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Health experts on the psychological cost of Covid-19 | World news

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On Instagram, a friend posts a photograph of a male nurse in an intensive care ward of an American hospital. He is wearing full protective clothing and holding up a patient questionnaire on which he has scrawled a message for his colleagues. It reads: “Just going to hold his hand for a while, I don’t think he has long.”

On an Irish radio station, a woman reads a poem she has written for a loved one lost to the virus. It is called My Sister Is Not a Statistic. It begins:

Tomorrow, when the latest Deathometer of Covid is announced in sonorous tones,
Whilst all the bodies still mount and curl towards the middle of the curve
Heaped one atop and alongside the other
My sister will be among those numbers…

On Radio 4’s Woman’s Hour, a critical care nurse from Sierra Leone, who works in a hospital in the south of England, describes the frantic chaos of the first few weeks of the pandemic. “We didn’t have equipment at all, but our ordinary aprons and gloves… I’d go in there praying and hoping I don’t get infected. Then I’d go home, praying and hoping, and trying to isolate myself from my daughters so I am not passing it on to them.”

Colby Hutson, a nurse at Ascension Seton Hays in Texas, holds a sign that reads: ‘Just going to hold his hand for a while, I don’t think he has long.’



Colby Hutson, a nurse at Ascension Seton Hays in Texas, holds a sign that reads: ‘Just going to hold his hand for a while, I don’t think he has long.’ Photograph: Ascension Seton Hays, Austin, Texas / Facebook

Amid the prolonged stasis imposed by lockdown, as the days drift into one another, the unreal magnitude of what is unfolding is momentarily undercut by acutely personal testimonies from the eye of the storm. These are just three examples of ordinary people who have responded in extraordinary ways. Their actions speak of selflessness, defiance and bravery in the face of the invisible threat that hovers around us in the very air that we breathe. But they also provide us with glimpses of the immense human cost of the pandemic, the great well of loss, fear, sadness and grief beneath the mounting statistics. 

In Britain, as I write, 37,000 people have lost their lives to the Covid-19 virus, while 267,000 have experienced and survived the terrible uncertainty of infection. As a fragile normality slowly returns, many mental health experts are asking the inevitable questions: what will be the long-term emotional and psychological cost of such a sudden and seismic disruption of our way of life?

“How the outside impacts on the inside is something that people like me think about all the time,” says psychotherapist and author Susie Orbach. “But now we are seeing it on a grand scale. The pandemic has been a prolonged assault from outside on our community. The state of uncertainty and unsafety it has created is new and utterly unfamiliar. Unless you are a refugee who has risked their life to get here, or a survivor of childhood abuse that could not be escaped, there is simply nothing to compare it to.”

Rose ‘Billy’ Mitchell



Rose ‘Billy’ Mitchell, who died in a nursing home in London. She is remembered in a poem by her sister Dorothy Duffy entitled My Sister Is Not a Statistic. Photograph: Dorothy Duffy/BBC Radio 4

Even in the early stages of the lockdown, the World Health Organization issued a statement that noted “elevated rates of stress or anxiety” in the general population, before warning that, “as new measures and impacts are introduced – especially quarantine and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise.” 

On 21 April , it was announced that 42 researchers from around the world had formed the International Covid-19 Suicide Prevention Research Collaboration amid growing concern about the longer-term mental health consequences of the virus. Leaving aside the probability of another spike, the aftershock of the pandemic is likely to last a long time and leave yet more casualties in its wake. 

Jo Stubley, a consultant psychiatrist and clinical psychoanalyst at the Tavistock and Portman clinic in London, is a specialist in trauma who has worked with survivors of the London terrorist attacks and the Grenfell Tower disaster. Those kinds of emergencies, she explains, are classed as “single events that occur within a limited time-frame and affect a defined population”. A global pandemic does not fit that model.

“The word most often used is ‘unprecedented’,” she says, “and it looks increasingly likely that the long-term consequences will also be unprecedented in scale. Given that mental health services have been starved of resources for years, one can only imagine the impact that a deep recession will have on an already beleaguered sector. So there is a lot of concern among health care professionals like myself about what will happen next.”

It is in the coming months and even years, then, that the psychological effects of the pandemic will become most apparent. “Trauma occurs when you are overwhelmed by an event that you cannot process,” says Julia Samuel, grief counsellor and bestselling author, whose latest book is titled Grief Works: Stories of Life, Death and Surviving. “While the crisis is happening, you are in it and everything is uncertain and unpredictable. You don’t have the emotional freedom to allow yourself to process the trauma, so it is held in the body. The most common reaction is to shut down and just exist somehow. It is only when the external world becomes more safe and predictable again that people may feel able to reach out for support.”

Those most at risk of suffering post-traumatic stress are the frontline medical staff who, in the first chaotic weeks of the Covid-19 pandemic, may have felt overwhelmed by the dramatically increased levels of patient suffering and deaths, as well as at risk from infection from inadequate PPE and anxious about bringing the virus home with them. 

Studies have also shown that, in ordinary times, patients who have spent time in intensive care are at a 20% increased risk of developing PTSD. “Already with some of the support initiatives that have been put in place, we are seeing survivors of Covid-19 showing post-traumatic symptoms,” says Stubley. She explains that there is an accepted timeline for the treatment of post-traumatic stress. “Time zero is the moment the trauma itself ends. In the first months or so afterwards, around 90% of those who experienced trauma will have PTS symptoms including feeling edgy or constantly on guard, sleeplessness, irritability and acute anxiousness. The Nice [National Institute for Health and Care Excellence] guidelines state that we should not treat people in that first month as these symptoms can often pass.”

Radiologists with a patient at the Royal Blackburn teaching hospital



Radiologists with a patient at the Royal Blackburn teaching hospital in east Lancashire. ‘Nurses and doctors will suddenly be thinking: ‘My God! What did I go through?’ says Lucy Warner, chief executive of NHS Practitioner Health, a service that treats doctors with mental health issues. Photograph: Hannah McKay/PA

The second stage is altogether more serious: flashbacks, nightmares, intrusive thoughts or images that are triggered by anything that reminds you of the trauma. The third stage, PTSD, which will affect around 10% of those who have experienced a traumatic event, is a kind of prolonged shutdown. “People dissociate from their feelings, go numb,” says Stubley. “It can last for years and years.”

Her main concern, though, is for those already in the mental health system, for whom lockdown has already had a major impact. It is an anxiety shared by many therapists, who have been unable to see their patients face to face throughout the lockdown period, instead hosting online sessions. 

Illustration by Jacob Stead of a coronavirus wrecking ball



Illustration by Jacob Stead.

“For those with a history of trauma,” says Orbach, “it has been a particularly difficult time, not just because of the loneliness and isolation, but because it may also have re-stimulated past traumas. There is so much about the pandemic that is disturbing and distressing on so many levels.”

The Royal College of Surgeons recently carried out research into the effects of the coronavirus pandemic on healthcare workers, gathering personal testimonies from nurses and doctors on the frontline. Many reported experiencing increased levels of anxiety, stress, depression as well as panic attacks and bouts of guilt about the amount of people who have died. “I can’t see how I can keep doing this…” said one. “I really wish I wasn’t a doctor,” said another. 

Writing in the Guardian, lead researcher and NHS doctor Ankur Khajuria noted that even before the pandemic around 50% of doctors and 40% of nurses were suffering from stress-related psychiatric illness. “A perfect storm is gathering,” he warned. 

Lucy Warner is chief executive of NHS Practitioner Health, a confidential service that treats doctors with mental health issues. They expect to treat around 3,500 doctors a year. When I spoke to her a few weeks ago, she said they had already treated about a third of that annual number in the preceding few weeks – “mostly through online spaces where people can connect, talk to each other, share their feelings and reflect.”

In the early stage of the pandemic, she says, “there was a lot of anticipatory anxiety. It was new and people didn’t really know what was happening or how long it would go on, but they knew it was frightening.” As the weeks have passed in long shifts and rising numbers of the sick and the dead, that gave way to “a lot of emotional fatigue, a kind of mental and physical exhaustion. It was becoming a toil, it was becoming difficult for doctors to go on while not knowing how the pandemic would play out.” 

Over the last months, that state of mental and physical fatigue has for many become the default mode. “In a way, it no longer feels like a break with the norm,” says Warner, “it just feels normal.” 

Like Stubley, Warner thinks the psychological fallout of the pandemic will be a huge and protracted challenge for an overstretched and underfunded health system.

“This is a long game. We are seeing the beginnings of a surge in mental health issues among frontline staff, but over the next year or more we are going to see a lot of people who thought they were OK suddenly realising that they are not. There will be some nurses and doctors suddenly thinking: ‘My God! What did I go through?’ That’s when we may have to deal with a surge in PTSD symptoms, and those people will need individual support but also support on an organisational level.” 

While the government and some media were quick to apply the language of wartime to the pandemic – heroic British frontline warriors battling an invisible enemy – Jo Stubley told me of her and her colleagues’ discomfort at that kind of distracting rhetoric. “The NHS is not the military,” she said quietly, “and nurses are not soldiers.” 

Like several others I spoke to, Warner was also uncomfortable with what she called “the hero narrative” that has taken hold of the public imagination during the long weeks of lockdown. “It is unhelpful in some ways because you don’t want doctors and nurses to feel they are superheroes, who have to pat themselves on the back when they are on the line and not sleeping or even having time for a pee. What can tend to get overlooked is that they are human beings who are entitled to a rest as much as we all are. They are ordinary people doing their very best, but we need them to be well to do their jobs well.”

Doctors hold a silent protest outside Downing Street on 28 May.



Doctors hold a silent protest outside Downing Street on 28 May. Photograph: Tolga Akmen/AFP/Getty Images

In response to the emergency of the last few months, several psychotherapists have set up online drop-in support groups for NHS staff, who may be feeling overwhelmed or emotionally exhausted. I spoke to one who, with a colleague, has created “a support group for clinical staff” in London. She asked for anonymity. 

“The first thing to stress is that it is drop-in support, not psychotherapy – the midst of a crisis is not the time to start psychotherapy for clinical staff. What they need is a safe space to come together, share their thoughts and anxieties and listen to others experiencing similar challenges. To this end, everyone uses first names only and they do not have to say where they work. They can also choose to be seen on a screen or not.”

Perhaps surprisingly, the take-up rate has been low and almost all those who have used the service are doctors rather than nurses. “I think there are various reasons for that,” she says. “First, they are in it, and when they get home, they are utterly exhausted. Also, they are perhaps not aware of what help has been made available to NHS staff, even though there is actually a lot of help out there.”

The other more positive reason is that they may already be receiving support from their fellow workers, from the strength of being part of a team that is responding well in extremely difficult circumstances. “The way the nursing profession works is that you tend to get on with it,” says Jo Stubley. “You are to a degree encouraged to feel that way, so even when the normal rules don’t apply there is the sense that this is what you have been trained for. It’s amazing in many ways, but it means that everybody seems to be coping on the surface, while underneath they may well be struggling.” 

Medical staff at the Royal Blackburn teaching hospital.



Medical staff at the Royal Blackburn teaching hospital. Photograph: Hannah McKay/AP

In the first chaotic weeks of the Covid pandemic, many nurses and doctors felt not just overwhelmed, but threatened and unsafe. There were serious issues over the lack of adequate PPE, leading to increased anxiety about contracting the virus and passing it on to family members. Both the workplace and the home thus became places that were unsafe and uncertain. 

The nurse from Sierra Leone quoted at the beginning of this article recalled her feelings of being alone, at risk and anxious. “Initially it was chaos – we didn’t have equipment, we didn’t have senior support, we were short-staffed.” 

For two long weeks, she and her colleagues worked in an environment she compared to a war zone, tending to patients who were “very unwell, very unstable, very sick… We didn’t even have masks. We were tired, dehydrated, thirsty,” she continued, still sounding traumatised. She recalled returning home each night to her daughters, thinking: “What is happening? How far will this go?” 

That anonymous nurse belongs to the BAME community who make up 20% of the NHS workforce. On 25 May, the Guardian reported that 200 healthcare workers had died from Covid-19. More than six out of 10 victims were from BAME backgrounds. One of their number was urologist Abdul Mabud Chowdhury, whose 18-year-old son voiced what many inside the NHS were feeling. “It’s good to see NHS workers getting the recognition they deserve,” he said, “but they should not have to give their lives, they should not have to go as martyrs. They did not sign up to battle on the frontline and give up their lives.”

In the coming second pandemic of mental health issues, it may well be those we heralded as heroes who will be among the most vulnerable, alongside key workers on low incomes who also toiled through this long emergency at considerable and often unnecessary risk to their health, their lives. 

“If we were prepared to clap for our health workers, we should also be insisting that they are looked after in the wake of this emergency,” says Jo Stubley. “I want to be optimistic about that, but the market economy has been a disaster for the health service and, within it, mental health has always been the poor sibling. I have spent years saying to my managers, we need more resources, too many people are waiting. If there was no room in the system before this began, what will happen when it ends and we are in the middle of another recession?” 

Julia Samuel concurs: “The fear is that the system will be overwhelmed, not least because there is not the parity of resources in mental health that there is in physical health.”

When this is over, how will we acknowledge the haunting presence of the dead, the thousands of lives lost unexpectedly and in often extremely upsetting circumstances for loved ones? In time to come, hard questions must surely be asked about the British death rate and the practical ways many thousands of those deaths might have been prevented. For now, it is the hardest aspect of the pandemic to grasp, much less make sense of. Only months ago, it would have seemed like the stuff of dark imaginings: gothic fiction or apocalyptic sci-fi. How swiftly it has become real; all too real. 

On Sunday 24 May, The New York Times filled its entire front page with death notices from across America, a bold statement that nevertheless only hinted at the immensity of the human toll: 1,000 victims symbolising around 100,000. Outside of wartime or other historical pandemics like the Spanish flu in 1918, there is no precedent for the number of lives lost within a relatively short period. 

The global virus has, in the most insidious and cruelly indiscriminate way, turned our world upside down, denting our faith in the infallibility of science and medicine, global capitalism and in progress itself. It has made us fretful for our lives and the lives of those around us, while simultaneously robbing us even of our traditional way of death. Relatives have not been allowed to visit their loved ones in their final days or to be present when they breathed their last. Some have been forced to keep a vigil on their computer screens via live feeds from a Covid ward. Funerals have been limited to small groups of people, all keeping the requisite two metres from one another. 

If distance and isolation have become the new touchstones of daily life, they have also intruded even on people’s heartbreak and their grieving. “The thing that makes grief tolerable for many people is the love and affection of others,” says Samuel, “We need to be held when we feel broken.” 

The New York Times front page from 24 May.



The New York Times front page from 24 May.

In her heartbreaking poem, My Sister Is Not a Statistic, Dorothy Duffy remembered her sister, Rose, who

died without the soft touch of a loved one’s hand. Without a feathered kiss upon her forehead. 

Without the muted murmur of familiar family voices gathered around her bed…

In composing that sad, defiant elegy, Duffy found a way to express her tumult of emotions in the face of the virus’s assault on our collective sensibilities. In this, though, she was undoubtedly the exception. Countless others have not found a way to articulate their sorrow, their isolation and their disorientation. “You don’t expect to lose someone in this way,” says Orbach, “to not be able to say goodbye and then to be forced to grieve alone.” 

For Orbach, the pandemic has also brutally exposed our culture’s collective denial of the final inevitable. “The rituals are there to help us get through it,” she elaborates, “but also because death is such a problematic idea in our culture, an almost impossible idea. We don’t live with death, as it were. Instead, we live to a great degree in denial of it, particularly our own death. And suddenly, we are witnessing death on a grand scale. It has in effect cut through our belief systems, our expectations of what life is.”

As someone who specialises in grief, what does Julia Samuel think will be the lasting collective impact of so many deaths, but also of our prolonged proximity to the threat of death?

“The impact will by no means be the same for everyone,” she says. “For an older person to lose a long-term partner so suddenly and unexpectedly is a different experience to a family who have lost someone young who was expected to survive. Both traumas will leave a deep and lasting imprint on their family members.” 

Samuel points out that guilt is often a component of grief, and may be exacerbated by the ways in which people have died during the pandemic. “To be the only family member permitted to be present in an ICU is heartbreaking of itself, but then to have to be in full PPE, while your loved one is on a ventilator surrounded by medical staff who also look like astronauts. It is as good as it can be, but it is not the death that anyone would wish for.”

I ask Julia Samuel if there is any way to accurately predict what the long-term fallout of the pandemic will be…

“As humans, we are born to adapt,” she says. “But while we are still in it and so much is still uncertain, I don’t think we have a clue what the long-term consequences will be.” 

A burial plot



A fresh burial plot in Oxfordshire. Relatives have been unable to visit loved ones during their final days, and only a small number of mourners are allowed to attend funerals.

When pressed, she mentions one of the possible beneficial effects of our time in lockdown. “One thing I sense is that many people are questioning how they lived before. The badge of busyness, for instance, has to a degree lost its lustre. Being busy was somehow being important, but maybe people have realised that busyness is essentially an anaesthetic to feeling.”

I ask Susie Orbach the same question. She, too, attests to the power of not being frantic. “The lockdown certainly changed our relationship to time. In the beginning, there was a kind of panic about time running though our hands – it was two o’clock and suddenly it’s five o’clock. How did that happen? I think not being frantic was a challenge for some people, but for others, the not-doing and simply being became almost mindful. To just be is actually quite liberating.” 

Will these small epiphanies be enough for the reorientation of our social and political values that some have suggested will be the necessary outcome of this global emergency? Writer and activist Arundhati Roy has described the pandemic as “a portal, a gateway between one world and the next”. We can, she suggested, “choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.”

Orbach cautiously agrees. “Part of me thinks that this is somehow a moment of possibility. Many of us who believe we need to work together to democratise our institutions saw that actually happen when the doctors and nurses took control on the ground, while management did not have a clue.” 

She pauses for a moment, gathering her thoughts. “In terms of our political culture, we entered the pandemic with a government born of fright. Brexit was essentially an act of fright, and the climate of fear that was created left so many people feeling marginalised in this swashbuckling, Darwinian, self, self, self culture. And yet, against all that, when the pandemic happened and real fear spread among us, people wanted to make a contribution, they wanted to be decent.” 

The experts agree that the psychological fallout of the Covid-19 pandemic will be felt for some time to come and that, as ever, the most vulnerable, no matter their recent sacrifices, will be most at risk. In the new normal, will we find ways to be fairer, kinder, more decent when this is all over, if it can ever be said to be truly over? Or will today’s “heroes” become tomorrow’s overlooked victims like the traumatised veterans of so many wars we willed ourselves so quickly to forget? 

Will we hold our political leaders to account when the coming economic crisis inevitably takes precedence over the psychological one and already limited resources are channeled away from a beleaguered NHS that nevertheless saved us from an even deeper, darker abyss? Or will we simply get on with it as before, finding ways to forget that, for a long, uncertain time, when time itself seemed out of joint, we lived amid the mounting dead in a world turned upside down. Ultimately, how we respond to this looming second pandemic may be the measure of how much the first one really taught us about ourselves and the kind of world we want to live in. 

 In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org

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The Latest: Greece tightens restrictions as virus spreads | World News

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ATHENS, Greece — Greece will shut down restaurants, bars, cafes, cinemas and gyms across a large part of the country, including the capital Athens, after a surge in coronavirus cases.

Outlining the measures in a televised address, Prime Minister Kyriakos Mitsotakis said the changes will take effect Tuesday morning and last for the whole of November.

The areas affected are most of northern Greece and the Athens region.

Though closed for sitting customers, restaurants in these areas will be able to offer food for takeaway and deliveries.

In other measures, Mitsotakis said masks will become mandatory across the whole of Greece and a curfew will come into force from midnight to 5 a.m. University classes across the country will have to be conducted online.

In contrast to the spring lockdown, travel within the country will not be affected and retail shops will stay open.

Like other countries in Europe, Greece is in the grip of a resurgence of the virus. Daily infections surged over 1,000 this week, peaking at 1,690 Friday.

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HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— UK government mulls lockdown for England.

— State leaders facing 2nd wave resist steps to curb virus

— Parisians flee, sidewalks empty as France enters lockdown

— 2nd study testing a COVID-19 antibody drug has a setback

— A multi-state coronavirus surge in the countdown to Election Day has exposed a clear split between President Donald Trump’s bullish embrace of a return to normalcy and urgent public warnings from the government’s top health officials.

— European countries are calling for the World Health Organization to be given greater powers to independently investigate outbreaks and compel countries to provide more data, after the devastating coronavirus pandemic highlighted the agency’s numerous shortcomings.

— Day of the Dead will undoubtedly be harder this year for Latino families across the U.S. torn apart by coronavirus. The annual Mexican tradition of reminiscing about departed loved ones is typically celebrated Nov. 1-2.

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Follow AP’s coronavirus pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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HERE’S WHAT ELSE IS HAPPENING:

LONDON — The British government is considering imposing a new national lockdown in England, after its scientific advisers warned that hospitalizations and deaths from the resurgence of the coronavirus could soon surpass the levels seen at the outbreak’s spring peak.

Epidemiologist John Edmunds, a member of the government’s scientific advisory group, said cases were running “significantly above” a reasonable worst-case scenario drawn up by modelers early this month.

Prime Minister Boris Johnson has introduced a system of local restrictions for England based on levels of infection. But scientists say it has not been enough.

The Times of London says Johnson could announce a month-long lockdown as soon as Monday, though the government says no decisions have been made.

Any new lockdown would likely see non-essential businesses close and people told to stay mostly at home, though schools would remain open.

The U.K. is recording more than 20,000 new coronavirus infections a day, and government statisticians say the true figure is far higher. On Saturday the country is likely to surpass 1 million confirmed cases since the outbreak began.

The U.K. has Europe’s highest coronavirus death toll at more than 46,000.

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BERLIN — Chancellor Angela Merkel is pledging to help companies hit by a new German partial shutdown “quickly and unbureaucratically” as the country reports the latest in a string of daily coronavirus infection records.

German officials decided this week to shut down bars, restaurants and leisure facilities for four weeks starting Monday and impose new contact restrictions. The aim is to curb a rapid rise in new infections and prevent the health system from being overwhelmed.

The government plans to spend up to 10 billion euros ($11.7 billion) to compensate companies hit by the latest shutdown.

Merkel said in her weekly video message that “we will not leave companies that face difficulties because of the current crisis through no fault of their own alone. We want to help quickly and unbureaucratically.”

On Saturday, the national disease centre, the Robert Koch Institute, reported 19,059 confirmed new cases over the last 24 hours, and another 103 deaths. The figure — up from the previous record set Friday of 18,681 — takes Germany’s total cases since the pandemic started to 518,753 and its death toll to 10,452.

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BRATISLAVA, Slovakia __ A national rapid-fire testing program for the coronavirus has launched in Slovakia with the government aiming to test anyone older than the age of 10 over the coming two weekends.

The results of the free tests, which look for antigens, will be available within minutes and anyone in the country of 5.4 million testing negative won’t have to abide by strict limits on movement imposed.

Like other countries in Europe, Slovakia has seen a sharp rise in new cases in recent weeks.

Some 5,000 testing sites have been established by the armed forces but despite help from volunteers, some still didn’t have enough medical personnel on Saturday morning, authorities said.

Long queues of cars have already formed at the sites.

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BEIJING — China has reported six new confirmed cases of COVID-19 in an outbreak in Xinjiang, bringing the total in the far-west region to 51.

Six were in serious condition, Xinjiang health authorities said Saturday. Another 161 people have tested positive but show no symptoms.

The outbreak in Shufu county, near the city of Kashgar, appears to be linked to a garment factory that employs 252 people and has been sealed off.

China has largely curbed the spread of the coronavirus but continues to see localized outbreaks with infections in the hundreds.

The National Health Commission also reported 27 new cases among people who had arrived recently from overseas.

The total number of confirmed cases has reached 85,973, including 4,634 who have died. China does not include people without symptoms in its confirmed case count.

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NEW DELHI — India has registered 48,268 new confirmed coronavirus cases in the past 24 hours, continuing a downward trend.

The Health Ministry on Saturday also reported 551 additional deaths, taking total fatalities up to 121,641. The figure raises the country’s total virus tally to over 8.1 million, behind only the U.S. Over 7.4 million people have recovered.

The slowdown in daily infections has held for more than a month with fewer than 60,000 cases for nearly two weeks. Some experts say the trend suggests the virus may have finally reached a plateau in India but others question the testing methods and warn a major festival due in a few weeks and the winter season could result in a new surge.

The capital of New Delhi, which recently became the worst-hit city in India, is already witnessing high air pollution levels, making the coronavirus fight more complicated in months ahead.

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COLOMBO, Sri Lanka — For the first time, Sri Lanka police have arrested dozens of people for not wearing masks and failing to maintain social distancing, under the new laws imposed to contain the spread of the coronavirus.

Police spokesman Ajith Rohana said 39 people were detained, and separately, another 221 were held for violating a curfew.

Since Thursday, the government has imposed the curfew in the whole of Western province where new outbreaks at a garment factory and the main fish market were discovered early this month. It includes the capital Colombo, where nearly 30% of the 22 million population live.

Infections from the two clusters have grown to 6,945 by Saturday, including 633 in the last 24 hours, bringing to over 10,000 the number of confirmed cases in the island nation, including 19 deaths.

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CANBERRA, Australia — Australia has announced it will spend 500 million Australian dollars ($351 million) to secure COVID-19 vaccines for the Pacific and Southeast Asia “as part of a shared recovery for our region from the pandemic.”

The government said it would use a range of advance purchase agreements with manufacturers via the global COVAX Facility plan, which aims to ensure virus vaccines are shared with all nations.

“We are committing an additional AU$500 million over three years towards this effort,” it said. “The funding will further help ensure that the countries of the Pacific and East Timor are able to achieve full immunization coverage, and will make a significant contribution toward meeting the needs of southeast Asia.

“A fast, safe vaccine rollout … will mean we are able to return to more normal travel, tourism and trade with our key partners in the region.”

Meanwhile, officials in Victoria state reported just one new case of COVID-19 on Saturday as Melbourne residents head into a weekend of greater social freedom.

Figures from the state’s Health Department show an average of just 2.4 new cases per day for the past 14 days.

The easing of restrictions means families can visit each other at home. A 25-kilometre (15-mile) travel limit remains in place and outdoor gatherings are still capped at 10 people.

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FRANKFORT, Ky. — Kentucky reported a near-record number of new coronavirus cases Friday as the surging outbreak continued sending more people to hospitals, Gov. Andy Beshear said.

“This is a dangerous time. We’re moving the wrong way,” the Democratic governor said as he urged Kentuckians to wear masks in public to protect themselves and those around them.

Beshear reported 1,941 new COVID-19 cases — the second-highest statewide daily total since the pandemic began — and 15 more virus-related deaths.

The state’s positivity rate reached 6.19% — the highest level since May 6, he said.

The recent surge has led to rising hospitalizations. On Friday, there were 974 patients hospitalized in Kentucky due to the virus, the governor said, noting the number of COVID-19 patients in intensive care rose to 241.

“Remember, the more cases, the more people in the hospital, the more people in the ICU and the more people who die,” Beshear said.

Total statewide COVID-19 cases surpassed 105,000, and the virus-related death toll reached at least 1,476. The latest deaths announced included people ranging in ages from 39 to 91.

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ORLANDO, Fla. — Walt Disney World says it plans to lay off more than 11,000 unionized workers because of the new coronavirus, bringing the total number of pandemic-related job casualties at the Florida resort to almost 18,000 positions.

Disney World said in a letter to state and local leaders Thursday that the 11,350 union workers — mostly part-timers — will be laid off at the end of the year. Company officials previously had said that another 6,400 nonunion Disney employees in Florida would lose their jobs.

Earlier this week, 720 Disney World actors and singers were laid off since many of the live entertainment shows at the Florida resort have gone dark, according Actors’ Equity Association, the labour union representing the performers.

The layoffs are part of a decision by The Walt Disney Co. last month to eliminate 28,000 positions in its parks division in California and Florida because of the pandemic.

Disney’s parks closed last spring as the coronavirus began spreading in the U.S. The Florida parks reopened this summer with restrictions on how many people could be in the parks at any given time and new requirements for social distancing and mask-wearing. The California parks have yet to reopen because of restrictions by the state of California.

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TOPEKA, Kan. — Kansas counties that require masks have seen about half as many new coronavirus infections as counties that don’t mandate face coverings, a study has found, as cases statewide surged again to record levels.

“Do Masks Matter in Kansas” produced by the Institute for Policy and Social Research at the University of Kansas found that counties that require masks saw a decrease in their seven-day rolling average of daily cases per 100,000 population starting 14 days after the mandate was issued.

“Masks, it is important to note, do not eliminate COVID, but they significantly slow the spread of the disease — at least here in Kansas,” said Donna K. Ginther, the institute’s director, in a video presenting the study’s findings. The Institute for Policy and Social Research at the University of Kansas has been tracking the impact of COVID-19 on the state, The Kansas City Star reported.

Kansas Gov. Laura Kelly tried over the summer to issue a statewide mask mandate, but most of the state’s 105 counties opted out. This week, Kelly and top Republicans agreed to try to persuade counties that are coronavirus hot spots to impose mask requirements rather than having the state step in. But she said she could still call the Republican-controlled Legislature into special session to impose a statewide rule.

Counties without mask mandates have seen the seven-day rolling average of daily cases per 100,000 steadily increase. And in September, those counties started to have higher case rates compared to counties with a mask mandate, Ginther said.

“We found a 50% reduction in the spread of COVID-19 in counties that had a mask mandate compared to those without,” Ginther said.

___

NEW YORK CITY — The coronavirus can spread more extensively in households than previous research suggests, and kids can transmit it at about the same rate as adults do, according to a new study.

The study shows how important it is for people who test positive to isolate themselves within a home, and for them and everyone else to wear masks when they are in common areas, researchers said.

The Centers for Disease Control and Prevention released the study Friday. The researchers focused on 101 households in Tennessee and Wisconsin.

In each home, after a person was diagnosed, other household members agreed to undergo nasal swab or saliva tests and kept symptom diaries. Nearly 300 people participated. About 100 were identified as the first to be infected and the other 200 people lived with them.

About 53% of the household members tested positive, and most were diagnosed within five days of the time the first person got sick. Previous studies have estimated the secondary infection rate at around half that.

___

SAO PAULO — Four tourists were arrested on Thursday in Brazil for allegedly falsifying COVID-19 tests in an attempt to reach what some say is the world’s most beautiful beach.

The two men and two women were arrested after landing in Fernando de Noronha, a group of islands offshore northern Brazil, according to a statement posted on the archipelago’s official website. The Brazilians, who took a private jet and arrived Wednesday night, were accused of falsifying documents, using falsified documents and criminal association.

TripAdvisor users rated Fernando de Noronha’s Sancho Bay as the world’s top beach in 2020.

Fernando de Noronha reopened to tourists on Oct. 10, requiring COVID-19 tests that show negative results and administered no earlier than one day before departure. The visitors presented test results that were dated three days prior to their arrival.

___

KNOXVILLE, Tenn. — Three tigers at a Tennessee zoo are in quarantine after one tested positive for the coronavirus, according to a Friday news release from Zoo Knoxville.

The United States Department of Agriculture’s national veterinary lab confirmed the positive test for Bashir, an 11-year-old male Malayan tiger, the Knoxville News Sentinel reported.

Two other tigers, 11-year-old male Tanvir and 6-year-old female Arya, are presumed positive while their tests are being processed. All three animals have experienced mild coughing, lethargy and decreased appetite.

___

SIOUX FALLS, S.D. — South Dakota broke its record for new coronavirus infections reported in one day on Friday as 1,560 people tested positive.

The new virus cases brought the number of cases statewide to 13,520, according to the Department of Health. That means that roughly one out of every 65 people currently has an active infection. The state has ranked second in the nation for new cases per person over the last two weeks, according to Johns Hopkins researchers. There were about 1,359 new cases per 100,000 people.

The Department of Health also reported 12 new deaths, bringing the tally of COVID-19 deaths to 415 since the pandemic began. October has been the state’s deadliest month as health officials reported 192 of those deaths this month.

The number of hospitalizations declined by 10 people to 403, breaking a run where hospitalizations hit new highs for five days in a row. About 31% of general-care hospital beds and 37% of ICU beds remained available in the state.

___

BALTIMORE — The U.S. now has 9 million confirmed cases of the coronavirus, according to data compiled by Johns Hopkins University, as infections continue to rise in nearly every state.

It took two weeks to reach the mark from 8 million, the fastest jump of 1 million yet. It had taken more than three weeks for the total to rise from 7 million to 8 million.

Confirmed U.S. cases are on the rise in 47 states. Deaths are up 14% over the past two weeks, averaging more than 800 every day. The virus has now killed more than 229,000 Americans.

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Police shooting of Black man near Portland raises tensions amid ongoing protests – National

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The shooting of a Black man by law enforcement in Washington state threatened to increase tensions around Portland, Oregon, where protesters against racial injustice have clashed repeatedly with right-wing groups.

Friends and family identified the dead man as Kevin E. Peterson Jr., 21, and said he was a former high school football player and the proud father of an infant daughter. The shooting happened in Hazel Dell, an unincorporated area of Vancouver, Washington, about 12 miles (19 kilometres) north of Portland.

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Walter Wallace Jr. shooting death sparks scrutiny of Philadelphia police training

In a statement, Clark County Sheriff Chuck Atkins said a joint city-county narcotics task force was conducting an investigation just before 6 p.m. Thursday and chased a man into the parking lot of a bank, where he fired a gun at them. A firearm was recovered at the scene, Atkins said.

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Authorities have not named the person who was shot, but Kevin E. Peterson Sr. told The Oregonian/OregonLive the person was his son, Kevin E. Peterson Jr. Atkins referenced the Peterson family in his remarks but did not confirm Peterson was the person who was killed.

“I can say that our agency is grieving as is the Peterson family and the community,” Atkins said. “As the community grieves, I call for there to be a respectful and dignified observance of the loss of life in this matter. There is always the potential for misinformation, doubt and confusion — and there may be those who wish to sow seeds of doubt.”


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Biden says ‘no excuse’ for looting, violence in Philadelphia following shooting death of Black man


Biden says ‘no excuse’ for looting, violence in Philadelphia following shooting death of Black man

The investigation has been referred to the Southwest Washington Independent Investigation Team, and the Camas Police Department is taking the lead, Atkins said.

Investigators said Friday evening that the narcotics task force had contacted a man suspected of selling illegal drugs in a motel parking lot and that he fled on foot with officers following. The man produced a handgun and the officers backed off, investigators said. A short time later, the man encountered three Clark County deputies, all of whom fired their pistols at the man, they added. They did not say the man fired a handgun found at the scene, making it unclear what happened just before the shooting.

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The community is a short drive north across the Columbia River from Portland, where racial justice protests have played out nearly every night since George Floyd’s killing by police in May. Southwest Washington is also home to the right-wing group Patriot Prayer, which has held rallies for President Donald Trump in Portland in recent months that ended in violence.

Read more:
Black Chicago woman injured in police shooting says cops let boyfriend die

Peterson’s family members, including the mother of his infant daughter, grieved on social media and questioned why it took authorities so long to make the shooting public and allow family to identify the body.

“Kevin did everything for me … doesn’t matter what it was or what time he always came when i asked. I regret every argument please come back,” his girlfriend, Olivia Selto, wrote on Twitter. “I miss him so much already.”

More than a dozen Black Lives Matter protesters lined a busy street in Hazel Dell on Friday afternoon in front of the US Bank parking lot where Peterson died. They held signs reading, “Honk for Black lives. White silence is violence” and “Scream his name.”

Bouquets of flowers were tied to a fence where the shooting happened along the street lined with strip malls and fast food restaurants. Most drivers honked in support of protesters, but one man screamed expletives and threats at the protesters and revved his engine as he drove past.

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Protesters clash with law enforcement following fatal police shooting in Philadelphia

A vigil was planned for Friday evening at the location and by 8 p.m. hundreds of people had gathered, lighting candles and chanting Kevin Peterson’s name and “Black Lives Matter” before Peterson’s family members arrived.

A smaller group of people in support of police and President Trump gathered and waved flags across the street. Some shouted obscenities at the people attending the vigil, a pickup truck and cars with Trump and other flags zoomed past at a high rate of speed and at least one minor scuffle between the groups appeared to break out before 9 p.m., according to footage from news outlets at the scene.

Brooklyn Tidwell, 16, said she and other students attended the rally instead of going to school.

“Black lives aren’t treated the same as my life,“ said Tidwell, who is white. “We should be voicing this and we should be protesting this because it needs to change.”

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Read more:
Illinois officer who shot, killed Black man fired from police force

Daniel Thompson, 26, stopped by with a bouquet of pink roses to leave at the scene. Thompson, who is Black, said he did not know Peterson but could identify with the shooting death.

“I walk this street every day. It’s sickening. It could have been anyone of us,“ he said.

A few blocks away, supporters of law enforcement also gathered, with people holding signs, including some that read, “Police Lives Matter.”

Bystanders at the scene of the shooting said Peterson’s car was towed but his body remained for hours.

Mac Smiff, an organizer of Black Lives Matter protests in Portland, said he knows Peterson’s sister and spent more than five hours at the scene.


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Protests erupt in Philadelphia hours after fatal police shooting


Protests erupt in Philadelphia hours after fatal police shooting

“There was a ton of grief, a ton of grief. He’s 21 and has a baby, an infant,” Smiff said. “They’re not sure what happened, why the encounter took place. Everyone was extremely disheveled and confused.”

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The elder Peterson told the newspaper that he arrived at the scene about 6 p.m. Thursday but “did not get a chance to identify my son” until 5:30 a.m. Friday.

Jake Thompson, a high school acquaintance of Peterson, said he took photos at the wedding of Peterson’s parents in Portland in 2018. On Friday, he posted a black-and-white photo of Peterson in a suit and bow tie as he flashed a big grin.

“I didn’t sleep much last night,” he said Friday.

Peterson played football at Union High School in Vancouver, Washington, loved sports of any kind and was a big personality who was known and liked by everyone at school, Thompson said.




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Live Covid-19 Global Updates – The New York Times

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Credit…Stefani Reynolds for The New York Times

The United States recorded more than 92,000 coronavirus cases on Friday, a level reached for the first time since the pandemic began. After eight months battling the virus, two dozen states are reporting weekly records for new cases — and none are recording improvements.

Eleven states reported single-day records for new cases on Friday: Wyoming, North Dakota, South Dakota, Utah, Montana, Illinois, Minnesota, Pennsylvania, West Virginia, Ohio and Maine. And two states hit record deaths: Tennessee with 78 and Montana with 27.

The outbreaks look different across the country, with states close in proximity sharing phases of the pandemic. Some, like North Dakota and South Dakota, have endured an extremely high number of cases for weeks — the Dakotas are ranked first and second nationally in recent cases per capita. Officials in North Dakota reported a single-day record Friday for the second day in a row. Neighboring Montana and Wyoming also hit single-day records for new cases on Friday.

In the Midwest, Illinois, Ohio and Michigan, are experiencing swift, alarming rises in case counts. In Illinois, new cases have increased 70 percent in two weeks, with more than 8,010 new cases on Friday, the second single-day record in a row. Ohio reported 3,845 new cases on Friday, the second single-day record in a row. And Michigan has been averaging more than 2,800 cases per day for the past week — an increase of 91 percent from the average two weeks ago.

And the numbers in states like New Hampshire and Maine remain low, but they are backsliding after long periods of stability. Maine in particular has seen three of the four highest single day totals come this week. Rhode Island limited gatherings to 10 people Friday, after a single high school party in the state led to five positive coronavirus cases and 1,000 people in quarantine.

In Utah, where officials last week issued urgent pleas saying they were planning on opening a field hospital, the state reported more than 2,260 new cases on Friday, a single-day record. Officials deployed a statewide wireless emergency alert because of the rising case counts on Friday, which read: “Almost every county is a high transmission area. Hospitals are nearly overwhelmed.”

Hospitalizations and deaths are also trending upward. Across the nation, more than 46,600 people were hospitalized with the virus on Friday, an increase of about 25 percent over the last two weeks, according to the COVID Tracking Project. The country has averaged just over 800 deaths a day over the last week.

On Thursday, more than 1,000 Americans died from Covid-19, an increase of 16 percent from two weeks ago. On the same day, the president’s son Donald Trump Jr. sought to downplay the severity of the virus, saying that deaths were “almost nothing” in an appearance on Fox News. In total, more than 229,000 Americans have died from the virus.

Cities, too, are issuing warnings as cases tick upward. San Francisco Mayor London Breed announced that the city was temporarily pausing the reopening of certain businesses and activities that were scheduled to resume on Tuesday — restaurants will now stay at 25 percent capacity for indoor dining, and indoor pools and locker rooms at gyms will remain closed, among other changes.

Yet experts warn that the variability may simply end with the virus resurging to high levels across the entire country.

“We’re going to see much less evidence of regionalization of this virus over the course of the next several weeks,” said Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota. “I think this is going to ultimately end up being an entire country on fire.”

This week, the United States reached its worst week for virus cases, with more than 500,000 new cases reported in the past week, and at least 90,000 new cases reported on Thursday. The country also crossed the threshold of nine million infections since the pandemic started. The virus still has the potential to infect millions more, since the country has not neared herd immunity, Dr. Osterholm said. “The virus is going to keep coming back,” he said.

The combination of pandemic fatigue, more indoor transmission of the virus during the winter months, and the reopening of businesses and activities, such as sports, could mean that states that aren’t seeing an increase in infections may see one soon. “I don’t see any location in the United States that’s going to be free of a major increase in cases,” he said. “And I think we’re just getting started.”

When high case counts emerge in communities, the spillover to surrounding populations is rapid, Dr. Osterholm said. The situation, he noted, can be likened to a “coronavirus forest fire.”

“A forest fire never burns evenly everywhere,” he said. “But if the embers are still around, they ignite again and then that area does burn eventually. And I think that that’s what we’re seeing here.”

Credit…Bing Guan/Reuters

People who contract Covid-19 can quickly spread the virus through their households, the Centers for Disease Control and Prevention reported on Friday, based on a study of 101 patients in Tennessee and Wisconsin, and 191 of their household contacts.

And “substantial transmission” occurred, whether the first patient was an adult or a child, the researchers found. The transmission rate was high across all racial and ethnic groups.

The findings highlight the need for strict measures, even at home, to help control the spread of the disease. And they reinforce concerns raised by other studies and public health experts that parents exposed to the disease on the job and multi-generational households may pose risks for children.

The report urged that “persons who suspect that they might have Covid-19 should isolate, stay at home, and use a separate bedroom and bathroom if feasible.” Everyone in the home should wear a mask, especially in shared spaces where it’s difficult or impossible to socially distance.

Of the 191 household contacts in the study, 102 — or 53 percent — became infected within a week or so of the first patient’s diagnosis. Many who contracted the disease at home had no symptoms, “underscoring the potential for transmission from asymptomatic secondary contacts and the importance of quarantine,” the researchers wrote.

In 14 households, the first patient was younger than 18. Among those younger than 12 years, 53 percent appeared to have spread the disease. Of patients aged 12 to 17 years, 38 percent apparently infected someone else at home.

The study helps fill important gaps in the evidence about how the coronavirus spreads. There has not been much systematic study of household transmission, and data on disease spread from children has been limited, the researchers said.

Their findings have some limitations, including some uncertainty about which household member was actually infected first, and uncertainty about whether some of the infected household contacts might have picked up the virus outside the home, rather than from the infected person in their household.

  • Stocks fell on Friday, dropping for the fourth time in the past five days in a retreat that has added up to Wall Street’s worst week since March, as rising pandemic cases, new shutdowns and a sell-off in large technology stocks all dragged the major benchmarks lower.

  • The S&P 500 fell 1.2 percent, bringing its loss for the week to 5.6 percent. That’s its biggest weekly drop since the week through March 20, when stocks plunged 15 percent before they began to rebound after the Federal Reserve and lawmakers in Washington stepped in to bolster the economy. The Dow Jones industrial average fell 6.5 percent this week.

  • The latest sell-off has come as a second wave of cases forced more lockdowns in Europe, threatening the economic recovery and spooking investors around the world. In the United States, a record number of cases is prompting city and county governments to start imposing some curfews and limits on gatherings.

  • And trading has been volatile for much of October, with investors whipsawed by expectations about whether Congress and the White House would agree on a new economic relief plan, anticipation of a contested election next week and concern about the sharp rise in virus cases.

  • The decline on Friday leaves the S&P 500 with a gain of 1.2 percent for the year. As recently as Oct. 12, the index was up more than 9 percent for the year.

  • “The Covid infections are moving in the wrong direction at a pretty quick pace, not just here in the U.S., but globally as well, so there’s a lot of concern about that among investors,” said Chris Larkin, managing director of trading and investment products at E-Trade Financial.

  • Concern about the economic impact of any pandemic-related shutdown has been particularly evident in energy markets. West Texas Intermediate crude, the American benchmark, fell 1 percent on Friday, bringing its losses to 10 percent for the week, its biggest five-day decline since April.

  • In the stock market on Friday, big technology stocks led the retreat even after many of them reported a jump in profit. Twitter was the worst-performing stock in the S&P 500, dropping 21 percent, after its user growth fell short of expectations. Apple fell more than 5 percent, after it said a delay in the release of the iPhone 12 led to a drop in iPhone sales.

  • Facebook and Amazon were also sharply lower. Alphabet was the only one of the four tech giants that reported results on Thursday to gain, climbing more than 3 percent after reporting a rise in advertising on Google and YouTube. The Nasdaq composite fell 2.5 percent.

  • Shares in Europe were mixed on Friday, with the Dax in Germany and the FTSE 100 in Britain lower, while the CAC 40 index in France rose slightly.

  • Data published Friday showed Europe’s economy recorded its strongest rebound on record in the third quarter, jumping 12.7 percent from the previous quarter in countries that share the euro. But the latest lockdowns mean economists are now worried about a double-dip recession, if economic growth is wiped out by weeks of orders to stay at home and the closure of bars, restaurants and nonessential shops.

Credit…Suzanne DeChillo/The New York Times

The drug maker Regeneron said on Friday that it would stop enrolling very sick people in a trial of its antibody treatment in hospitalized patients with Covid-19, in another sign that the treatments appear to not work well in patients who have advanced forms of the disease.

The company said that an outside panel of experts had recommended that people who required high-flow oxygen or mechanical ventilation not be given the antibody treatment because the risks outweighed the benefits. But it said patients who were hospitalized but not as sick — those who needed either no or low-flow oxygen — could continue in the trial.

Earlier this week, Eli Lilly announced that hospitalized patients in one of its trials would no longer receive its antibody treatment after a similar finding that the therapy did not appear effective.

The news added further evidence to the theory that monoclonal antibodies work best when given to people early in the course of the disease, soon after they have been infected. This week, Regeneron released new data from a separate trial of outpatients that found that the treatment significantly reduced levels of the virus and the need for medical visits, and Eli Lilly has published similar results.

President Trump received Regeneron’s antibody treatment shortly after he tested positive for the virus.

Both Regeneron and Eli Lilly have applied to the Food and Drug Administration for emergency use of their antibodies in outpatients, and Regeneron said Friday’s news did not affect its study of the treatment in that group.

Credit…Gerald Herbert/Associated Press

A committee of experts advising Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, is considering a wide-scale vaccine distribution approach for people at high risk living in communities hit hardest by the virus. Those communities often are predominantly people of color who have been getting sick and dying from Covid-19 at a much higher rate than the rest of the population.

Citing principles of equity and justice, public health experts are urging that a portion of the first, limited supply of coronavirus vaccines be set aside for these people. The idea, which draws on other proposals, may be the first of its kind for broad vaccine distribution in the country.

The virus’s devastating spread across the United States overlapped with periods of great social unrest over police brutality, though few if any clusters of infections were linked to the protests themselves. In some ways, the concurrent national crises magnified the inequities in health care that has long existed across the country.

“I see this as a seismic shift,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “We can’t go back to colorblind allocation.”

A C.D.C. advisory group on immunizations is developing the plan, and members say it will not vote on a final proposal until a vaccine receives either full approval or an emergency use authorization from the Food and Drug Administration, likely weeks or months from now. There are currently four vaccines in late-stage trials in the U.S.

But priorities extend beyond those in hard-hit neighborhoods.

The advisers suggest a framework that divides the U.S. population into four broad groups for vaccine allocation when supplies are short, and a vaccine would be administered in phases, with the possibility of dedicating portions to people in the hardest-hit populations. The first phase would offer a vaccine to health care workers, a large group that constitutes at least 15 million people and includes low-wage workers, such as nursing assistants and housekeepers in nursing homes.

The second potential phase is made up of essential workers who are not in health care, a group that includes teachers. It also includes people in homeless shelters, and those who work in or are confined in correctional facilities. It also includes those with medical conditions that place them at high risk and people older than 65.

Subsequent phases include people at lower and lower risk levels until the final phase, which includes everyone not offered vaccines in the previous phases.

But any move to weave justice and equity into the distribution of a coronavirus vaccine raises difficulties. Its underlying concepts and execution must be further defined, and the approach may then face legal and political challenges, even as the medical system grapples with the anticipated logistical hurdles of distributing new vaccines.

new York Region Roundup

Credit…Mark Abramson for The New York Times

New York has reached an agreement with school officials to allow public and private schools to reopen in areas at the heart of several small clusters of the virus in the state, even as other stringent restrictions remain in place, Gov. Andrew M. Cuomo announced on Friday.

The plan will clear a path for about 290 schools across the state to reopen in the coming weeks. It will largely affect Hasidic yeshivas in Rockland and Orange counties, which are just north of New York City, as well as Brooklyn. Hundreds of yeshivas were shuttered in early October after virus positivity rates spiked in areas with large populations of Orthodox Jews. Elected officials and parents in those communities have been calling on the governor to reopen the schools for weeks.

“The schools — private schools, Catholic schools, yeshivas, public schools — want to be open in the red and the orange zones,” Mr. Cuomo said on Friday about the areas with higher positivity rates. “And we’ve been working with them to try to find ways to keep people safe but allow children to go to school.”

Mr. Cuomo said the affected schools must start large-scale testing programs in order to reopen. The schools must test all returning staff and students, and must randomly test a quarter of all students and staff weekly. The state will supply rapid tests, which can return results in less than an hour without the need for sophisticated equipment, but are less accurate than slower laboratory tests.

Schools with relatively small student populations must close again if they have more than nine positive tests and schools in New York City that test more than 300 students will have to close if the positivity rate exceeds 2 percent. That threshold will be raised to 3 percent for schools outside the city.

Although rapid tests are cheap and convenient, experts have expressed concerns about their accuracy. They are worse at detecting the coronavirus when it is present at low levels in the body, raising the risk of false negatives. The products can also produce false positives, mistaking healthy people as infected.

Mr. Cuomo and Ms. Garvey did not say how soon schools may be allowed to reopen or how quickly tests would be provided to schools.

It also was not immediately clear how many public and private schools remain closed in New York. The state has a tiered system of restrictions that sorts areas with relatively high positive test rates into red, orange, and yellow zones.

In red and orange zones, all private and public schools have been restricted to remote learning. When Mr. Cuomo first announced the restrictions on Oct. 6, hundreds of schools were expected to be affected.

Restrictions will reman in place on businesses and houses of worship.

Statewide, Mr. Cuomo said that the seven-day rolling average positive test rate was at 1.4 percent, and that 1,085 people were hospitalized. These numbers represent a significant uptick over previous months, during which New York managed to keep its positivity rates at or below 1 percent, due in large part to vigilant testing.

In New York City, the school district became the first of the country’s largest to reopen all of its public schools for in-person instruction earlier this month, a major step in its recovery from having been the global epicenter of the pandemic and a hopeful sign for the country’s unsteady effort to return children to classrooms.

In other news from New York and the region:

  • Hospitalizations have been slowly but steadily rising in New York City, but thanks to widespread masking and social distancing, the level remains far lower than in the spring surge. Patients with serious cases are spending less time in the hospital on average and, with medical personnel more experienced and informed, fewer patients are dying: 139 people died from the virus in the four weeks ending on Oct. 24, compared to more than 800 confirmed and probable deaths at the spring peak.

  • New York City now has 200 testing sites, but disseminating information about them has been poor. The city’s wealthiest ZIP codes showed the highest rates of testing in September and October, and the poorest neighborhoods largely correlated with the lowest, according to research by a doctoral student in environmental health at Columbia, Wil Lieberman-Cribbin. Public-health experts note that high rates of positivity have emerged in areas with low rates of testing, suggesting infections could be much more widespread than they appear.

  • As of Thursday, three of Connecticut’s largest cities — New Haven, Bridgeport and Stamford — said they would roll back planned reopenings. The state has seen an average of 725 cases a day over the past week, more than double its average two weeks earlier, according to a Times analysis. Gov. Ned Lamont reported on Thursday that the state’s average positivity rate in the last week was 3.1 percent — a rate not seen there since early June. “There’s no good news in those numbers,” Mr. Lamont said.

Global Roundup

Credit…Valentin Bianchi/Associated Press

The prime minister of Belgium, which has one of the world’s highest Covid-19 infection rates, announced a national lockdown on Friday, calling it a “last chance” to keep the country’s health care system from collapse.

The announcement came a day after surges across Europe led France to reimpose a national lockdown and Germany to sharply increase restrictions.

Belgium, with 11 million inhabitants, has an average of 15,000 cases per day, and hospitals have been filling at an alarming rate for weeks. Doctors warned that unless radical steps were taken, intensive care units would be overwhelmed.

The government tried imposing a partial lockdown, closing bars and restaurants and instituting a nightly curfew. But the restrictions differed among the country’s three regions, which have a high level of autonomy, creating a chaotic patchwork of measures that were hard to understand.

The prime minister, Alexander de Croo, said Belgium’s lockdown would begin Sunday and last until mid-December. All nonessential businesses, including hairdressers and beauty salons, will be closed, but shops will be allowed to offer curbside pickups. Social contacts outside households must be limited to one person — with an exception for those living alone, who can see two people, but not at the same time.

Schools will remain closed until November 15, and traveling abroad is discouraged though not forbidden.

“At the moment, we have only one choice, to limit our physical contacts as much as possible,” Mr. de Croo said.

The measures are the strictest since the first wave of the pandemic hit the country in the spring. In those early months, Belgium also recorded one of the world’s highest infection rates, as well as one of the highest death rates, largely because thousands of nursing home residents were denied hospital care.

In other developments around the world:

  • The World Health Organization has warned that the pandemic has reached “an alarming juncture” in the Middle East region, where countries including Israel, Lebanon and Turkey have been grappling their highest weekly number of new cases since the beginning of the pandemic. Iran saw two days of record deaths this week, logging nearly 400 deaths on Thursday and bringing the reported death toll in the region’s worst-hit country to more than 34,000 — though officials have acknowledged that is likely an undercount. As a whole, the region has seen about three million confirmed cases and 75,000 related deaths.

  • Last Sunday, before Chancellor Angela Merkel of Germany announced a second national lockdown, a homemade bomb exploded in the early morning hours in central Berlin, close to a research institute that tracks virus cases and less than a mile from Ms. Merkel’s office. No one was hurt, but a letter threatened more of the same unless all measures aimed at stopping the spread of the virus were halted, the entire government resigned and new elections were held, the newsmagazine Der Spiegel reported on Thursday. In a speech to Germany’s Parliament the same day, Ms. Merkel condemned the lies and conspiracy theories around the virus, noting that they impeded the fight against the virus.

  • Ahead of a long holiday weekend, several cities and regions around Spain announced new restrictions on Friday, including the northwestern region of Galicia, where the authorities banned all city residents from traveling during the three-day vacation. In northeastern Catalonia, residents will have to stay within their municipalities not only this coming weekend, but also during the following ones. On Thursday, Parliament approved maintaining the country’s state of emergency until May, although the government is delegating to regional authorities many key decisions on new restrictions.

  • A small drop in reports of new daily infections in Finland over the last two weeks has raised the country’s hopes that it may be spared the upward trajectory of cases in many other European nations. The number of infections per 100,000 people over the past 14 days is 45.2, down from 52.9 over the previous 14 days, according to official data. On Thursday, Dr. Mika Salminen, the country’s director of health security said that the peak had passed, but that, “Naturally, we can’t be assured that the situation will prevail.” Indeed, as a reminder of both the volatility of virus trends and the uncertainty of a single day’s data, Finland reported its highest number of daily infections to date — 344 — on Friday.

  • Thousands of people left Paris on Thursday, just hours before France went into its second nationwide lockdown, clogging the city with massive traffic jams as many sought to be confined in the countryside and less crowded areas. Lines of cars stretched across hundreds of miles in the city and on the Boulevard Périphérique, the multilane ring road that circles around Paris, in scenes reminiscent of an exodus in the spring, when France imposed its first lockdown.

  • In Spain, a protest against the latest lockdown measures in Barcelona turned violent late Friday, as some demonstrators clashed with the police, resulting in the detention of a dozen people. At least 24 people were injured, including 20 police officers, according to the authorities. During the violent clashes, demonstrators hurled stones at the police and burned down street furniture.

Credit…Michael Conroy/Associated Press

With many colleges ending in-person instruction for the semester before Thanksgiving, public health officials are encouraging schools to help curb the spread of the coronavirus as students return home to their families.

The American College Health Association, which represents college health officers, issued public health guidelines on Thursday recommending that schools encourage students to get tested before their Thanksgiving departures, not travel if they test positive and quarantine for 14 days at home upon arrival.

Students should stay put and have a socially distant “Friendsgiving” on campus or celebrate virtually with their families if their school plans to resume face-to-face classes after Thanksgiving weekend, the association advised. Schools should also plan to keep quarantine housing open and provide support for students who test positive in the days just before dismissal.

Some colleges had already begun to make plans. The State University of New York announced this week that its students would have to test negative for the coronavirus during the 10 days before they leave campus; positive cases will be quarantined for a period prior to returning home. Pennsylvania State University and the University of Southern California are both offering free departure testing to students, though not mandating it.

More than a third of U.S. colleges invited students back for the fall with some degree of socially distanced campus housing and face-to-face instruction, and more than a quarter have been holding classes mostly or entirely in person, according to the College Crisis Initiative and the Chronicle of Higher Education. They have been tracking about 3,000 schools.

Many colleges have experienced serious outbreaks throughout the fall, though some hot spots have managed to contain the coronavirus in recent weeks. A New York Times survey of more than 1,700 American colleges and universities has found more than 214,000 cases since the pandemic began, with more than 50 colleges reporting at least 1,000 cases.

Credit…Lynne Sladky/Associated Press

Cruise ships can begin taking measures to set sail again beginning Sunday under a conditional order issued by American health officials that aims to mitigate the risk of coronavirus transmission, by imposing a regimen of testing and other safeguards aimed at keeping crews and passengers safe.

The order was issued on Friday by the Centers for Disease Control and Prevention and outlined a phased-in approach to allow for the resumption of cruises.

The federal agency had tried to extend until next February the no-sail order it had issued last March. But the White House blocked the extension in an apparent attempt to avoid alienating the powerful tourism industry in Florida, one of the swing states that could determine the outcome of the presidential election on Nov. 3.

Companies would need agency certification to resume full operations in U.S. waters, by first conducting simulated health and safety protocols on board with volunteers.

Those efforts would have to be evaluated by the agency to receive certification to set sail with commercial passengers.

“This framework provides a pathway to resume safe and responsible sailing,” said Dr. Robert R. Redfield, the director of the C.D.C. “It will mitigate the risk of Covid-19 outbreaks on ships and prevent passengers and crew from seeding outbreaks at ports and in the communities where they live.”

The world’s major cruise lines have been idled for months under no-sail orders.

And many cruise lines, like Royal Caribbean, had already announced they would not resume sailing until at least December. Some have canceled future sailings — Carnival Cruise, for example, has cancelled all sailings through Dec. 31, as well as some sailings in 2021 and 2022. But with cases rising to record levels in the United States, and European countries initiating new lockdowns as infections spread, an imminent return to cruise-ship travel remains in doubt.

The no-sail order has been extended several times since March but is set to expire on Saturday.

Also on Friday, French authorities allowed the cruise ship Le Jacques Cartier to set sail to France days after being grounded in Italy because crew members and passengers tested positive, according to a statement by PONANT, the French luxury cruise operator that owns the ship.

As of Friday, 10 crew members and three of the 72 passengers had tested positive. None showed critical conditions, the statement said. When they arrive in France, crew and passengers will be transferred to the care of French health authorities.

The company said that “strict sanitary protocols” had been applied to both crew members and passengers, including testing before boarding and temperature controls three times a day. The coronavirus shut down the cruise industry in the early months of the year, but by the summer, some European countries had relaxed no-sail orders, but ships have been sailing below capacity. PONANT said that since July 11, it had successfully operated more than 60 cruises, with 3,500 passengers.

Italian health authorities could not be reached for comment.

Credit…Andrew Seng for The New York Times

Like so many other plans this pandemic year, Halloween, at least as people have long known it, is canceled.

Would-be revelers across the United States are grappling with how to celebrate a holiday that is normally dependent on placing a great deal of trust in complete strangers at a time when social distancing is paramount.

The Centers for Disease Control and Prevention has warned that many traditional ways of marking Halloween, including trick-or-treating and crowding into haunted houses, are “higher risk” activities.

Some towns in Massachusetts, New Jersey and Texas, among other states, have banned door-to-door trick-or-treating altogether. Others are promoting reimagined celebrations like open-air costume parties or outdoor movie nights, which are considered “moderate risk.”

In New York City, Mayor Bill de Blasio said that Halloween should still be celebrated, trick-or-treating and all. He stressed that any festivities should take place outdoors, and with both ordinary face coverings and costume masks. But he expressed hope that Halloween would bring some relief to children weary of the pandemic.

“It can be exciting for our youngest New Yorkers,” the mayor said. “And they deserve it. They deserve it after everything they’ve been through.”

One parent, Christian Foster, a Bronx resident, said Halloween ranked high on the holiday list for his two school-aged children.

“These past six months have pretty much been disappointment after disappointment,” Mr. Foster said. “And you don’t want this to be another ‘maybe next year we’ll be happy again.’ But we also have to be real about the safety of it.”

Credit…James Estrin/The New York Times

As Covid cases rise around the United States and the holidays approach, mayors and governors have begun to preach a doctrine of mirthlessness to American families: This will be the year of pie eaten alone in front of an iPad.

But some will find a way to travel to places where they will sit at communal tables, conviviality unhindered.

The difference often comes down to testing.

Kim Kardashian West, for example, recently flew friends and family to a private island for her 40th birthday, after “2 weeks of multiple health screens,” she wrote on Twitter.

In New York City, the disparities are unmistakable.

Wil Lieberman-Cribbin, a doctoral student in environmental health at Columbia, tabulated the prevalence of testing in the city during September and October by ZIP code.

Overwhelmingly, he found, the wealthiest neighborhoods showed the highest rates of testing, and the poorest neighborhoods largely correlated with the lowest.

What concerns public-health experts is that high rates of positivity have emerged in areas with low rates of testing, which suggests that infection could be much more widespread than it appears. And while the city now has 200 testing sites, disseminating information about them has been poor.

In the view of Beverly Xaviera Watkins, a social epidemiologist at the University of California-Irvine, messaging in low-income communities of color has been “horrendous.’’ The authorities have had little success overriding suspicions of a medical class with a history of exploiting Black Americans or easing a broader mistrust of government.

Such doubt is amplified in public housing, where decades of neglect and deceit have resulted in buildings tainted with lead paint and mold and a vanished faith among people who live there that their well-being is anyone’s priority.

Surveying a sample of people living in three New York City Housing Authority complexes in Brooklyn, Dr. Watkins and Dawn Blondel, an environmental justice advocate, found that a vast majority of respondents had not been tested even though more than a third knew someone who had died of Covid-19.

“The thing is, you could get control of the virus everywhere in the city,” said Dr. Watkins, “but if you can’t get it down in public housing, you’ve lost the war.”

Credit…Chang W. Lee/The New York Times

Voters in several swing states are casting their ballots at the same time the coronavirus reaches new peaks in their communities, creating more uncertainty about how they will vote — and for whom.

The pandemic has killed nearly 230,000 people in the United States and upended the nation’s economy. Now it could help decide the presidential election.

Some electoral battlegrounds, like Michigan and North Carolina, are seeing record numbers of new cases and deaths. Hospitals in Wisconsin and other hard-hit areas are reaching capacity, pushing health care providers to the brink and leaving their workers reeling. Other swing states, like Pennsylvania, Florida and Arizona, are experiencing more mild upswings.

“Things are really running rampant, so there is a lot of discontent,” said Barry Burden, director of the Elections Research Center at the University of Wisconsin-Madison.

Wisconsin narrowly voted for President Trump in 2016, but the virus may change the outlook for him there.

“I do think it provides more of a challenge for Trump to try and win the state because any news about the pandemic — it’s not good for him,” Dr. Burden said.

Already, the pandemic has complicated the voting process.

Because of concerns the virus would hamper people’s ability to vote, several states have encouraged mail-in voting. About 1.64 million people had returned absentee ballots in Wisconsin as of Thursday, more than half of the total ballots cast in 2016.

In other battleground states like North Carolina, Florida and — this year — Texas, the president could see fading support from Republicans who feel frustrated by what they see as a lackluster federal response to the coronavirus. Those states may also see higher turnout among Democrats who opted to vote by mail for former Vice President Joseph R. Biden Jr.

“Enthusiasm for turning out for Trump among Trump supporters will wane somewhat, and so it will affect turnout somewhat,” said John Aldrich, a professor of political science at Duke University. “I don’t think it’s going to be a massive thing.”

Still, he said, in places where elections can come down to a few thousand votes, “everything matters.”

Credit…Lucy Nicholson/Reuters

The Los Angeles Unified School District, the country’s second-largest system, will probably not bring students back into classrooms until at least January, two members of the Board of Education said on Thursday.

The state requires a county to have no more than seven new daily cases per 100,000 people for two weeks before schools can fully reopen. In Los Angeles County, the daily case number is now about 18, and it has been climbing.

The president of the school board, Richard Vladovic, said that even if infections started declining soon, it would not make sense to reopen schools just as the holidays are about to begin. The news was first reported by The Los Angeles Times.

With the current county case numbers, Los Angeles schools are allowed to bring up to a quarter of students back onto campus, and can seek waivers to bring back all students in prekindergarten through second grade. But the district has not pursued those options.

Katie Braude, chief executive officer of Speak Up, a group that advocates for educational equity, said the district’s hands were tied because it had agreed with the teachers’ union that no teachers would be required to come back in person until schools were reopened for all students. The agreement expires on December 31.

Ms. Braude said the district, which has over 600,000 students, had done a lot of work to make the return to school safe, setting up an ambitious testing system for students and the staff and replacing ventilation systems.

“It’s just kind of ironic that the district has really gone out of its way on that front and they’re still not able to get kids back on campus who really need to be on campus,” she said, adding that “these kids are all losing out, and these are the kids who are already falling behind.”

The vice president of the Board of Education, Jackie Goldberg, said that even January was optimistic.

“It may be February or March,” she said.

And at that point, she said, the question may be whether it is worth starting in-person instruction if many children have to change teachers that late in the year.

The district has said that when it does reopen, it will use a hybrid model, in which students cycle between going to school buildings and learning at home.



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