British Prime Minister Boris Johnson plans to end an England-wide lockdown as scheduled on Dec. 2 and will announce a return to regional restrictions as statistics show that coronavirus infections have stabilized.
Johnson’s office also confirmed plans to begin a nationwide COVID-19 vaccination program next month, assuming regulators approve a vaccine against the virus. The government also will increase mass testing in an effort to suppress the virus until vaccines can be rolled out.
Johnson’s office said late Saturday that the government plans to return to using a three-tiered system of localized restrictions in England, with areas facing different lockdown measures based on the severity of their outbreaks. More communities are expected to be placed in the two highest virus alert categories, it said.
The government put England under a four-week lockdown that started Nov. 5. The Cabinet is to discuss the plans Sunday, and the prime minister aims to give Parliament the details on Monday, according to the statement.
The U.K. as a whole has the worst virus death toll in Europe, at over 54,700 deaths.
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Johnson announced the lockdown in England on Oct. 31 after public health officials warned that an exponential rise in new daily coronavirus infections was threatening to overwhelm the National Health Service as the winter flu season approached. The lockdown closed non-essential business like many shops, gyms, bars, restaurants — although takeout was permitted. It also banned most social gatherings but schools remain open.
New known cases of COVID-19 have started to drop across the U.K., with the number of positive tests during the past seven days falling 13.8 per cent from the week before. Some 2,861 COVID-related deaths were reported over the last 7-day period, 17 fewer than a week earlier. Still, the infection rate remains high, at 244 cases for every 100,000 people.
Health Secretary Matt Hancock told reporters Friday that the lockdown has been successful in slowing the spread of the virus, though he stressed that people needed to keep following the rules to keep cases down.
Professor Jonathan Van-Tam, the government’s deputy chief medical officer, warned that any gains from the November lockdown could be quickly lost to a virus that takes “just seconds” to spread.
People should “keep up the pressure on this virus and push down on it as much as we can right to the end of the period (of lockdown),” he said.
The government’s scientific advisory group, known as SAGE, is expected to publish reports on Monday showing that Johnson’s earlier three-tiered strategy wasn’t strong enough and recommending tougher restrictions when it returns.
Under that system, a “medium” alert level requires restaurants and pubs to close at 10 p.m. and prohibits residents from mixing in groups larger than six. The “high” level prevents people from gathering indoors with anyone not in their household or extended “support bubble.”
In areas under a “very high” alert, pubs and bars only can remain open and serve alcohol only if it comes with a hearty meal. People are advised not to travel in or out of those areas.
New Brunswick health officials will move the Saint John region to the orange level of the province’s coronavirus recovery plan as the number of cases in the region has doubled in the past two days.
The decision comes a day after the Moncton region was also moved to the orange phase following a recommendation from Dr. Jennifer Russell, New Brunswick’s chief medical officer of health.
Orange phase for Saint John and Moncton areas
The orange phase of the recovery plan means that only a single household bubble is permitted. That single household can be extended to caregivers or immediate family members requiring support.
The province has also modified its existing guidance for the orange phase.
The revised rules mean that outdoor gatherings with physical distancing are permitted with 25 people or fewer.
Faith venues can operate under an approved COVID-19 operation plan but the province says that in-person services are limited to 50 participants or fewer depending on the size of the facility.
Unregulated health professionals, barbers, hair stylists and spas may operate under a COVID-19 operational plan. They must actively screen patrons, have enhanced barriers and closed waiting rooms.
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Gyms and fitness facilities may also operate under a COVID-19 operation plan although physical distancing of two metres and masks are mandatory for “low-intensity fitness classes” such as yoga, tai chi and stretching.
For high-intensity activities such as spin, aerobics and boot camps, that physical distancing must be extended to three metres.
Entertainment venues such as casinos, bingo halls, arcades and cinemas may operate under a COVID-19 operations plan although occupancy limits are set at 50 patrons or fewer, depending on the size of the venue.
On Friday the province reported nine new cases in New Brunswick, seven of which are located in Saint John. There are now 51 active cases in the province.
Russell also declared a COVID-19 outbreak at Tucker Hall on the Shannex campus in Saint John.
A single case was confirmed at the facility at Tucker Hall on Thursday.
Although there are 90 residents located at Tucker Hall, Russell said that all residents and staff at the entire Shannex complex — totalling more than 400 people — are being tested for COVID-19 Friday.
N.B. reaches 400-plus cumulative cases
There have been 401 cases in the province since the pandemic began, 344 of which are considered to be resolved at this time.
Russell also told the media on Friday that there is one person in the hospital but that no one is in intensive care at this time.
There have been six deaths as a result of the coronavirus.
New Brunswick has completed 114,020 COVID-19 tests.
Russell and Higgs have repeatedly advised New Brunswickers to significantly limit travel outside of the Atlantic region, even for the holiday season, as well as limit travel in and out of the orange zones in the province.
Faced with a seemingly unstoppable surge in coronavirus infections, officials at the Centers for Disease Control and Prevention on Thursday urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households — a message sharply at odds with a White House eager to downplay the threat.
The plea, delivered at the first C.D.C. news briefing in months, arrived as many Americans were packing their bags for one of the most heavily traveled weeks of the year. It is the first time that the agency has warned people away from traditional holiday celebrations.
“The safest way to celebrate Thanksgiving this year is at home with members of your household,” said Erin Sauber-Schatz, who leads the agency’s community intervention and critical population task force. She urged Americans to reassess plans for the coming week.
The C.D.C.’s warning runs counter to messages from administration officials, who have denounced concerns that Thanksgiving celebrations will speed the virus’s spread.
“A lot of the guidelines you’re seeing are Orwellian,” Kayleigh McEnany, the White House press secretary, said on “Fox & Friends,” singling out a requirement in Oregon that gatherings not exceed more than six people.
Members of the White House coronavirus task force did not even mention Thanksgiving at a news conference on Thursday, even as they warned of the hazards associated with indoor gatherings and urged “vigilance” in the face of rampant infections.
Earlier in the week, Dr. Scott Atlas, a scientific adviser to President Trump, mocked the idea that older relatives would be put at risk over the holiday weekend, although there is ample medical evidence that seniors are much more likely to become ill if they are exposed to the virus and to die if they become sick.
“This kind of isolation is one of the unspoken tragedies of the elderly, who are now being told, ‘Don’t see your family at Thanksgiving,’” Dr. Atlas said. “For many people, this is their final Thanksgiving, believe it or not.”
An estimated 55 million Americans had planned to travel for the holiday, according to AAA Travel. But rising coronavirus infections, new quarantine rules and increased unemployment have combined to deter travelers in the past few weeks, and that number will be at least 10 percent lower now, the largest year-over-year decrease since 2008.
United Airlines said recently that it expected Thanksgiving week to be its busiest period since the pandemic’s onset. But on Thursday, the airline reported that bookings had slowed and cancellations had risen. American Airlines has slashed flights between the United States and Europe as cases rise sharply on both sides of the Atlantic.
Emboldened C.D.C. officials, rarely heard from in recent months, have been speaking more forcefully since President-elect Joseph R. Biden Jr. won the election. On Thursday, agency researchers said they were alarmed by the “exponential” rise in coronavirus infections, hospitalizations and deaths across the country.
More than one million new cases have been reported in the past week alone.
“Amid this critical phase, the C.D.C. is recommending against travel during the Thanksgiving period,” Dr. Henry Walke, Covid-19 incident manager at the agency, said at a news briefing. “All Americans want to do what they can to protect their loved ones.”
As of Wednesday, the seven-day average of daily new cases across the country had surpassed 162,000, an increase of 77 percent from the figure two weeks earlier. More than 79,000 hospitalizations were reported on Wednesday.
Officials in California on Thursday announced a curfew aimed at trying to quickly curb a surge of new coronavirus infections. Nearly all of the residents of the nation’s most populous state will be barred from leaving their homes to do nonessential work or to gather from 10 p.m. to 5 a.m.
Gov. Gavin Newsom’s order comes amid what state officials and experts have described as an alarming — but not yet irreversible — wave of new infections heading into a dangerous Thanksgiving week.
Given the growing crisis, the C.D.C.’s timing confounded some scientists who have warned for weeks that the holiday gatherings may accelerate the pandemic.
“They’re a little late — everybody’s got their plane tickets,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “But better late than never.”
Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Mr. Biden’s Covid-19 advisory board, warned that a Thanksgiving feast was the perfect setting for spreading the virus.
“This is a bad time to be swapping air with people that are not immediate household members,” he said. “You can have one person sitting at the table who appears to be perfectly healthy, and you can infect most the people, if not all of the people, sitting at that table.”
Small household gatherings help spread the virus, although their contribution to the overall toll has been hard to define. Older family members are particularly vulnerable to developing severe Covid-19, especially if they have chronic health conditions.
Traveling itself puts people at risk of exposure to the virus, regardless of how they travel. “What we’re concerned about is not only the actual mode of travel — whether it’s an airplane or bus or car — but also the transportation hubs,” Dr. Walke said.
“When people are in line to get on a bus or plane,” social distancing becomes difficult and viral transmission becomes more likely, he said.
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Even driving in a car poses risks, because travelers can be exposed at rest stops and gas stations. If Americans choose to travel, they must wash hands, wear masks and maintain social distancing, C.D.C. officials said.
Dr. Walke and others were at pains to differentiate between household members and family members. Many Americans believe that it is safe to gather with family, even if they don’t live together; in fact, most scientists say only other members of the household are safe company.
Researchers define a household as people who have been living together under the same roof for the last 14 days. That definition may apply to unrelated roommates who share living quarters but may exclude close family members who have been living apart from their parents.
The new recommendations pose a particular quandary for families anticipating the return of a college student or hoping to host an adult child who lives in a separate residence. Neither child is part of the household.
Colleges have encouraged students — many returning home for the remainder of the semester — to take a coronavirus test before they depart, but C.D.C. officials do not endorse testing before gathering for Thanksgiving.
Testing is far from foolproof, and a negative result indicates only that “you probably were not infected at the time your sample was collected,” according to the agency.
If members of different households are gathering in someone’s home for the Thanksgiving meal, they should all wear masks, except when eating, and remain six feet apart, federal officials said.
Guests should be encouraged to wash their hands with soap and water, and no one should hug or exchange handshakes. When gathering inside, attendees should wear masks as much as possible when not eating. Windows and doors should be kept open as much as possible to improve ventilation.
The C.D.C.’s advice went so far as to urge people to speak in low voices, because shouting — or singing — can spread the virus. Only one person should serve the food, federal officials said. If there are overnight guests, they should have their own bathroom.
Other medical organizations also issued dire warnings on Thursday. In an unusual “open letter to the American people,” groups representing physicians, nurses and hospitals jointly urged people to scale back holiday gatherings.
Though the letter did not explicitly discourage travel, the groups noted that Covid-19 cases had spiked after other holidays, like the Fourth of July and Labor Day, and that health care systems were already stretched to the limit in many parts of the country.
Michael Shear contributed reporting from Washington, and Karen Zraick, Shawn Hubler and Niraj Chokshi from New York. Jill Cowan contributed reporting from Los Angeles.
In a sign that Americans are becoming less hesitant to take a coronavirus vaccine, a Gallup poll released on Tuesday showed that 58 percent of the adults who were surveyed were willing to be vaccinated, up from 50 percent in September.
The survey was conducted between Oct. 19 and Nov. 1, as coronavirus cases were surging across the country but before Pfizer and Moderna announced that their vaccines were 90 percent effective or better against the virus in late-stage trials.
Still, the results were promising for an eventual vaccine rollout, as widespread inoculation against the virus is seen as essential before restrictions can be lifted and life can return to normal, or something close to it.
The survey’s authors cautioned, however, that confidence in a vaccine remained lower than it was earlier in the pandemic. In June, for instance, Gallup reported that 66 percent of Americans said they would be vaccinated.
While the percentage of American adults who said they would not be vaccinated dropped to 42 percent from 50 percent in September, skepticism about a rushed vaccine, among other factors, still presents a significant challenge for officials who will need to convince the public that any approved coronavirus vaccine is safe.
“A longer period of development and clinical testing” may help ameliorate some of the most common reasons for concern, the survey’s authors wrote.
Dr. Phoebe Danziger, a pediatrician at the University of Michigan who writes about medicine, ethics and culture, said in an interview that the Gallup data was consistent with what she had observed anecdotally.
“Clearly there’s a lot of hesitation out there, but it seems like there’s a slight shift into a positive view,” she said. As cases continue to rise across the Midwest, she senses that people across the political spectrum are starting to see that they are “really going to need this to get out of this mess.”
The poll, which reflects an online survey of 2,985 adults, has a margin of error of plus or minus three percentage points.
The increased willingness to take a coronavirus vaccine was more pronounced in certain groups, particularly Democrats and Americans between the ages of 45 and 64.
Among Democrats, willingness to take a vaccine rose to 69 percent last month from 53 percent in September. Nearly half of Americans between the ages of 45 and 64 — 49 percent — said they were willing to take a vaccine, up from 36 percent in September. Despite the increase, people in that age group remained least likely to say they would get the vaccine.
Democrats have consistently signaled that they were more likely to get vaccinated than Republicans and Independents, but there were shared concerns in the late stages of the presidential campaign.
A poll released last month by the Kaiser Family Foundation found that a clear majority of Americans were skeptical about a rushed vaccine, with 62 percent of adults saying they were concerned about the Trump administration pressuring the Food and Drug Administration to approve a coronavirus vaccine before the election.
In September, President-elect Joseph R. Biden Jr. said he did not trust President Trump to determine when a vaccine was ready. “Let me be clear: I trust vaccines. I trust scientists,” he said. “But I don’t trust Donald Trump, and at this moment, the American people can’t either.”
Lydia Saad, Gallup’s director of U.S. social research, suggested that coronavirus vaccination had become a more rancorous partisan issue, contributing to a decline in confidence among Democrats. Their confidence rebounded somewhat in the latest survey, she said, possibly because the political rhetoric had moved away from the issue.
“People went back to their original tendencies,” she said in an interview.
A rushed approval process for a vaccine was a concern for 37 percent of the adults Gallup polled, while 26 percent said they would wait for confirmation that a vaccine was safe. A smaller group — 12 percent — said they did not trust vaccines in general, reflecting a mistrust of vaccines that has been on the rise across the country in recent years, stemming from the legacy of government experimentation on African-Americans and the disadvantaged as well as distrust of the pharmaceutical industry.
With Pfizer and Moderna’s vaccines both showing early success, Ms. Saad said she expected the willingness of Americans to be vaccinated to rise, though she was reluctant to speculate about how quickly.
“I would certainly think there’s more room for Democrats to feel more confident,” she said. “I think Republicans are likely to rally around this vaccine, because it was developed on Trump’s watch. On the other hand, there are pre-Covid attitudes that would make people resistant regardless, so there may be a ceiling for how high support will go.”
No decision has been made, but the consensus among many experts in the U.S. and globally is that health care workers should be first, said Sema Sgaier of the Surgo Foundation, a nonprofit group working on vaccine allocation issues.
An expert panel advising the U.S. Centers for Disease Control and Prevention is also considering giving high priority to workers in essential industries, people with certain medical conditions and people age 65 and older.
Once a vaccine gets a green light from the Food and Drug Administration, the panel will look at clinical trial data on side effects and how people of various ages, ethnicities and health statuses responded. That will determine the panel’s recommendations to the CDC on how to prioritize shots.
State officials are expected to follow the CDC’s guidance as they distribute the first vaccines.
Vaccine supplies will be limited at first. There won’t be enough to protect everyone, yet getting the shots to the right people could change the course of the pandemic.
Many other questions about distribution remain unanswered, Sgaier noted, such as whether to distribute shots equally across the country, or to focus on areas that are hot spots.
The AP is answering your questions about the coronavirus in this series. Submit them at: [email protected]
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A hope that Colorado might be past the worst of a fall COVID-19 wave have proved short-lived, as a slowdown in hospitalizations heading into the weekend ended with a new spike.
The number of hospitalizations dipped Friday and remained roughly level Saturday. But by Monday, 107 more people were hospitalized with confirmed cases of COVID-19 than had been Saturday, bringing the total receiving hospital care for confirmed cases to 1,294. Another 130 were hospitalized with suspected COVID-19 but were awaiting test results.
In comparison, on the worst day in April, there were 1,277 people hospitalized with confirmed and suspected cases combined.
Beth Carlton, an associate professor of environmental and occupational health at the Colorado School of Public Health, said people should “hunker down” for the next few weeks to avoid spreading the virus and overwhelming hospitals until a vaccine becomes available. The highest-risk interactions are those where people are indoors and not wearing masks, she said.
“We can finally see the light at the end of the tunnel. We just need to get through this dark tunnel,” she said.
On Friday, the Colorado Hospital Association announced it was activating a system to transfer patients from overburdened hospitals to those with extra beds. Some hospitals transferred patients over the weekend, association spokeswoman Cara Welch said, though she wasn’t sure how many.
A day after the hospitals’ announcement, Gov. Jared Polis said he was ordering the State Emergency Operations Center to move to the highest level of alert, and directed hospitals to come up with a plan to increase the number of intensive-care and general medical beds they have available. If those plans don’t generate enough beds, hospitals could be ordered to stop nonurgent procedures. Fields hospitals could reopen if all other efforts fail.
The Colorado Department of Public Health and Environment reported 30,843 cases of COVID-19 in the week ending Sunday. Past increases in cases came with the caveat that infections were at the highest level since Colorado has had reliable data, because testing was so scarce in the spring. Now, more people in the state are infected than have been at any time since the virus emerged, Carlton said.
“We’ve blown past the April peak,” she said.
Deaths may have increased again last week, based on high initial reports, but the final toll won’t be known for at least another week.
In the week ending Nov. 8, 121 people died of COVID-19, which was the highest number since the week ending May 10. At the worst point, in the third week of April, 237 people died of the virus.
Since March, 167,713 people in Colorado have tested positive for the new coronavirus and 11,203 have been hospitalized. As of Monday, 2,276 people had died of the virus, and 302 others died with it.
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When President-elect Joseph R. Biden Jr. takes office in January, he will inherit a pandemic that has convulsed the country. His transition team last week announced a 13-member team of scientists and doctors who will advise on control of the coronavirus.
One of them is Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and assistant professor at the New York University Grossman School of Medicine. In a wide-ranging conversation with The New York Times, she discussed plans to prioritize racial inequities, to keep schools open as long as possible, and to restore the Centers for Disease Control and Prevention as the premiere public health agency in the world.
The incoming administration is contemplating state mask mandates, free testing for everyone and invocation of the Defense Production Act to ramp up supplies of protective gear for health workers. Indeed, that will be “one of the first executive orders” of the Biden administration, she said.
Below are edited excerpts from our conversation.
Tell us about Mr. Biden’s Covid advisers. Who is doing what?
The coronavirus task force is the team the vice president leads within the current administration. I’m a part of the Biden-Harris advisory board. Then there’s the internal transition team, which is much bigger. The transition team has been developing a Covid blueprint, the nuts and bolts of the operations, and this is something they’ve been working on for months.
The purpose of the advisory board is really to have a group of people who think big, creatively and in interdisciplinary ways — to be a second set of eyes on the blueprint they’ve come up with, and also to function as a liaison with state and local health departments.
How often will you meet with Mr. Biden and the Vice President-elect Kamala Harris?
We’re going to have, at a minimum, a weekly meeting as a group. But in addition to that, we may be asked to brief members of the transition team and the president-elect and vice president-elect. I’ve already been on two of those briefings.
They’re asking very insightful questions, very thoughtful questions, which demonstrate that they are sensitive to who has really been hit hard, who has suffered. In terms of awareness of the technologies, they understand more than I ever thought a politician would understand. Like asking what would be the appropriate timing and target populations for monoclonal antibodies. For somebody who doesn’t follow these things, that is a really good question.
What’s the plan to help communities that have been hit hardest?
Race disparities are definitely going to be a through line for all the plans — for example, with respect to testing, making sure that you are locating testing facilities in communities of color. They have not been adequately served, and the lines to wait to get tested, the turnaround times, have not been equitable.
Another area that is really of interest is Indigenous people. They are often misclassified in terms of their race and ethnicity, and that makes it very difficult to do analyses to figure out what are the trends in those communities and to target interventions accordingly. Being really attentive to detailed data surveillance, and using that to inform how we address these disparities, is going to be very, very central.
What’s the thinking on school reopenings?
If you have widespread community transmission, there may come a tipping point where you do need to go back to virtual schooling. But I think the priority is to try to keep schools open as much as possible, and to provide the resources for that to happen.
From an epidemiologic perspective, we know that the highest-risk settings are restaurants, bars, gyms, nail salons and also indoor gatherings — social gatherings and private settings.
I would consider school an essential service. Those other things are not essential services. The smarter we are about being very responsive to trends in transmission — to closing indoor restaurants sooner — the longer you’re likely to be able to keep schools open.
We know that the risk of transmission in schools is not zero, but they’re not amplifying transmission the way some of these other places are.
We need to be supporting those businesses, whether it’s the restaurant owners and the people working in those restaurants, because it is not fair that they are bearing a very heavy brunt of the economic fallout from this.
Mr. Biden has said he would invoke the Defense Production Act to get companies to manufacture protective gear.
From the beginning we have been — and I’ve seen it firsthand — in a rationing mode. And now things are getting worse again, so that is a very high priority. I think that’s going to be one of the very first executive actions that Mr. Biden would be taking.
What role do you see the C.D.C. playing in this pandemic and in the future?
The approach is going to be much more along the lines of giving control back to the C.D.C. There’s recognition that the C.D.C. is the premiere public health agency in the world. And while their role has been diminished during this current crisis, they play a very important role in all this.
Schools During Coronavirus ›
Back to School
Updated Nov. 13, 2020
The latest on how the pandemic is reshaping education.
“I made all A’s and B’s. Now I’m failing.” Millions of students lacking reliable internet access, particularly in rural America, are struggling to learn.
President-elect Joseph R. Biden Jr.’s education agenda is starkly different from the Trump era, beginning with a far more cautious approach to school reopenings.
Europe is keeping schools open, but not restaurants. The United States has a different approach.
Remote learning, lockdowns and pandemic uncertainty have increased anxiety and depression among adolescents.
It’s really going to be about rebuilding public health infrastructure. Since 2008, there have been massive budget cuts, staffing losses. And so some of it will be around that, and some of it will be around tech infrastructure and building more robust surveillance systems and dashboards.
Rural areas are particularly unequipped to deal with outbreaks. How do you plan to help them?
I have myself worked on Indian reservations in the Southwest, and I know some of my colleagues are really struggling right now. Once things really start to trend up again, they simply don’t have the I.C.U. beds — not just on the reservation, but in any kind of proximity in the state — to transfer people to. And once your hospital capacity gets saturated, case fatality rates shoot up.
I don’t have a good answer for you right now as to what we can do right away. But it’s definitely on the radar.
Mr. Biden has talked about making testing available to all. Is the plan to provide rapid antigen tests?
The issue with the antigen test is how well it performs in asymptomatic people. What we’ve seen in some cases is that the performance characteristics are just not that great, so I think that needs to be better assessed and studied.
You do also need separate regulatory pathways, one for a public health surveillance kind of test, one for a clinical diagnostic test. The sensitivity of the surveillance test does not need to be as high, especially if it’s cheap, and something you can be doing frequently, repeatedly.
What are your thoughts about vaccine distribution?
Your local doctor’s office is not going to have the deep-freeze capability that, at least for the Pfizer vaccine, you’re going to need. They’re not necessarily going to have the tech systems to track and call people back to make sure they get their second doses.
That kind of capacity really resides either in public health departments or in the private commercial sector, like CVS and Walgreens. So it’s really going to require collaboration with them.
The White House has not permitted access to information about Operation Warp Speed or any other Covid plans. How big a problem is that?
That’s clearly a frustration. The normal way of doing business has not been the case for the entire administration. So why start now?
I do think it’s important to remember, though, that you have very experienced, seasoned people on the Biden team. These are not people who are new to federal government.
It’s not just about the federal government. So much of public health happens at the state and local level, so a lot of the communication in the coming weeks is going to be with governors, state and local public health officials. For things like tests and diagnostics, the monoclonal antibodies and vaccines, those are really conversations with the private sector.
So yes, it is it is an obstacle. It’s rather unfortunate, but the team really does still plan to be prepared to jump right in on Day 1 and address the crisis.
Two years ago, Dr. Kelly McGregory opened her own pediatric practice just outside Minneapolis, where she could spend as much time as she wanted with patients and parents could get all of their questions answered.
But just as her practice was beginning to thrive, the coronavirus hit the United States and began spreading across the country.
“As an independent practice with no real connection to a big health system, it was awful,” Dr. McGregory said. At one point, she had only three surgical masks left and worried that she could no longer safely treat patients.
Families were also staying away, concerned about catching the virus. “I did some telemedicine, but it wasn’t enough volume to really replace what I was doing in the clinic,” she said.
After her husband found a new job in a different state, Dr. McGregory, 49, made the difficult decision to close her practice in August. “It was devastating,” she said. “That was my baby.”
Many other doctors are also calling it quits. Thousands of medical practices have closed during the pandemic, according to a July survey of 3,500 doctors by the Physicians Foundation, a nonprofit group. About 8 percent of the doctors reported closing their offices in recent months, which the foundation estimated could equal some 16,000 practices. Another 4 percent said they planned to shutter within the next year.
Other doctors and nurses are retiring early or leaving their jobs. Some worry about their own health because of age or a medical condition that puts them at high risk. Others stopped practicing during the worst of the outbreaks and don’t have the energy to start again. Some simply need a break from the toll that the pandemic has taken among their ranks and their patients.
Another analysis, from the Larry A. Green Center with the Primary Care Collaborative, a nonprofit group, found similar patterns. Nearly a fifth of primary care clinicians surveyed in September say someone in their practice plans to retire early or has already retired because of Covid-19, and 15 percent say someone has left or plans to leave the practice.
The clinicians also painted a grim picture of their lives, as the pandemic enters a newly robust phase with record case counts in the United States. About half already said their mental exhaustion was at an all-time high. Many worried about keeping their doors open: about 7 percent said they were not sure they could remain open past December without financial help.
For some, family obligations left them no choice.
“Honestly, if it hadn’t been for the pandemic, I would have still been working because it was not my plan to retire at that point,” said Dr. Joan Benca, 65, who worked as an anesthesiologist in Madison, Wis.
But her daughter and son-in-law hold administrative positions in a hospital intensive care unit, treating the sickest Covid patients, and they have two small children. When cases climbed in the spring, their day care center closed, and Dr. Benca’s daughter desperately needed someone she trusted to look after the children.
“It wasn’t the way I wanted to end my career,” Dr. Benca said. “I think for most of us, we would say, you would fall on your sword for your family but not for your job,” she said, adding that she knows other female colleagues who have stayed home to care for children or older relatives.
Dr. Michael Peck, 66, an anesthesiologist in Rockville, Md., decided to leave after working in April in the hospital’s intensive care unit, intubating critically ill patients, and worrying about his own health. “When the day was over, I just said, ‘I think I’m done’ — I want to live my life, and I don’t want to get ill,” said Dr. Peck, who had already been cutting back his hours.
He is now spending a few hours a day as the chief medical officer for a start-up.
Still, most practices have proved resilient. The Paycheck Protection Program — authorized by Congress to help businesses, including medical practices, with the economic fallout of the pandemic — helped many doctors remain afloat. That money “kind of made me solid,” said Dr. Ripley Hollister, a family physician in Colorado Springs who serves as chairman of the research committee for the Physicians Foundation. The volume now “is really coming back,” he said.
But, depending on the future course of the pandemic, Dr. Lisa Bielamowicz, a co-founder of Gist Healthcare, a consulting firm, predicts “another wave of financial stress hitting practices.” Many doctors’ groups will seek a buyer, whether a hospital, an insurance company or a private equity firm that plans to roll up practices into a larger business.
One doctor, who asked not to be identified because the discussions are confidential, said she and her partner had already been talking with the nearby hospital nearby about buying their pediatric practice before the pandemic arrived in the United States.
Although federal aid has helped, patient visits are still 15 percent below normal, she said, and they are continually worried about making payroll and having enough doctors and staff to see patients. As the number of virus cases balloons in the Midwest, her employees must deal with increasingly agitated parents.
“They’re yelling and cussing at my staff,” she said. Working for a telemedicine firm might be an alternative, she added. “It’s a hard job to begin with, to own your own business,” she said.
The coronavirus crisis has amplified problems that doctors were already facing, whether they own their practice or are employed. “A lot of physicians were hanging on by a thread from burnout before the pandemic even started,” said Dr. Susan R. Bailey, the president of the American Medical Association.
In particular, smaller practices continue to have difficulty finding sufficient personal protective equipment, like gloves and masks. “The big hospitals and health care systems have pretty well-established systems of P.P.E.,” she said, but smaller outfits might not have a reliable source. “I was literally on eBay looking for masks,” she said. The cost of these supplies has also become a significant financial issue for some practices.
Doctors are also stressed by the never-ending need to keep safe. “There is a hunker-down mentality now,” Dr. Bailey said. She is concerned that some doctors will develop PTSD from the chronic stress of caring for patients during the pandemic.
Even those who are not responsible for running their own practices are leaving. Courtney Barry, 40, a family nurse practitioner at a rural health clinic in Soledad, Calif., watched the cases of coronavirus finally ebb in her area, only to see wildfires break out. Many of her patients are farmworkers and work outside, and they became ill from the smoke.
In 14 years as a nurse, Ms. Barry has never experienced anything “like this that is just such a high level of stress and just keeps going,” she said, adding, “The other hard part is there’s no end in sight.”
She tried working fewer days but decided eventually that she would stop altogether for several months beginning in early December. Ms. Barry hasn’t figured out what’s next for her.
“My intention is to stay in medicine, although I would not be totally opposed to doing something in a totally different area, which is something that I would not have said in the past,” she said.
And patients have indeed felt the effects. The pandemic has developed into “a really huge disruption,” said Dr. Hollister, the family physician, who thinks closed practices are likely to result in “a significant impairment to patients’ access to medical care.” In his community, where both specialists and primary care doctors are leaving, he is tending to more patients who no longer have a doctor.
It is an issue that Dr. McGregory, who took a job at the University of Wisconsin School of Medicine and Public Health in Madison, worries about. There were some families in her practice whom she could not convince to find another pediatrician immediately. She said they “are waiting, which I discouraged, because I think every child should have a medical home.”
As cases of the coronavirus continue to climb worldwide, many countries are doubling down on testing policies that can grant or bar entry to travelers attempting to move across international borders.
But an unusual new testing policy, announced by China at the end of October, has health experts baffled. It requires inbound travelers to present negative results from an antibody test — which can neither reliably rule out infections nor prove that a person is not transmitting the virus to others.
“I don’t understand why they would be doing this,” said Dr. Krutika Kuppalli, an infectious disease physician at the Medical University of South Carolina. “It seems like this is their method of security theater.”
The strange guidelines, experts said, seemed to reflect an outdated understanding of the ways in which the virus and the immune system interact. In the spring, several companies attempted to market antibody tests as potential diagnostics of active infection. Some (but not all) later tempered or walked back these advertisements as researchers gathered more information about the timing of the antibody response to the virus, which does not kick into gear until levels of the pathogen are waning.
“I thought we were past this stage,” said Elitza Theel, a clinical microbiologist and expert in antibody testing at Mayo Clinic in Rochester, Minn. Guidelines from the Centers for Disease Control and Prevention describe antibody positives as a generally poor proxy for the presence of active virus in the body.
Previous iterations of China’s policies stipulated that travelers would need to test negative only by a “nucleic acid test,” a tool that hunts for the coronavirus’s genetic material. Most available tests that meet this requirement rely on a laboratory technique called polymerase chain reaction, or P.C.R., which can home in on the virus even when it is present at very low levels in the body.
But as the coronavirus continued to spread in countries like the United States, the United Kingdom, Ireland, and Russia, Chinese health officials became concerned that some foreign travelers might slip through the diagnostic cracks. The officials opted to pair P.C.R. with a second test to help ensure “greater accuracy in Covid-19 screening,” a spokesperson for China’s embassy in the United States wrote in an email.
In theory, that could be a sound strategy, said Deepta Bhattacharya, an immunologist at the University of Arizona: “We’re fans of being able to check with two independent kinds of tests.” But the approach quickly falls apart, he added, if officials select the wrong test as a safety net, as appears to be the case with China.
In addition to requiring negative nucleic acid test results, China now asks travelers to prove they have tested negative on an IgM antibody test, taken within 48 hours of boarding. These tests detect disease-fighting molecules called antibodies, in particular one called immunoglobulin M, or IgM, which is usually the first type of antibody roused against infectious invaders. IgM’s presence is ephemeral; eventually, two other types of antibodies that are much longer-lived, called IgG and IgA, take over.
But IgM antibodies are, at best, a lagging indicator of a viral infection, Dr. Bhattacharya said. Against the coronavirus, IgM antibodies seem to be particularly sluggish; it can take two weeks after the onset of symptoms, perhaps more, for many people to mount an IgM response that is reliably detectable by an antibody test.
Contagiousness, meanwhile, is thought to peak during the couple of days before and after people start feeling sick, after which levels of the virus dwindle.
It’s possible that an IgM test might turn positive as the virus is on its way out of the body, Dr. Theel said. But these products look for a delayed reaction to the virus, rather than the virus itself. As such, the absence of IgM does not guarantee a person is virus-free.
Many tests designed to detect IgM have bedeviled researchers with false positives, mistakenly identifying antibodies in people who actually lack them. “Some of these tests are kind of garbage,” Dr. Kuppalli said.
In the spring, faulty antibody tests flooded the market after being hastily greenlit by the Food and Drug Administration. Alarm about their poor accuracy prompted the agency to revoke clearance of several products. Test quality has improved substantially since then, but IgM remains difficult to accurately detect compared with other antibody types.
When asked whether these concerns would be addressed by China’s new testing policy, the embassy spokesperson said only that the IgM antibody test was capable of producing “stable” results. Combining nucleic acid tests and IgM antibody tests “has been put into practice in some countries on a trial basis, and is working well,” said the spokesperson, echoing earlier comments made at a news conference. The spokesperson did not respond to repeated requests for clarification or comment on which countries had implemented such protocols, or whether data existed to support the efficacy of the dual-test tactic.
Another concern, Dr. Theel said, is that IgM tests can also be very difficult to find. The new requirements could raise needlessly stressful barriers for people trying to make their way home, and waste time and money. “That is a huge inconvenience, for a test that adds, in my opinion, minimal value,” she said.
Colorado recorded a record-breaking number of COVID-19 hospitalizations on Sunday, with more than 1,000 people in hospitals statewide with the novel coronavirus
The surge is hospitalizations comes just days after the state surpassed the April peak for hospitalizations. State officials warned last week that Colorado is headed into a critical phase of the pandemic.
On Sunday, 1,023people were hospitalized with confirmed COVID-19, the disease caused by the novel coronavirus. Previously, hospitalizations peaked in April with 888 people hospitalized, according to the Colorado Department of Public Health and Environment.
Currently, 84% of the state’s 1,984 available intensive-care unit beds are in use, a percentage that’s been creeping up since September.
The state health department recorded 2,766 new cases of the novel coronavirus on Saturday.