Republican lawmakers have largely brushed off state financial woes, insisting that governors and other local leaders foot part of the pandemic aid bill and refusing to “bail out” Democratic-led states struggling with huge shortfalls in their public pension plans.

Obesity alone, apart from accompanying health problems, adds to Covid-19 risks for men.

Various factors are known to increase the risk of severe Covid-19, including older age and chronic health conditions like high blood pressure and heart disease. The Centers for Disease Control and Prevention also lists extreme obesity as a high risk.

But is it the excess weight that is to blame? Or is it the health problems that accompany obesity, like metabolic disorders and breathing problems?

A new study points to obesity itself as a culprit. An analysis of thousands of patients treated at a Southern California health system identified extreme obesity as an independent risk factor for dying among Covid-19 patients — most strikingly among younger and middle-aged adults 60 and younger, and particularly among men.

Among female Covid-19 patients, body mass index — a measure of body fat based on height and weight — does not appear to be independently associated with an increased risk of dying at any age, the authors said, possibly because women carry weight differently than do men, who tend to have more visceral and abdominal fat. The study was published in Annals of Internal Medicine on Wednesday.

“Body mass index is a really important, strong independent risk factor for death among those who are diagnosed with Covid-19,” said Sara Tartof, the study’s first author, a research scientist at Kaiser Permanente of Southern California.

But “the impact is not uniform across the population,” she added. “You don’t really see it for the older ages, and we didn’t see it as an important risk for females at any age.”

Even as coronavirus infections continued to spread, in-person school re-openings were scrapped and unemployment stayed near historic levels, Americans kept shopping in July, with retail sales rising 1.2 percent from June, reflecting a rare bright spot in the battered economy.

The jump in sales reported on Friday by the Commerce Department, though smaller than the increases in the previous two months, showed that the bounce back in spending to pre-pandemic levels was not a fluke. Sales are now back at the level they were in February. It was instead a sign that consumerism, buoyed by government support, remains resilient even as many other facets of American life are increasingly bleak.

“It shows there is a willingness and a desire to spend,” said Michelle Meyer, chief U.S. economist at Bank of America. “There is no doubt the recovery in consumer spending has been robust.”

Retail sales in June rose 8.4 percent. That followed a May jump, 18.2 percent, which was the largest monthly surge on record. But that had followed two months of record declines.

Some of the recovery has been helped by the $600 a week in unemployment assistance, which expired at the end of July. If Congress fails to extend the emergency benefit, it could derail the retail rebound in coming months. And there are certain sectors of the industry that may never truly bounce back until a vaccine is approved and widely distributed, allowing people to shop and dine indoors again without fear.

Foot traffic to brick-and-mortar stores selling primarily discretionary goods, including apparel retailers, remains down by as much as 43 percent from last year, according to Morgan Stanley’s research.

That persistently low traffic — following weeks and even months of temporary store closures — helps to explain why a record number of retailers have declared bankruptcy or closed down during the pandemic, even as sales of products like groceries, at-home entertainment and appliances have been booming.

Whatever one calls them — learning pods, pandemic pods or microschools — small groups that hire teachers to supplement or even replace the virtual instruction offered by public schools have become an obsession among many parents of means.

Practically overnight, a virtual cottage industry of companies and consultants has emerged to help families organize these small-group, in-home instruction pods and pair them with instructors, many of whom are marketing themselves on Facebook pages and neighborhood listservs.

But the cost — often from $30 an hour per child to $100 or more — has put them out of reach for most families, generating concerns that the trend could make public education even more segregated and unequal.

Shy Rodriguez, a single mother in Wilkes-Barre, Pa., with two sons, ages 8 and 11, said the pods were discouraging for people who cannot afford them. People who live paycheck to paycheck, she said, feel “like we’re directly failing our children because we can’t offer or afford the same level of opportunities.”

In Washington, D.C., one parent started a GoFundMe page to raise money to subsidize learning pods for low-income students in the district.

Education experts say fund-raising efforts and “pod scholarships,” however well meaning, are no solution for millions of low-income parents juggling the educational, child care and economic challenges of the pandemic.

More useful, they say, would be if school districts or city governments created their own version of learning pods, especially for at-risk students or children of essential workers.

In other news from around the United States:

  • The five metropolitan areas that now have the highest rate of new coronavirus cases relative to their population are all in South Texas, according to data compiled by The New York Times.

  • Gov. Gretchen Whitmer of Michigan said Friday that the state would give four million free face masks to homeless shelters, tribal organizations, community health centers, schools and grocery stores. The effort, which targets people particularly vulnerable to the virus, includes one million masks provided by the Federal Emergency Management Agency and 1.5 million masks donated by Ford Motor.

  • The National September 11 Memorial & Museum canceled its annual light display on the anniversary of the 2001 terrorist attacks because of the coronavirus. The decision was made “after concluding the health risks during the pandemic were far too great for the large crew,” a museum spokesman said.

  • The N.C.A.A. president, Mark Emmert, announced Thursday that Division I fall sports championships excluding football would be canceled. The championships were not explicitly dropped for health and safety reasons, but because there were fewer than the benchmark 50 percent of teams to compete in sports like women’s volleyball, soccer, cross country and men’s water polo.

The Department of Homeland Security on Friday announced an extension of the U.S. agreement with Canada and Mexico to limit nonessential travel through Sept. 21 as part of its continuing effort to stop the spread of the coronavirus. It was the fifth time the agreement has been extended since the measure was first put in place in March. Chad Wolf, the department’s acting secretary, announced the extension on Twitter.

According to a New York Times database, the number of new cases in the United States each day is on a slight decline, though nowhere near under control.

The State Department continues to advise that Americans “avoid all international travel” because of the pandemic. But even without the State Department guidance, many summer vacations were scrapped because travelers from America are not welcome in nations around the world, including China, Costa Rica and countries in the European Union. The United States is among the countries with the most persistent spread of the virus, second only to India. Over the past week, the United States has logged an average of more than 53,000 new cases a day. India has been seeing an average of 62,000 new virus cases a day over the same time period.

Paris and the Marseille area are named high-risk zones, and France goes on Britain’s expanded quarantine list.

France on Friday declared Paris and the Marseille region in the southeastern part of the country to be high-risk zones, granting local authorities powers to restrict the movements of people and vehicles, limit access to public transportation and public buildings and close down restaurants and bars.

France’s seven-day average is now above 2,000 cases, according to a New York Times database, a level the country reached in late March during a sharp rise in its outbreak that peaked in early April with a seven-day average of more than 4,400 cases.

On Thursday, Britain added France to its list of countries that visitors arriving from must quarantine for two weeks. The Netherlands, where cases have been doubling every two weeks since early July, was also added, as were Aruba, Malta, Monaco and Turks and Caicos. Britain had already imposed restrictions on Spain and Belgium, among other countries.

Britain unveiled the expanded list with little more than a day’s notice, prompting an instant scramble from vacationers to get back to Britain before the quarantine is imposed at 4 a.m. on Saturday.

France’s rising caseload reflects not only an increase in the number of tests, which now stand at more than 600,000 per week, but also a higher infection rate, especially among young people, the health authorities said. The country’s total caseload has risen to 209,365, with 30,388 deaths, according to the Times database.

The Netherlands has 62,406 confirmed cases and 6,187 deaths, according to the database, but a leading Dutch health expert has said that if the current trajectory is sustained, the case count could grow to 250,000 infections by the fall. Over 60 percent of all new infections are in people under 40.

Britain, with its own seven-day average creeping back up from July’s lows, is steaming ahead with its efforts to revive an economy that has spiraled into the deepest recession of the country’s modern history.

Bowling alleys, theaters and casinos will be allowed to reopen in England starting Saturday with social distancing in place, and beauty salons will be allowed to provide “close contact” services such as facials and eyebrow threading for the first time since lockdown began.

Wedding receptions will be also allowed for up to 30 guests, providing they are socially distanced.

Penalties for refusing to wear a face covering, as is required in enclosed public spaces and public transport, will also increase. And organizers of illegal gatherings could be fined up to 10,000 pounds ($13,000).


North Korea, fighting the virus and flooding, lifts a border city’s lockdown.

North Korea on Friday lifted a lockdown that it had imposed on a border city last month, but without providing any details or saying whether the nation has a coronavirus outbreak.

North Korea imposed the lockdown in Kaesong, near the border with South Korea, based on the government’s suspicion that a runaway from South Korea had brought the virus with him. On Friday, it said only that the reversal had been “based on the scientific verification and guarantee by a professional anti-epidemic organization.”

North Korea sealed its borders in late January and has insisted for months that it had no coronavirus cases, although outside experts questioned the claim. It has not revealed whether the defector who crossed back from South Korea tested positive.

This summer, an unusually long monsoon season, as well as torrential rains, have set off floods and landslides in parts of North Korea that suffer chronic food shortages even during normal years.

The twin calamities of the pandemic and the floods have battered an economy that was already hamstrung by the sanctions imposed by the United Nations for North Korea’s nuclear weapons development — and which went into a tailspin this year as the border restrictions cut deeply into exports and imports with China, the North’s primary trading partner.

North Korea’s leader, Kim-Jong-un, has said the nation faces “two crises at the same time.” But on Friday, the North’s state-run media reported that he had ordered his country not to accept any international aid for fear that outside help might bring in the coronavirus.

By precluding outside aid, he appeared to be denying Seoul and Washington a chance to thaw relations with the North through humanitarian shipments.

“North Korea’s rejection of flood relief is ostensibly to prevent transmission of Covid-19 into the country,” said Leif-Eric Easley, a professor of international studies at Ewha Womans University in Seoul. “But humanitarian assistance is heavily politicized by the Kim regime, as it does not want to show weakness to the domestic population or international rivals.”

In other news from Asia:

  • South Korea reported 103 new cases on Friday, mostly in Seoul, the country’s biggest daily jump in three weeks. The daily caseload has remained in double digits since July 25. Last month’s spike was primarily attributed to South Korean workers returning home with the virus from Iraq, but 85 of the 103 new cases reported on Friday were local transmissions.

  • President Rodrigo Duterte of the Philippines has delayed opening schools from Aug. 24 until Oct. 5, his chief aide said Friday. All schools are also “instructed to ensure that all preparations have been made for the smooth and successful virtual opening of classes,” the aide, Salvador Medialdea, said in a memorandum. The Philippines has the highest number of infections in Southeast Asia, with 153,660 confirmed cases and 2,442 deaths, according to a New York Times database.

  • Health officials in Toronto said that about 550 people may have been exposed to the coronavirus at a bar in the city after an employee tested positive for the virus. Using a tracing log, the agency is contacting customers of the Brass Rail Tavern, a strip club, who visited on four dates in August and telling them to monitor themselves for symptoms of Covid-19. The occupation of the infected employee was not disclosed.

Cuomo sets a date for the reopening of museums and other cultural institutions in New York City.

As New York maintains its hard-won progress against the coronavirus, New York City’s museums and other cultural institutions will be allowed to open their doors again on Aug. 24, Gov. Andrew M. Cuomo said on Friday.

The announcement came as the state reported seven consecutive days of less than 1 percent of all coronavirus tests returning positive, the governor said. Yet even as Mr. Cuomo celebrated the date, he warned that residents must continue to work to keep the numbers low.

“While the other states are seeing real trouble, we are doing very well,” Mr. Cuomo said. “We have to protect the progress.”

The state was particularly concerned that clusters of virus cases were emerging among farm workers, he said, and officials planned to send mobile testing units to farms in rural counties to do more testing.

Though “low risk” indoor cultural activities like museums and aquariums had been allowed to return in other parts of the state, officials had kept them shuttered in New York City, as cases began to rise in other parts of the country.

The museums that reopen in the city will be limited to a quarter of their total occupancy, Mr. Cuomo said. Timed ticketing will be required, and the institutions must control the flow of visitors. Face coverings will be required.

Bowling alleys across the state will be allowed to reopen as soon as Monday, Mr. Cuomo said, with face coverings required and occupancies capped at 50 percent.

The state also plans to release guidance on Monday for gyms and fitness centers to reopen. Hundreds of gym owners in the state filed a lawsuit last month against Mr. Cuomo and the state in an attempt to force their reopening.

Vietnam’s health ministry announced that it had registered to buy Russia’s coronavirus vaccine, despite global health experts’ concerns that Russia is using it before the last phase of human trials have even begun.

The ministry said it had also registered to buy a vaccine from the United Kingdom. It did not say how many doses of foreign vaccines it expected to buy, and cautioned that using them would depend on the progress of clinical trials and compliance with Vietnam’s “strict regulations.”

Vietnam has said it is developing its own vaccine that it aims to make available by the end of next year.

“The Ministry of Health of Vietnam will be determined and make every effort to get the vaccine for COVID-19 prevention and control as soon as possible,” said a statement posted on the ministry’s website.

Using aggressive contact tracing, isolation and public education, the country has been one of the most successful in containing the virus, reporting its first death two weeks ago. But it is now fighting an outbreak that began in the central city of Danang and has spread to other parts of the country, causing about 400 cases and claiming 21 lives.

Vietnamese health officials say they have identified several versions of the virus in the country, and that the one causing the Danang outbreak is more contagious and severe than the others.

As of Friday, Vietnam reported a total of 929 cases, according to a New York Times database, many in people quarantined after returning from abroad.

Vietnam and Russia have collaborated since at least the 1960s. As part of the Soviet Union, Russia was a major supporter and weapons supplier to Vietnam as it fought against the United States in the Vietnam War.

Vietnam, which remains a Communist state, has purchased six Kilo-class submarines from Russia over the last decade to help patrol the South China Sea, an area of rising tension with China, a neighbor and longtime adversary.

Australia and New Zealand confront border failures amid new outbreaks.

The border, the border, the border: That’s been the mantra for Australia and New Zealand since the coronavirus emerged. But both countries are now learning that their definition of the border, and border security, needs to expand to control the pandemic.

In New Zealand, where a cluster that emerged on Tuesday had grown to 30 cases by Friday, officials struggled to explain a lack of regular testing for border officials and workers who manage hotel quarantine for the roughly 400 residents returning every day from overseas.

One respected epidemiologist, Sir David Skegg, a professor at Otago University, called the lack of testing an “extraordinary” breach of known best practices.

Investigators still haven’t determined how the virus re-entered the isolated Pacific country after 102 days without a case of community transmission. Prime Minister Jacinda Ardern, who on Friday extended a lockdown in Auckland for another 12 days, told reporters that officials had not yet linked the first identified case to either the border or quarantine facilities.

But New Zealand’s process for handling returning citizens and residents has become a focal point, in part because new details have emerged about what caused the outbreak that is still raging in Australia.

Leaked emails from government officials, published Friday by The Age, a newspaper in Melbourne, Australia, identified a hotel night manager as patient zero. He tested positive for the virus on May 26, and worked at one of the largest quarantine hotels in the city. Five security guards at the hotel later tested positive, after spreading the virus to relatives and their communities.

A public inquiry into how passengers infected with the coronavirus were allowed to disembark a cruise ship in Sydney, Australia, in March, setting off a major outbreak, also handed down its findings on Friday.

The detailed report from a panel of experts found a litany of “serious mistakes” and failures (a word the authors used 34 times) that ultimately led to 20 deaths in Australia and eight more in the United States. Chief among the errors was a lack of testing and the assumption that the ship’s 2,700 passengers were low-risk because they had come from New Zealand even though it was known that many of the arriving tourists had flown to their departure point from the United States and other high-risk locations.

The border at the cruise ship terminal in central Sydney was porous, investigators found, and the virus broke through.

“The events surrounding the ship’s voyage and disembarkation on 19 March 2020 will sadly have a lasting effect for many passengers and their families,” the report concluded. “It can only be hoped that this episode serves as a precautionary tale should public health authorities ever again encounter similarly challenging circumstances.”

More than five months have passed since the pandemic prompted the shutdown of nursing homes and assisted living complexes across the United States, and a number of geriatricians and health care researchers now fear that the restrictive visiting policies at these facilities have become injurious to the residents.

“It’s not just Covid that’s killing residents in long-term care,” said Dr. Jason Karlawish, a geriatrician at the University of Pennsylvania. “It’s the isolation, the loneliness.”

The shutdown, which barred virtually all visitors, made sense to experts in the early weeks of the outbreak, when so little about the virus was understood.

Older people are generally far more vulnerable to pathogens, and the shared space of an elder-care home adds its own risks. More than 40 percent of those who have died from Covid-19 in the U.S. were residents or staff members at long-term care facilities, a New York Times database shows.

“We felt they were being responsive and protecting residents,” Dr. David Grabowski, a health care researcher at Harvard Medical School, said of the federal Centers for Medicare and Medicaid Services, which ordered the shutdown in March.

But studies have repeatedly shown that isolated older adults have elevated rates of heart disease, stroke and dementia and increased mortality rates, comparable to those linked to smoking. And in a study co-authored by Dr. Grabowski, nursing home residents with dementia received a better quality of care at the end of life if a family member visited regularly.

“Some have termed this isolation ‘involuntary confinement,’” said Dr. Christian Bergman, a geriatrician and internist at Virginia Commonwealth University. “We can’t continue down this path for another six months.”

In May, Medicare officials issued recommendations for state and local officials on phased reopening for nursing homes. It includes expanded visiting with masks and distancing when a home has entered Phase 3, meaning that it has had no new Covid cases for 28 days and can provide adequate testing and protective equipment, with no staff shortages.

Dr. Bergman, who heads a panel of health care professionals developing reopening guidelines for long-term care, estimated that fewer than 5 percent of facilities nationally have reached that point.

At facilities that have already resumed family visits, the most common approach has been scheduling brief contacts outdoors or encounters through windows, sometimes supplemented by video chat and phone calls.

But the effort has not been universal. “We are hearing that many facilities are refusing to permit visits even if they are allowed to do so,” Robyn Grant, director of public policy and advocacy for the National Consumer Voice, said in an email.

How do people learn to be more resilient?

If you feel as if you can barely cope, while others are doing just fine, remember that the very earliest days of our lives, and our closest relationships, can offer clues about how we deal with adversity.

Reporting was contributed by Damien Cave, Choe Sang-Hun, Emily Cochrane, Michael Corkery, James Dobbins, Thomas Erdbrink, Manny Fernandez, Abby Goodnough, Jason Gutierrez, Sapna Maheshwari, Apoorva Mandavilli, Constant Méheut, Claire Moses, Colin Moynihan, Richard C. Paddock, Alan Rappeport, Rick Rojas, Anna Schaverien, Jeanna Smialek, Mitch Smith, Paula Span, Eileen Sullivan, Katie Thomas, Billy Witz and Katherine J. Wu.

Source link