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December 7, 2020 - Brief Issue 127

The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University.

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Top Headlines

Deborah Birx: Covid-19 Pandemic is the “Worst Event That This Country Will Face” (Health & Science)

CDC Issues Comprehensive Covid-19 Mitigation Strategy for States; Recommends Prioritizing In-Person School (Health & Science)

Much of California Under Stay-at-Home Orders (Health & Science)

U.S. Study Finds Children Just as Likely as Adults to Contract Coronavirus (Health & Science)

Top U.S. Official Says Covid-19 Vaccine Could Be Available to Nursing Home Residents By End of December; General Population By June (Health & Science)

Doctors Hesitant to Recommend Recently-Approved Covid-19 Drug (Health & Science)

Minnesota Study Links Anti-Diabetes Drug to Lower Covid-19 Death Rates in Women; Experts Advise Caution (Health & Science)

U.K. To Begin Vaccination Program on Tuesday; Russia Kicked Off Vaccination Program Over the Weekend; Pfizer Seeks Emergency Approval for Covid-19 Vaccine in India;  Indonesia Receives First Shipment of Sinovac Vaccine (Around the World)

Cases Still Climbing Across Europe (Around the World)

Japan Prepared to Deploy Military Nurses to Osaka and Hokkaido (Around the World)

Cases in South Korea Hit 9-Month High (Around the World)

Covid-19 Patients in Pakistan Die Due to Oxygen Shortage (Around the World)

China Tries to Rewrite the Narrative on Coronavirus Outbreak (Around the World)

Giuliani Tests Positive For Coronavirus; Arizona State Legislature to Close After Legislators Met with Giuliani (U.S. Government)

Some States To Defer Vaccine Prioritization to Health Care Providers (U.S. Government)

Biden Picks Xavier Becerra As Secretary of Health and Human Services (U.S. Government)

U.S. Labor Department Reports Tapering Job Numbers (U.S. Economy)

Baltimore Ravens Acknowledge That Protocol Breaches Played Role in Outbreak (U.S. Society)

FBI Raids New Jersey Coronavirus Test Lab, Urges Retests of All Customers (U.S. Society)

Health & Science

There have been 14,760,624 coronavirus cases in the United States, and 282,312 people have died (Johns Hopkins). Around 5,624,444 people have recovered, and the United States has conducted 34,958 tests. Worldwide, there have been 67,132,062 confirmed cases of coronavirus, with 1,537,070 deaths. At least 43,158,175 people have recovered from the virus.

Deborah Birx: Covid-19 Pandemic is the “Worst Event That This Country Will Face”

As Coronavirus cases and hospitalizations continue to mount across the U.S., White House coronavirus response coordinator Dr. Deborah Birx warned that the pandemic would likely go down as one of the most difficult events in U.S. history (NBC, CNBC).

“This is not just the worst public health event. This is the worst event that this country will face,” said Dr. Birx, speaking on Sunday to NBC’s “Meet the Press.” Dr. Birx also expressed disappointment with public officials who have downplayed the seriousness of the virus and resisted mitigation efforts. She urged increased public health measures nationwide, saying that “every state across this country needs to increase their mitigation and every state needs to be critically informing their state population that the gatherings we saw in Thanksgiving will lead to a surge.”

Cases and hospitalizations continue to rise across the United States. Saturday marked the fourth day in a row of more than 200,000 reported cases, and more than 100,000 people are currently hospitalized with Covid-19 (Johns Hopkins, COVID Tracking Project).

CDC Issues Comprehensive Covid-19 Mitigation Strategy for States; Recommends Prioritizing In-Person School

On Friday, the Centers for Disease Control and Prevention (CDC) issued a comprehensive set of guidelines for individuals and state and local governments to slow the spread of the coronavirus. Although most of the recommendations are not new, this is the first time the CDC has released a multi-pronged strategy guide to fighting Covid-19. The move reflects experts’ calls for a more uniform, nationwide approach. Dr. Jennifer Nuzzo, an epidemiologist at Johns Hopkins University, remarked, “we are not going to get past this pandemic unless we have a concerted national approach.”

Perhaps most prominently, the CDC now recommends the use of face masks in all settings outside the home, especially indoors and when physical distancing is not possible in outdoor settings. Other guidelines include avoiding nonessential indoor spaces and crowded outdoor spaces, increased testing, improved contact tracing, protecting high-risk individuals and essential workers, postponing travel, improved ventilation and sanitization practices and widespread vaccine use when a vaccine is released. The guidelines also emphasized the importance of keeping K-12 schools open for in-person learning, citing their “critical role for all children” and the crucial role they play for economically disadvantaged families (NYT, Politico, CIDRAP).

Much of California Under Stay-at-Home Orders

As of 11:59 p.m. Sunday night, many of California’s residents are under stay-at-home orders for at least the next three weeks. According to orders issued by California Governor Gavin Newsom, regions experiencing less than 15 percent ICU availability will be placed under intensive restrictions. The order was issued as part of an effort to prevent hospitals around the state from becoming overwhelmed. Stay-at-home orders took effect Sunday night in two of the five regions: San Joaquin Valley, with 6.6% ICU capacity, and Southern California, with 10.3% capacity as of Sunday. More than half of California’s residents live in one of these two regions. Officials in the San Francisco Bay Area announced Friday that the region would voluntarily implement the stay-at-home orders in order to prevent their hospitals from reaching the threshold. Under the stay-at-home orders, businesses such as bars and movie theaters must close, while retailers can remain open at 20% capacity and restaurants can provide takeout and delivery services. Essential businesses and schools that have already opened for in-person learning may remain open (NYT, CNN).

U.S. Study Finds Children Just as Likely as Adults to Contract Coronavirus

A study of 58 households in Wisconsin and Utah found that children and adults are equally susceptible to household-based Covid-19 transmission (CIDRAP). Because children frequently have less severe infections and represent a larger proportion of asymptomatic infections, it has been suggested that children are less susceptible to coronavirus infection than adults. However, studies on transmission to children have been limited. The new study, published in the journal Pediatrics, examined 120 adult and 68 pediatric contacts in 58 households. The study found that the rate of acquiring coronavirus infection from household contacts was the same for adults and children, though children were more likely to experience no symptoms or very mild symptoms. The authors of the study said that the lack of easily identifiable symptoms may lead to children being under-tested and therefore underrepresented in Covid-19 data. Approximately 35% of cases in the study were in children, compared to 8.3% nationwide. 

In an accompanying commentary, pediatric experts Drs. Benjamin Lee and William V. Raska said the study demonstrates the “incontrovertible” importance of mitigation strategies, especially consistent mask use, among children. However, they also emphasized the importance of balancing children’s academic, social, and emotional needs with infection and transmission risks. 

Top U.S. Official Says Covid-19 Vaccine Could Be Available to Nursing Home Residents By End of December; General Population By June

Dr. Moncef Slaoui, chief science adviser of Operation Warp Speed, said on Sunday that a Covid-19 vaccine could be available to some Americans as soon as this month (NYT). Trump administration officials outlined an ambitious vaccine rollout plan, with nursing home residents receiving vaccines first, followed by other high-risk individuals and then the general population. The plan, which assumes emergency approval of a vaccine this week or shortly after, aims to vaccinate individuals in nursing homes starting at the end of December or the beginning of January. Other high-risk individuals, including healthcare and other essential workers, would be vaccinated by mid-March, and the rest of the adult population by May or June. Dr. Slaoui and his team expect to meet with President-elect Biden this week to brief him on the plan.

Doctors Hesitant to Recommend Recently-Approved Covid-19 Drug

Last month, a repurposed arthritis drug known as baricitinib became one of the few anti-Covid-19 drugs to be granted limited emergency use authorization by the U.S. Food and Drug Administration (NYT). Clinical trials found that the drug given in conjunction with the antiviral remdesivir helped patients to recover an average of one day earlier than patients who received only remdesivir. However, doctors say that the modest benefits of baricitinib may not outweigh the drawbacks. For one thing, the drug comes with significant side effects, including blood clots. The medication also costs $1,500 per patient and the effects likely overlap with steroid treatments like dexamethasone. Currently, baricitinib is only authorized for use in hospitalized Covid-19 patients who require breathing support. Further trials, including those designed to directly compare baricitinib and dexamethasone, are underway to clarify the potential benefits of baricitinib. 

Minnesota Study Links Anti-Diabetes Drug to Lower Covid-19 Death Rates in Women; Experts Advise Caution

A study published last week in the journal Lancet Healthy Longevity found that the diabetes treatment metformin reduced the risk of Covid-19 death in women (CIDRAP). Diabetes has long been noted as a risk factor for worse Covid-19 outcomes, including risk of hospitalization, needing mechanical ventilation and increased mortality. The retrospective study analyzed medical records from 6,256 people with obesity or type 2 diabetes who were hospitalized with Covid-19. Researchers found that metformin decreased the risk of death by Covid-19 by 21.5% among diabetic or obese women hospitalized with the virus. No similar effect was found in men. The authors of the study noted the need for additional research, including prospective clinical trials. However, they were optimistic about the potential of the treatment, writing, “Our analysis supports the preventative use of metformin, before infection with SARS-CoV-2, to prevent severe COVID-19 in patients with diabetes or obesity.”

An accompanying commentary by experts who were not involved in the study offered a more cautious opinion. The authors of the commentary noted that a retrospective study such as this one is unable to capture important metrics on metformin use, such as dose, duration of treatment and whether the drug was taken at the time of hospital admission. The commentary also noted that the metformin users in the study were on average younger and had fewer comorbidities than non-users. In addition, metformin can cause serious side effects which would need to be considered before the drug could be broadly recommended. The commentary authors therefore advise that the results of the study be interpreted with caution.

Bonus Read: ‘New Mexico shut down nearly everything to keep hospitals from being overwhelmed by covid. It wasn’t enough,’ (WaPo).

Around the World

U.K. To Begin Vaccination Program on Tuesday; Russia Kicked Off Vaccination Program Over the Weekend; Pfizer Seeks Emergency Approval for Covid-19 Vaccine in India; Indonesia Receives First Shipment of Sinovac Vaccine

Shipments of the coronavirus vaccine developed by Pfizer and BioNTech were delivered in their super-cold containers to the U.K. on Sunday as the government prepares to start its vaccination program on Tuesday (AP, NYT). Around 800,000 doses are expected to be in place at around 50 hospital hubs in England to kick off the immunization program. “To know that they are here, and we are amongst the first in the country to actually receive the vaccine and therefore the first in the world, is just amazing,” said Louise Coughlan, joint chief pharmacist at Croydon Health Services NHS Trust, just south of London. Scotland, Wales, and Northern Ireland will also begin their vaccination rollouts on the same day. Last week, the U.K. became the first country to approve the Pfizer-BioNTech vaccine for emergency use.

On Saturday healthcare workers began vaccinating thousands of people in Moscow in a vaccination campaign that will expand to the rest of Russia over the course of this week. The vaccine, called Sputnik V, was approved for emergency use in August before a clinical trial to measure its efficacy even began, drawing widespread criticism from health experts. Last month, the makers of the Sputnik vaccine reported positive results from the clinical trial, but the vaccine was tested on a small number of people and the final trial has yet to be completed. This hasn’t stopped President Vladimir Putin’s government from moving forward with inoculating people, with doctors, healthcare workers, social workers, and teachers now receiving the vaccine in 70 locations across the capital. On Friday, Mayor Sergei Sobyanin said that 5,000 people had registered to get the vaccine; Deputy Prime Minister Tatiana Golikova cautioned those receiving it to avoid public places and reduce their intake of medicine and alcohol within the first 42 days after the first jab, because it could suppress the immune system, Reuters reported.

According to Indian health officials, Pfizer has sought emergency approval from the Indian regulatory agency for their Covid-19 vaccine (Reuters). It is the first company to seek vaccine approval in India, which currently has the third-highest rate of new daily coronavirus infections (Johns Hopkins). One major drawback of the Pfizer vaccine is that it must be stored at minus 70 degrees Celsius, which some officials have said will be difficult for many facilities to maintain. India also hopes to approve several locally-tested vaccines, including one from AstraZeneca and Oxford, which do not require storage at such low temperatures and may be easier to distribute. 

Indonesia received its first shipment of coronavirus vaccine from China on Sunday, President Joko Widodo said (Reuters). The government is preparing a mass inoculation campaign with the 1.2 million doses of China’s Sinovac Biotech Ltd. vaccine. Indonesia has been testing the vaccine since August and the country’s food and drug agency still needs to evaluate it before distribution can begin. “We have been preparing for months through simulations in several provinces and I am sure that once it is decided that we can begin the vaccination, everything will be ready,” the president said. The government plans to receive another 1.8 million doses in early January. Bonus read: "Scandal Dogs China's 'King of Vaccines' Partner to AstraZeneca" (NYT).

Europe

Cases Still Climbing Across Europe

Much of Europe has reentered some form of lockdown or enacted increased restrictions over the last month, but coronavirus cases continue to take a toll across the continent. In Italy, Covid-19-related deaths rose by 564 on Sunday, pushing the cumulative total to over 60,000 deaths since the pandemic began in February (Reuters). Italy is the sixth nation in the world to surpass 60,000 deaths. The health ministry also reported 18,887 new infections in the past 24 hours. 

Turkey recorded 30,402 new cases over the past 24 hours, the health ministry reported on Sunday, with the death toll rising by 195. Turkey was on lockdown over the weekend to try to get its surge in cases under control after 32,736 new cases were reported on Friday -- a record number since the beginning of the pandemic (Reuters). 

In Germany the region of Bavaria announced on Sunday that it will impose a tougher lockdown starting on Jan. 5 (Reuters). State Premier Markus Soeder said at a news conference that people in Bavaria will only be able to leave their homes for good reason, but noted that the rules would be relaxed for Christmas but put back in place to curb New Year celebrations. Bavarians will only be allowed to leave their homes to go to work, visit the doctor, or take a short walk for exercise. Shops and schools will remain open but children 13 years and above are only attending on alternate weeks. Germany as a whole entered “lockdown lite” in early November, but cases have stagnated at a high level, with the country reporting its highest single-day death toll on Wednesday. 

Asia

Japan Prepared to Deploy Military Nurses to Osaka and Hokkaido

Japan is preparing to send nurses from the Self-Defence Forces to Osaka and Hokkaido to help treat a surge in coronavirus infections as soon as the two prefecture governments request it, chief government spokesman Katsunobu Kato said on Monday (Guardian). Kyodo News reported that Hokkaido prefecture was planning to ask the government to send nurses after they experienced infection clusters at two hospitals. Osaka’s local government said on Sunday that they had exceeded 300 new cases for the sixth day in a row, according to public broadcaster NHK. 

Cases in South Korea Hit Nine-Month High

South Korea announced on Sunday it will impose heightened social distancing rules for the capital Seoul and surrounding areas as cases increased to the highest level in nine months. “We are in a very dangerous situation,” health ministry official Park Neung-hoo told a briefing, saying localized clusters have the potential to become a national outbreak (Reuters). “Right now it is exceeding the level that we can control in our hospital system,” Park added. The Korea Disease Control and Prevention Agency reported 631 new cases on Saturday, the largest daily tally since the outbreak’s peak in the country since earlier this year. Officials are concerned about the dwindling number of hospital beds after a month of triple-digit daily infections. On Saturday, Seoul launched unprecedented curfews, requiring most businesses to close by 9 p.m. and reducing public transit by 30% in the evenings. Gatherings of 50 people or more are prohibited, gyms, karaoke bars must close and religious services must be held online. 

Covid-19 Patients in Pakistan Die Due to Oxygen Shortage 

Six coronavirus patients have died in a hospital in Peshawar after oxygen supplied ran too low at Khyber Teaching Hospital (BBC). A delay in deliveries to the hospital meant that 200 patients were on reduced oxygen for hours. Hospital officials blamed the shortage and delay on the supply company, but several medical staff members were suspended. Pakistan is fighting a new wave of coronavirus cases, with a total of more than 400,000 cases and over 8,000 deaths since the beginning of the pandemic. 

China Tries to Rewrite the Narrative on Coronavirus Outbreak

Chinese authorities have begun pushing theories that the coronavirus originated outside of China as they continue to face global anger over their initial mishandling of the virus (NYT). Recently, officials have said that the virus could have been brought to China through packaged foods from overseas. Additionally, Chinese scientists have released a paper that proposes that the pandemic began in India and state news media has published false stories that misrepresent foreign experts as having said the virus originated elsewhere. The recent misinformation comes as the World Health Organization begins an investigation into how the virus jumped from animals to humans, a critical question in understanding how to prevent future pandemics. Even as recent studies have indicated that the virus could have infected people in the United States and elsewhere earlier than initially thought, researchers still believe the outbreak began in China.

U.S. Government & Politics

Giuliani Tests Positive For Coronavirus; Arizona State Legislature to Close After Legislators Met with Giuliani

Rudolph Giuliani, personal attorney to President Donald Trump, tested positive for the coronavirus, the president announced Sunday. Trump tweeted: “@RudyGiuliani, by far the greatest mayor in the history of NYC, and who has been working tirelessly exposing the most corrupt election (by far!) in the history of the USA, has tested positive for the China Virus. Get better soon Rudy, we will carry on!!!” Joining the president in his well-wishing was Jenna Ellis, a senior legal advisor for the Trump campaign who has frequently appeared at press conferences since the election alongside Giuliani. Ellis tweeted: “He is a tough warrior! The Trump Legal Team will continue our important work to fight for election integrity! We have a great team, along with able local counsel in each state. Our work won’t be affected and we press on.” The 76-year-old former mayor of New York City travelled throughout the country last week in a last minute effort to persuade state legislators to somehow overturn President-elect Joseph Biden’s victory. In the past, Giuliani has declined to self-quarantine following possible exposures, such as when his son tested positive last month. He has frequently joined the president in expressing skepticism of the virus’ severity. The former mayor, who has not yet announced his diagnoses himself, did not reply to requests for comment from the Washington Post (WaPo).

The Arizona Capitol Times reported that the Arizona state legislature will close for the whole week “after at least 15 current or future Republican legislatures may have been directly exposed to Covid-19 by meeting with Rudy Giliani.” Giuliani and fellow Tump attorney Jenna Ellis held an “unofficial hearing” at the Hyatt Regency Phoenix on Monday Nov. 30., less than a week before testing positive. Giuliani and Ellis talked, unmasked, for about 11 hours in the hotel ballroom with several state lawmakers present. The next day, Giuliani visited the state capitol and met with several lawmakers there. Following his visit to Arizona, Giuliani stopped in Michigan and Georgia, where he could have exposed other legislators as well. But according to the Trump campaign, no legislators or members of the press were on Giuliani’s contact tracing list because he had tested negative and did not experience any symptoms until at least 48 hours after meeting with them (Guardian). 

Some States To Defer Vaccine Prioritization to Health Care Providers

Some states are deferring to the healthcare industry the responsibility of choosing who will be first in line to receive vaccines, Politico reported Sunday. Kentucky, Mississippi and New York have told hospitals to plan their own tiering systems for prioritizing their employees while others, including Arkansas and Minnesota, are waiting to make decisions pending guidance from advisory councils. “They know who is most at risk,” said Kentucky Governor Andy Beshear during a Thursday press conference. “There are a limited number that we can include in this very first shipment.” Some hospital managers welcomed the move, arguing that individual providers are better equipped than state governments to make small-scale decisions. “I don’t believe any state can get down to the micro-level,” Mark Jarrett, chief quality officer at Northwell Health, New York’s largest private health system, told Politico. “It’s just easier to let it go to the local people.” But some health professionals have expressed concern that non-consistent responses across states will generate chaos that could undermine public confidence in the vaccine distribution.  “Bottom line: Things are going to be very messy,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security (Politico).

Biden Picks Xavier Becerra As Secretary of Health and Human Services

President-elect Joseph Biden has chosen Xavier Becerra, currently serving as California's attorney general, to lead the Department of Health and Human Services as the incoming administration puts its team in place to deal with the pandemic. Becerra, a former 12-term Democratic congressman, came as a surprise pick owing to his previous emphasis on social and economic issues ranging from immigration to tax policy rather than on public health. However, he has also previously worked extensively on preserving the Affordable Care Act amid Republican challenges. Becerra has also emerged as one of the chief advocates in the Democratic Party for increased attention to women’s health (NYT). The current secretary, Alex Azar, is among the top officials in the White House Coronavirus Task Force. It is unclear, however, if Biden’s health and human services secretary will play the same role as his predecessor in the fight against Covid-19. Sources told Politico that Rhode Island Governor Gina Raimondo, previously thought to be a favorite for the job, dropped out of consideration over fears that the department would be sidelined in the administration’s pandemic response. Advisors to the governor said they were worried that the new White House coronavirus team would take credit for successes while pinning blame for failures on the Department of Health and Human Services. Another source close to Biden decried the suspicion, calling it “an insulting misunderstanding” (Politico).

U.S. Economy

U.S. Labor Department Reports Tapering Job Numbers

On Friday, the Labor Department reported that employers added 245,000 news jobs in November, the fifth consecutive month of dwindling growth. While unemployment, which stood at 6.7%, was down slightly from October, the lower figure likely reflects workers who have given up on the job hunt and dropped out of the workforce. While more than half of workers laid off in the early stages of the pandemic have been rehired, there are currently about 10 million fewer jobs today than at the start of 2020. The situation, economists fear, is set to worsen as the public health crisis continues. “We’re in an unusual position right now in the economy,” said Ernie Tedeschi, an economist at the accounting firm Evercore ISI. While the impending release of vaccines give some cause for hope, “we’re going to have a few of the toughest months of this pandemic, and there will be a lot of scars left to heal” (NYT).

U.S. Society

Baltimore Ravens Acknowledge That Protocol Breaches Played Role in Outbreak

The Baltimore Ravens football team’s president admitted in a statement over the weekend that lax adherence to health protocols likely resulted in a coronavirus outbreak that has gutted its player roster. “Despite our best efforts, the protocol is only as effective as our weakest link,” Ravens President Dick Cass said in a statement released Saturday. “With a dangerous virus like this, everyone must comply with the protocol to avoid infecting many. We now know that not everyone at the Ravens followed the protocol thoroughly.” An outbreak in the team, which started last month, forced the cancellation of a game with the Pittsburgh Steelers scheduled for Thanksgiving Day. The game was postponed two more times before it was finally played on Wednesday. The interruption in the schedule also forced the NFL to delay two Ravens games scheduled for last week with the Dallas Cowboys and Washington Football Team. Cass also said at least four unique coronavirus strains were detected within the outbreak, suggesting multiple vectors. It remains to be seen what, if any, disciplinary actions the NFL will impose on the Ravens. The Tennessee Titans and New England Patriots were fined by the league $350,000 earlier this season for health violations, while the Las Vegas Raiders and New Orleans Saints were each fined $500,000 and denied a future draft pick (WaPo).

FBI Raids New Jersey Coronavirus Test Lab, Urges Retests of All Customers

The FBI has urged all people who got tested at a New Jersey lab to get retested immediately after it emerged that the center was apparently offering fraudulent services, NBC reported Sunday. Agents raided the Infinity Diagnostic Laboratory in Ventnor on Thursday after it emerged that the “rapid finger prick” tests offered at the site would fail to detect the coronavirus. The following day, the bureau issued a statement calling on people who had used the facility to come forward to assist in a federal investigation. The statement also advised the customers to get retested. While blood tests are used to detect antibodies following an active case, the only diagnostic tests available on the market involve nasal or saliva swabs. A man who used the service to test his employees said he was alarmed at the news that a lab would lie about the efficacy of its coronavirus testing during a pandemic. "I think giving fake, inaccurate tests just makes a bad situation 10 times worse," Brian Strahl of Margate told NBC. "Because you're putting ... people at risk, and you're also giving people a false sense of security. I think it's horrible” (NBC).

Analysis & Arguments

The Washington Post writes that students have lost too much time this year and the nation should prioritize reopening schools for in-person learning (WaPo).

Ribinson Meyer and Alexis C. Madrigal look at a statistic that they say shows U.S. healthcare workers are running out of space to treat Covid-19 patients (Atlantic).

Stuart A. Thompson describes potential vaccine distribution plans and in what order people will receive the vaccine in the U.S. (NYT).

 Readers can send in tips, critiques, questions, and suggestions to coronavirusbrief@newamerica.org.

The Brief is edited by David Sterman and Emily Schneider with Jessica Scott and Senior Editor Peter Bergen.

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