Coronavirus Live Updates: Malaria Drug Promoted by Trump Didnt Prevent Infections, Study Finds

 nytimes.com  06/03/2020 18:52:03 
ImagePresident Trump said that he was taking hydroxychloroquine last month.
President Trump said that he was taking hydroxychloroquine last month.Credit...Doug Mills/The New York Times

The malaria drug hydroxychloroquine did not prevent Covid-19 in a rigorous study of 821 people who had been exposed to patients infected with the virus, researchers from the University of Minnesota and Canada are reporting Wednesday.

The study was the first controlled clinical trial of hydroxychloroquine, a drug that President Trump has repeatedly promoted and said he had taken himself to try to ward off the virus.

Conducted in the United States and Canada, the trial was the first to test whether the drug could prevent illness in people who have been exposed to the virus. This type of study, in which patients are picked at random to receive either an experimental treatment or a placebo, is considered the most reliable way to measure the safety and effectiveness of a drug.

The take-home message for the general public is that if youre exposed to someone with Covid-19, hydroxychloroquine is not an effective post-exposure, preventive therapy, the lead author of the study, Dr. David R. Boulware of the University of Minnesota, said in an interview.

The results are being published in The New England Journal of Medicine.

The presidents promotion of the drug, and the backlash against it, have politicized medical questions that would normally have been left to researchers to answer objectively. The drug is approved to treat rheumatoid arthritis and lupus, as well as malaria, and is considered safe for those patients as long as they do not have underlying abnormalities in their heart rhythm.

Studies in very ill coronavirus patients have linked the drug  especially when combined with the antibiotic azithromycin  to dangerous heart-rhythm disorders, and both the Food and Drug Administration and the National Institute of Allergy and Infectious Diseases have warned that it should not be used outside of clinical trials or in hospitals.

A scientist in Modernas lab in Cambridge, Mass., in February. The Trump administration tapped Moderna and four other companies as the most likely candidates to produce a vaccine for the coronavirus.Credit...David L. Ryan/The Boston Globe, via Getty Images

By winnowing the field in weeks from a pool of about a dozen companies, the government is betting that it can identify the most promising vaccine projects at an early stage, speed along the process of determining which will work and ensure that the winner or winners can be quickly manufactured in huge quantities and distributed across the country.

Noah Weiland and David E. Sanger of The New York Times report that the five companies are Moderna, a Massachusetts-based biotechnology firm, which Dr. Anthony S. Fauci said he expected would enter the final phase of clinical trials next month; the combination of Oxford University and AstraZeneca, on a similar schedule; and three large pharmaceutical companies: Johnson & Johnson, Merck and Pfizer. Each is taking a somewhat different approach.

The announcement of the decision will be made at the White House in the next few weeks, government officials said. Dr. Fauci, the federal governments top epidemiologist and the director of the National Institute of Allergy and Infectious Diseases, hinted at the action when he told a medical seminar on Tuesday that by the beginning of 2021, we hope to have a couple of hundred million doses.

Despite promising early results and the administrations strong interest in nurturing a government-industry partnership, substantial hurdles remain. Many scientists consider Mr. Trumps goal of having a vaccine widely available by early next year to be optimistic, if not unrealistic. Vaccine development is notoriously difficult and time-consuming; the record is four years, and a decade is not unusual.

U.s. Roundup

The number of confirmed cases is rising in 16 states, partly a consequence of expanded testing.

A volunteer directs traffic at a testing site in Central Los Angeles in May.Credit...Jae C. Hong/Associated Press

Police brutality, protests and unrest may have knocked the pandemic from the lead of many U.S. newscasts, but the outbreak is continuing to spread. Even as some Northeast states are seeing improvements, daily case numbers are reaching new highs in others.

That is partly a consequence of the countrys vastly expanded testing capacity. Earlier in the pandemic, when test kits were scarce, many people who contracted the virus were not tested and not included in official counts. Here is a look around the country.

  • In California, daily case reports exceeded 3,000 twice in the past week, a threshold the state had not crossed before. In Northern California, six chief health officers said in a statement that they were encouraged by what we are seeing in some areas and concerned about what we are seeing in others. As more businesses were allowed to reopen, they said, each decision we make involves difficult trade-offs.

  • Arizona, Tennessee, Wisconsin, at least 12 other states and Puerto Rico are also seeing an upward trend of newly reported cases, and some are reaching new highs.

  • In Mississippi, the 439 cases announced Saturday were the most yet on a single day. In Alaska, which has so far avoided the worst of the virus, cases have soared to their highest levels in recent days.

  • The Trump administration said that it planned to block Chinese airlines from flying into or out of the United States starting on June 16, after the Chinese government effectively prevented U.S. airlines from resuming service between the countries.

  • In Dallas County, Texas, case numbers have continued to rise, and the 16 deaths announced on Tuesday were the most of any day so far. Clay Jenkins, Dallas Countys chief elected official, said there was also no improvement in data on hospitalizations and intensive care unit admissions. He called for residents to use caution even though restrictions had eased.

  • Chicago moved to its third phase of reopening, which eases restrictions on businesses combined with new precautions. Child care centers are reopening, but children are screened for signs of illness, and parents and teachers must wear face coverings. Restaurants will reopen with outdoor dining only. Riders will be encouraged to wear face masks while using public transportation.

  • In most of New York State outside of New York City and its suburbs, restaurants can offer outdoor dining starting Thursday. In New Jersey, outdoor dining can start on June 15. There were an additional 112 virus-related deaths reported in New Jersey and 49 deaths in New York.

  • As moviegoing has essentially ceased around the country, AMC Theaters, the largest theater operator in the world, said in a financial filing on Wednesday that substantial doubt exists about our ability to continue as a going concern for a reasonable period of time because of the disruption caused by the pandemic.

GLOBAL ROUNDUP

As Italy removes travel restrictions, some in Venice hope for a future with fewer tourists.

A demonstration in Venice on Monday against the construction of a new pier that would bring boatloads of tourists into one of the citys last livable neighborhoods.Credit...Alessandro Grassani for The New York Times

Italy lifted travel restrictions on Wednesday, hoping to restore some of the tourism that usually makes up 13 percent of the countrys gross domestic product. But it is clear that some Italians have new skepticism about that level of economic dependence.

The countrys addiction to tourism has priced many residents out of historic centers and crowded out creativity, entrepreneurialism and authentic Italian life.

Of all Italys cities, Venice  a tourism cash cow worth 3 billion, or about $3.3 billion  changed most drastically during the months of lockdown.

Without visits by giant cruise ships and hordes of day-trippers, the citys alleys, porticoes and campos reverberated with conversations in Italian, and even with the Venetian dialect. The lack of big boats reduced the waves on the canals, allowing locals to take their small boats and kayaks out on cleaner water. Residents even ventured to St. Marks Square, which they usually avoid.

This is a tragedy that has touched us all, but Covid could be an opportunity, said Marco Baravalle, a leader of the anti-cruise ship movement in Venice who called the absence of big boats magnificent.

Heres what else is happening around the world:

  • Germany will lift its travel ban on 29 European countries, including Britain and Iceland, on June 15 and replace it with travel advisories, Foreign Minister Heiko Maas said. According to the new rules, if regional infections should mount, bans to specific countries could be reinstated.

  • A powerful cyclone slammed into Indias coast, pushing thousands of people into shelters in the commercial hub of Mumbai, which is struggling to contain a rising number of infections. More than 100 Covid-19 patients were evacuated from a makeshift hospital to higher ground.

  • Swedens restrictions should have been tighter, the architect of its no-lockdown policy, Anders Tegnell, said on Wednesday. Mr. Tegnell, the state epidemiologist, told Radio Sweden: If we encountered the same disease knowing what we know today, I think we would end up doing something in the middle between what Sweden did and what the rest of the world did.

Coronavirus patients on ventilators at Elmhurst Hospital in Queens, N.Y., last month.Credit...Erin Schaff/The New York Times

Long considered the worlds premier public health agency, the Centers for Disease Control and Prevention made missteps that undermined Americas response to the most urgent public health emergency in the agencys 74-year history  a virus that has killed more than 100,000 people in the United States.

A New York Times review of thousands of emails, and interviews with more than 100 state and federal officials, public health experts, C.D.C. employees and medical workers, revealed how the pandemic shook longstanding confidence in the agency and its leader, Dr. Robert R. Redfield. These are some of the key findings.

  • Aging data systems left the agency with blind spots. As the virus began to spread in the United States in January, the C.D.C.s response was hampered by an antiquated data system and a fractured public health reporting system. The C.D.C. could not produce accurate counts of how many people were being tested, compile complete demographic information on confirmed cases or even keep timely tallies of deaths.

  • The C.D.C. clashed with White House aides who viewed them as the deep state. As the crisis deepened, tensions between the agency and the White House increased, with aides to Mr. Trump referring to the scientists at the C.D.C. as members of the deep state who were eager to wound him politically by leaking to the press. At the same time, some C.D.C. employees watched with growing alarm as Mr. Trump, facing criticism for his administrations response, repeatedly undermined the agency. And they paled at what they saw as meddling by politically motivated Trump aides.

  • The C.D.C.s culture slowed its response. The culture at the C.D.C.  risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis  shaped its scientists ambitions and contributed to some of its failures as it tried to respond to the pandemic.

  • Redfield felt he was on an island between his agency and the White House. The pandemic underscored the need for Dr. Redfield to manage the mercurial demands of the president who appointed him and the expectations of the career scientists at the agency he leads. Although he is on the White House coronavirus task force, Dr. Redfield soon found himself eclipsed by Dr. Anthony S. Fauci, the nations chief  and most famous  infectious disease specialist, and Dr. Deborah Birx, an AIDS expert and former C.D.C. physician.

  • Confusing guidance left doctors, public officials and others to look elsewhere. The C.D.C. struggled at times to provide clear and timely guidance, leading many to say they looked to universities, mailing lists or online research articles for detailed recommendations about how to safely care for infected patients.

Virgina Dressler spends her days at homein Newbury, Ohio, caring for her 3-year-old twins while managing her career as a digital librarian.Credit...Da'Shaunae Marisa for The New York Times

As the pandemic upends work and home life, women have carried an outsized share of the burden: They are more likely to lose a job and more likely to shoulder the responsibilities of closed schools and day care. The gradual reopening threatens to compound their problems  forcing them out of the labor force or into part-time jobs while increasing their duties at home.

In February, right before the outbreak began to spread in the United States, working women passed a milestone: making up more than half of the nations civilian nonfarm labor force. But the effects of the pandemic could last a lifetime, reducing their earning potential and work opportunities.

We could have an entire generation of women who are hurt, Betsey Stevenson, a professor of economics and public policy at the University of Michigan, said of pregnant women and working mothers whose children are too young to manage on their own. They may spend a significant amount of time out of the work force, or their careers could just peter out in terms of promotions.

Women who drop out of the work force to take care of children often have trouble returning, and the longer they stay out, the harder it is.

The economic crisis magnifies the downsides. Wage losses are much more severe and enduring when they occur in recessions, and workers who lose jobs now are likely to have less secure employment in the future.

Even the limited gains made in the past decades are at risk of being rolled back, warned a recent report from the United Nations on the effects of the virus on women.

The New York City subway in April.Credit...Hilary Swift for The New York Times

New York City is still working toward lifting some virus-related restrictions on Monday. But one larger question looms: How can the citys mass transit system safely accommodate all the people who are expected to return?

The Metropolitan Transportation Authority, which runs the buses and subways, and Mayor Bill de Blasio have outlined their visions, but many details remain to be worked out.

On Wednesday, for instance, Mr. de Blasio reiterated his request that social distancing be enforced by limiting seating. It is crucial that every other seat be blocked off so that its clear that you never end up sitting next to someone, he said.

The agency dismissed the proposal.

Like many of the mayors ideas, this is nice in theory but utterly unworkable, an M.T.A. spokeswoman said in a statement. The mayors plan would allow us to serve only a tiny percentage of our riders  likely around 8 percent.

On Tuesday, in an open letter to the mayor, the agency released some elements of its plan: Full service will resume across the system on Monday, though subways will still close for nightly disinfecting from 1 a.m. to 5 a.m. Social-distancing floor markings will be set at stations. Workers known as platform controllers will try to reduce crowding.

Under the first phase of the citys reopening, curbside retail pickup and nonessential construction and manufacturing can restart. The mayor has said he expected that at least 200,000 people would begin returning to work.

But the M.T.A.s plan said that during that phase, subway and bus service would remain for essential trips only.

Mr. de Blasio had also asked that trains and buses skip stops if they are over capacity and that the agency temporarily close stations when needed during peak hours, which could make slow commuting. The agencys letter to the mayor did not address either request.

The death of a doctor who worked on the front lines of Chinas coronavirus battle has prompted an outpouring of grief and anger, and also revived concerns about Beijings handling of the outbreak.

The doctor, Hu Weifeng, 42, died on Tuesday in Wuhan, where the pandemic originated and where officials have nearly completed a vast testing campaign to keep the virus contained. He endured more than four months of treatment, according to reports in the state-run news media, and had become widely known when photos circulated showing him in his hospital bed with darkened skin.

Health officials said a drug used during the treatment had caused changes in his complexion.

Dr. Hu, a urologist, is the sixth worker at Wuhan Central Hospital to die of the virus. The reaction to his death echoes the mourning after the loss of another worker there: Li Wenliang, a 34-year-old ophthalmologist who tried to sound the alarm about the outbreak, only to be silenced by the police. He died on Feb. 6.

Farewell, hero, one user said of Mr. Hu on Weibo, a popular microblogging site. How did Wuhan Central Hospital become a major disaster zone?

Who can protect the medical workers? another user wrote on Weibo, reacting to Mr. Hus death. Who will protect the people of Wuhan?

In Europe, a drive-in disco has built-in social distancing.

The concept of a drive-in disco has proved popular in the parking lot of a club on the Dutch-German border.Credit...Laetitia Vancon for The New York Times

Beyond cinema, the drive-in format never really found a place within live-event culture. But amid a pandemic, its time has perhaps come.

Across Europe and the United States, pastors have set up drive-in churches, and promoters have set up drive-in concerts and drive-in plays. In an era of social distancing, it turns out there are few better distancing devices than a car door.

Few have embraced this concept like the owners of Index, a family-run nightclub in Schttorf, a small German town just east of the Dutch border, where Dopebwoy, a Dutch rapper, played last Friday.

Index has been one of the pioneers of the lockdown drive-in, holding a drive-in disco every weekend since early May. Revelers arrive at the club in their cars, park in the adjacent parking lot and then stay behind their wheels to watch performances from singers and D.J.s.

The events have proved surprisingly popular, despite lacking most of the physical experiences generally deemed essential to a successful club night. Its a good thing, too, because nightclubs like Index are not expecting to reopen their dance floors until 2021.

This feels like Saturday again! said Ronan Zwaagstra, a 19-year-old student attending Dopebwoys show in his hatchback.

Then he paused.

But without the drinking.

Another pause.

Or the dancing.

But he likes the drive-in club experience so much that he drives nearly 60 miles to attend, and crosses a national border in the process. (Travel between the Netherlands and Germany has been less tightly regulated than other European borders during the pandemic.)

Can people still flirt in a disco without a dance floor?

Yes, said Jenny Kollak, 24, a bank manager. Oh yes.

People write their numbers on balloons and hold them up to people in nearby cars.

Or, said Ms. Kollak: We scream at them. They scream at us.

Police officers on patrol in Piccadilly Circus in central London in April.Credit...Andrew Testa for The New York Times

Black and Asian people in London were more likely to be fined under Englands coronavirus lockdown rules than white people, according to figures released on Wednesday by the citys police service.

Black Londoners make up 12 percent of the citys population but received 26 percent of the 973 lockdown-related fines from late March to mid-May. Asian people, who are 18 percent of the citys population, were given 23 percent of the fines. White people make up 59 percent of Londons population but received 46 percent of the penalties.

The figures were released amid marches in London over the death of George Floyd, who died after being handcuffed and pinned down by a police officer in Minneapolis, and racism in Britain. They mirror differences by race in enforcement of the lockdown rules in New York.

The Metropolitan Police, Londons main police force, acknowledged that there were some differences in the use of Covid-19 related enforcement with regard to to gender, age and race.

It said that enforcement of the lockdown tended to be heaviest in places that were already priority areas for policing, such as high-violence areas, and that officers had stepped up proactive policing of drugs, robbery and domestic abuse.

Black people in England and Wales are more likely to die from the virus than white people, even accounting for differences in class and in some underlying health measures, according to official figures.

The police in London also arrested 747 people on charges of breaching lockdown regulations, but 711 of those arrests were primarily for a separate criminal offense, like drug possession, theft or assault. Officers made only 36 arrests exclusively for breaking the lockdown rules, the police said.

Tear gas used against protesters across the U.S. could make them more susceptible to the virus.

Kentucky State Troopers fired tear gas at demonstrators in Louisville, Ky., on Monday.Credit...Luke Sharrett for The New York Times

The billowing clouds of tear gas that the authorities are sending through protest crowds across the United States may increase the risk that the virus could spread through the gatherings.

Along with the immediate pain that can cause watering eyes and burning throats, tear gas may cause damage to peoples lungs and make them more susceptible to getting a respiratory illness, according to studies on the risks of exposure. The gas can also incite coughing, which can further spread the virus from an infected person.

Sven-Eric Jordt, a researcher at Duke University who has studied the effects of tear gas agents, said he had been shocked to watch how much the authorities had turned to the control method in recent days.

Im really concerned that this might catalyze a new wave of Covid-19, Mr. Jordt said.

The protests against police brutality and racism after the killing of George Floyd in Minneapolis have already raised alarm among health experts who have watched as protesters gathered by the thousands in cities around the country. While some demonstrators have worn masks and gloves, the crowds have often involved shouting and chanting in close quarters  a risky activity for a virus spread by respiratory droplets. Epidemiologists have said the protests would almost certainly lead to more cases.

Because of delays between exposure and the start of symptoms, the impact of protests on the virus likely wont be known for several weeks.

On Wednesday, Gov. Andrew M. Cuomo of New York said that the virus is still in people and in society.

Were still battling that, he said.

Video
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Our ride with New York City medics during the coronavirus peak revealed a new side to their job: guiding patients on whether to go to the hospital.CreditCredit...Yousur Al-Hlou/The New York Times

In the wake of the pandemic, patients and their families have grown more fearful of a trusted institution: the hospital.

You know everything you would hear on the news and social media about the hospitals being at capacity and, you know, ready to explode  it was true, said Tommy Wittmer, a longtime paramedic.

Families have been forced to make difficult decisions: to send their loved ones to a hospital  where they may die alone  or to fight illnesses at home without medical intervention.

Often, the decision comes down to a matter of minutes, starting the moment a medic arrives in their homes to check their loved ones blood oxygen levels and ending as they are loaded into the ambulance. Once at the hospital, visitors are no longer allowed in Covid-19 units, so the patients face their uncertain fates alone.

The whole pandemic definitely changed peoples thought process, said Mr. Wittmer.

In our video, we rode along with Mr. Wittmer and Jessica Hundertmark, two critical care supervisors with SeniorCare, a private ambulance service in New York City that partners with Mount Sinai to treat patients at home.

The medics are bringing new ways of providing care to the bedside, and guiding families through their most difficult decisions.

U.S. emergency room visits plunged, raising concerns about the care for people with serious conditions.

Brookdale Hospital Medical Center in Brooklyn in April.Credit...Marian Carrasquero for The New York Times

As the virus spread, visits to emergency rooms in the United States decreased 42 percent over four weeks in April, compared to the same period in 2019, according to a new analysis released Wednesday by the C.D.C. The declines were greatest among children 14 and younger, women and in geographic areas like the Northeast.

While there were high numbers of emergency room visits because of the virus, including an increase in visits related testing for infectious diseases and for pneumonia, these were outweighed by the steep declines in visits that typically make up trips to the emergency room.

The C.D.C. also noted that there had been a recent rebound in visits, but the volume of visits remained significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared to a year earlier.

The agencys report highlights the monthslong decline in general hospital care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in Covid-19 patients. While hospitals have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid them.

The number of E.R. visits fell nationwide in March and April after the declaration of a national emergency for Covid-19.

March 13 declaration

of a national emergency

March 13 declaration

of a national emergency

By The New York Times | Source: Centers for Disease Control and Prevention

While E.R. treatment for complaints of minor ailments were far fewer this year, agency officials pointed to a more disconcerting drop in the number of people seeking emergency care for chest pain, including those undergoing a heart attack. There were also declines in children requiring emergency help for conditions like asthma.

C.D.C. officials also said the drop in emergency room visits could affect peoples ability to get care when they have no other alternative sources.

The analysis of visits from the National Syndromic Surveillance Program, which collects real-time electronic health data, representing nearly three quarters of all U.S. emergency room visits, was published in an early release of the Morbidity and Mortality Weekly Report by the C.D.C.

Two Afghan officials in a province at war with the Taliban die of the virus.

Two prominent Afghan officials in a province hammered by Taliban attacks died of the coronavirus this week, laying bare the costs of the countrys dual wars against the pandemic and the militants.

Brig. Gen. Abdul Rashid Bashir was the police chief of Kunduz Province, and Ahmad Fahim Qarloq was the governor of one of its most dangerous districts, Qala-I-Zal.

Halting the spread of the virus has been a formidable challenge for the northern province, where testing capacity remains extremely limited, like must of the rest of the country. According to official figures, there are 133 cases of the virus in the province, but local officials say that more than 60 percent of the population is likely infected.

There is no laboratory in Kunduz to test samples, so we send it to Kabul, said Ehsanullah Fazli, Kunduzs provincial health director. We sent more than 150 samples to Kabul last week, but up to now we have not received the results.

The area has had to fight off Taliban attacks on the outskirts of Kunduz city amid the pandemic. In May, the militants targeted at least 17 government outposts and bases in the area. The city had been captured by the Taliban twice before, in 2015 and 2016.

On Wednesday, Wahidullah Majrooh, a deputy health minister, said the government had performed 1,323 coronavirus tests across the country in the past 24 hours, with 758 coming back positive. That brought the number of confirmed cases nationwide to 17,267, with 294 deaths, though the actual numbers are likely much higher.

Reporting was contributed by Fahim Abed, Reed Abelson, Liz Alderman, Yousur Al-Hlou, Mike Baker, Michael Cooper, Andrew Curry, Melissa Eddy, Thomas Erdbrink, Sheri Fink, Thomas Gibbons-Neff, Abby Goodnough, Denise Grady, Javier C. Hernndez, Jason Horowitz, Patrick Kingsley, Eric Lipton, Apoorva Mandavilli, Sarah Mervosh, Benjamin Mueller, Andy Newman, Najim Rahim, Luis Ferr Sadurn, Dagny Salas, David E. Sanger, Christopher F. Schuetze, Michael D. Shear, Kaly Soto, Tracey Tully, Megan Twohey, Mark Walker, Noah Weiland and Karen Zraick. Albee Zhang contributed research.

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