POST 39. July 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

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APRIL 26, 2020

“The first diagnosis of the coronavirus in the United States occurred in mid-January, in a Seattle suburb not far from the hospital where Dr. Francis Riedo, an infectious-disease specialist, works. When he heard the patient’s details—a thirty-five-year-old man had walked into an urgent-care clinic with a cough and a slight fever, and told doctors that he’d just returned from Wuhan, China—Riedo said to himself, “It’s begun.”…

Epidemiology is a science of possibilities and persuasion, not of certainties or hard proof. “Being approximately right most of the time is better than being precisely right occasionally,” the Scottish epidemiologist John Cowden wrote, in 2010. “You can only be sure when to act in retrospect.” Epidemiologists must persuade people to upend their lives—to forgo travel and socializing, to submit themselves to blood draws and immunization shots—even when there’s scant evidence that they’re directly at risk…

The lead spokesperson should be a scientist. Dr. Richard Besser, a former acting C.D.C. director and an E.I.S. alumnus, explained to me, “If you have a politician on the stage, there’s a very real risk that half the nation is going to do the opposite of what they say.” During the H1N1 outbreak of 2009—which caused some twelve thousand American deaths, infections in every state, and seven hundred school closings—Besser and his successor at the C.D.C., Dr. Tom Frieden, gave more than a hundred press briefings. President Barack Obama spoke publicly about the outbreak only a few times, and generally limited himself to telling people to heed scientific experts and promising not to let politics distort the government’s response. “The Bush Administration did a good job of creating the infrastructure so that we can respond,” Obama said at the start of the pandemic, and then echoed the sohco by urging families, “Wash your hands when you shake hands. Cover your mouth when you cough. I know it sounds trivial, but it makes a huge difference.” At no time did Obama recommend particular medical treatments, nor did he forecast specifics about when the pandemic would end…

Constantine told me that he understands why politicians “want to be front and center and take the credit.” And he noted that Seattle has many of “the same problems here you see in Congress, with the partisanship and toxicity.” But, he said, “everyone, Republicans and Democrats, came together behind one message and agreed to let the scientists take the lead.”…

Today, Washington State has less than two per cent of coronavirus cases in the U.S. At EvergreenHealth, hospital administrators have stopped daily crisis meetings, because the rate of incoming patients has slowed. They have empty beds and extra ventilators. The administrators remain worried, but are cautiously optimistic. “It feels like we might have stopped the tsunami before it hit,” Riedo told me. “I don’t want to tempt fate, but it seems like it’s working. Which is what makes it so much harder when I look at places like New York.”…

The initial coronavirus outbreaks in New York City emerged at roughly the same time as those in Seattle. But the cities’ experiences with the disease have markedly differed. By the second week of April, Washington State had roughly one recorded fatality per fourteen thousand residents. New York’s rate of death was nearly six times higher.

There are many explanations for this divergence. New York is denser than Seattle and relies more heavily on public transportation, which forces commuters into close contact. In Seattle, efforts at social distancing may have been aided by local attitudes—newcomers are warned of the Seattle Freeze, which one local columnist compared to the popular girl in high school who “always smiles and says hello” but “doesn’t know your name and doesn’t care to.” New Yorkers are in your face, whether you like it or not. (“Stand back at least six feet, playa,” a sign in the window of a Bronx bodega cautioned. “covid-19 is some real shit!”) New York also has more poverty and inequality than Seattle, and more international travellers. Moreover, as Mike Famulare, a senior research scientist at the Institute for Disease Modeling, put it to me, “There’s always some element of good luck and bad luck in a pandemic.”

It’s also true, however, that the cities’ leaders acted and communicated very differently in the early stages of the pandemic. Seattle’s leaders moved fast to persuade people to stay home and follow the scientists’ advice; New York’s leaders, despite having a highly esteemed public-health department, moved more slowly, offered more muddied messages, and let politicians’ voices dominate….

Today, New York City has the same social-distancing policies and business-closure rules as Seattle. But because New York’s recommendations came later than Seattle’s—and because communication was less consistent—it took longer to influence how people behaved. According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same. Tom Frieden, the former C.D.C. director, has estimated that, if New York had started implementing stay-at-home orders ten days earlier than it did, it might have reduced covid-19 deaths by fifty to eighty per cent. Another former New York City health commissioner told me that “de Blasio was just horrible,” adding, “Maybe it was unintentional, maybe it was his arrogance. But, if you tell people to stay home and then you go to the gym, you can’t really be surprised when people keep going outside.”

More than fifteen thousand people in New York are believed to have died from covid-19. Last week in Washington State, the estimate was fewer than seven hundred people. New Yorkers now hear constant ambulance sirens, which remind them of the invisible viral threat; residents are currently staying home at even higher rates than in Seattle. And de Blasio and Cuomo—even as they continue to squabble over, say, who gets to reopen schools—have become more forceful in their warnings. Rasmussen said, “It seems silly, but all these rules and sohcos and telling people again and again to wash their hands—they make a huge difference. That’s why we study it and teach it.” She continued, “It’s really easy, with the best of intentions, to say the wrong thing or send the wrong message. And then more people die.” (A)

“You relish the little things here in Seattle: Toilet paper is back on some shelves, the hoarders sated for the moment. Instead of making vodka, distilleries are rolling out hand sanitizer. The dreaded daily number of new coronavirus cases shows that while the curve is not yet flat, the rate has gone both down and up on different days this week, carrying our hopes on the bumpy ride.

As for the tally of the dead: Instead of doubling every five days in Washington State, as it was just two weeks ago, now it doubles roughly every nine — a horrific number still, but that movement is in the right direction.

We are not necessarily your city’s future, but a likely version of your future if you do the right thing. Washington State had the first known case of Covid-19 in the United States, on Jan. 19; the first reported death, more than a month after that; and the first full-blown outbreak. We’re well ahead of the rest of the nation in our cycle of denial, panic, action.

Social distancing started early. Testing has been broad, though more help from the federal government is needed. A communal fight or flight instinct has moved into something more settled. Even as the president floats an idea that could sacrifice the elderly to keep Wall Street happy, we take care of our own. We will not throw Grandma from the train.

“There really is no middle ground,” said Bill Gates, whose foundation has put up $100 million to blunt the impact of the Covid-19 pandemic. “It’s very tough to say to people, ‘Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies in the corner.’ ”

President Trump’s talk of opening the United States for business by Easter is greeted in this precinct of sanity as the heartless bluster of a career con man. The public radio station in Seattle, KUOW, has stopped airing Trump’s live briefings because the volume of misinformation he puts out cannot be corrected in real time.”  (B)

“…on Jan. 15, at the international airport south of Seattle, a 35-year-old man returned from a visit to his family in the Wuhan region. He grabbed his luggage and booked a ride-share to his home north of the city.

The next day, as he went back to his tech job east of Seattle, he felt the first signs of a cough — not a bad one, not enough to send him home. He attended a group lunch with colleagues that week at a seafood restaurant near his office. As his symptoms got worse, he went grocery shopping near his home.

Days later, after the man became the first person in the United States to test positive for the coronavirus, teams from federal, state and local agencies descended to contain the case. Sixty-eight people — the ride-share driver at the airport, the lunchmates at the seafood restaurant, the other patients at the clinic where the man was first seen — were monitored for weeks. To everyone’s relief, none ever tested positive for the virus.

But if the story ended there, the arc of the coronavirus’s sweep through the United States would look much different.

As it turned out, the genetic building block of the virus detected in the man who had been to Wuhan would become a crucial clue for scientists who were trying to understand how the pathogen gained its first, crucial foothold.

Working out of laboratories along Seattle’s Lake Union, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center rushed to identify the RNA sequence of the cases from Washington State and around the country, comparing them with data coming in from around the world.

Using advanced technology that allows them to rapidly identify the tiny mutations that the virus makes in its virulent path through human hosts, the scientists working in Washington and several other states made two disconcerting discoveries.

The first was that the virus brought in by the man from Wuhan — or perhaps, as new data has suggested, by someone else who arrived carrying a nearly identical strain — had managed to settle into the population undetected.

Then they began to realize how far it had spread. A small outbreak that had established itself somewhere north of Seattle, they realized as they added new cases to their database, was now responsible for all known cases of community transmission they examined in Washington State in the month of February.

And it had jumped.

A genetically similar version of the virus — directly linked to that first case in Washington — was identified across 14 other states, as far away as Connecticut and Maryland. It settled in other parts of the world, in Australia, Mexico, Iceland, Canada, the United Kingdom and Uruguay. It landed in the Pacific, on the Grand Princess cruise ship.

The unique signature of the virus that reached America’s shores in Seattle now accounts for a quarter of all U.S. cases made public by genomic sequencers in the United States.

With no widespread testing available, the high-tech detective work of the researchers in Seattle and their partners elsewhere would open the first clear window into how and where the virus was spreading — and how difficult it would be to contain.

Even as the path of the Washington State version of the virus was coursing eastward, new sparks from other strains were landing in New York, in the Midwest and in the South. And then they all began to intermingle….

There was minimal coronavirus testing in the United States during February, leaving researchers largely blind to the specific locations and mutations of the spread that month. The man who had traveled from Wuhan was not at the dance, nor was anyone else known to have traveled into the country with the coronavirus. But researchers learned that the virus by then was already spreading well beyond its point of origin — and all the cases of community transmission that month were part of that same genetic branch.

There was another spreading event. On the Saturday after the dance, a group of friends packed the living room of a one-bedroom apartment in Seattle, sharing homemade food and tropical-themed drinks.

Over the following days, several people began coming down with coronavirus symptoms. “Among people who attended, four out of every 10 got sick,” said Hanna Oltean, an epidemiologist with the Washington State Department of Health.

Several people passed on the virus to others. By late March, the state health department had documented at least three generations of “transmission occurring before anyone was symptomatic,” Ms. Oltean said.

By then, it was becoming clear that there were probably hundreds of cases already linked to the first point of infection that had been spreading undetected. It left a lingering question: If the virus had this much of a head start, how far had it gone?

The large outbreak on the Grand Princess, a researcher said, could probably be traced to a single person linked to the Washington State cluster….

A group of cases throughout the Midwest, first surfacing in early March, appears to have roots in Europe. A group of cases in the South, which emerged around the same time, on March 3, appears like a more direct descendant from China.

But of all the branches that researchers have found, the strain from Washington State remains the earliest and one of the most potent.

It has surfaced in Arizona, California, Connecticut, the District of Columbia, Florida, Illinois, Michigan, Minnesota, New York, North Carolina, Oregon, Utah, Virginia, Wisconsin and Wyoming, and in six countries…

One of the enduring mysteries has been just how the virus managed to gain its first, fatal foothold in Washington.

Did the contact tracers who followed the steps of the man who had traveled from Wuhan miss something? Did he expose someone at the grocery store, or touch a door handle when he went to the restaurant near his office?

In recent days, the sequencing of new cases has revealed a surprising new possibility. A series of cases in British Columbia carried a genetic footprint very similar to the case of the Wuhan traveler. That opened up the possibility that someone could have carried that same branch of the virus from Wuhan to British Columbia or somewhere else in the region at nearly the same time. Perhaps it was that person whose illness had sparked the fateful outbreak.

But who? And how? That would probably never be known.” (C)

JULY 13, 2020

For the first time in months, there was a 24-hour period in which no one in New York City died of the coronavirus.

The New York City Department of Health and Mental Hygiene reported zero deaths on Saturday, but that number could change as death data can lag and new deaths could be confirmed retroactively at any point. The city’s first confirmed coronavirus death was March 11.

Mayor Bill de Blasio called the milestone a statement about “how this city fights back and people do not ever give in.”

“It’s something that should make us hopeful, but it’s very hard to take a victory lap because we know we have so much more ahead. This disease is far from beaten,” de Blasio said during a news conference Monday. “And we look around the country and we look at what so many other Americans are going through and so many other states and cities hurting so bad right now. So no one can celebrate, but we can at least take a moment to appreciate that every one of you did so much to get us to this point.”..

On Monday, the city reported a 2% positivity rating for coronavirus testing. Fifty-six patients were admitted to the hospital, and 279 patients were in intensive care units.” (D)

JULY 16, 2020

“In what seems like almost a lifetime ago, America’s coronavirus story started in January in Washington State, with the nation’s first confirmed case followed by an early outbreak that spread with alarming ferocity.

But swift lockdown measures were credited with holding down illnesses and deaths. By June, nail salons and bars had begun to reopen, even as the virus began to rage in Texas, Arizona and Florida. Washington still had relatively low case numbers, and some counties were even contemplating a return to movie theaters and museums.

Now, those plans are on hold.

The coronavirus is once again ravaging Washington, and the number of cases has hit grim new milestones. Since the middle of June, the state has reported an average of 700 new cases per day — the highest levels since the start of the pandemic. More than 45,000 people have been infected, and over 1,400 have died.

“If these trends were to continue, we would have to prepare to go back to where we were in March,” Gov. Jay Inslee said recently.

Six months after the coronavirus first reached the United States, the state that was on the initial front line — a state that locked down early and hard — is only now beginning to see how complicated and lengthy the fight may be.

A lot of things are going wrong at once. Young people, less likely to die of the virus and undoubtedly weary of social distancing measures, have been driving a spike in new infections in the Seattle area. And an outbreak here in Yakima County that began powering its way through agriculture workers in the spring has now spread widely through a community that has not embraced self-isolation and masking to the degree that many Seattleites have.

Yakima, the eighth-most populous county, now has the second-highest number of cases. While the county cannot be blamed for hot spots elsewhere, Yakima does show how the virus can simmer along at a seeming lull — until a new outbreak suddenly surges through an entire region, challenging officials to stitch together cohesive policies for a patchwork of different problems.

“It’s really important for people to understand that their individual behaviors, everyone’s individual behaviors, collectively have a big impact on transmission,” said Dr. Kathy Lofy, Washington’s health officer. “We can increase testing, we can do case and contact investigations, we can do outbreak response, but those activities only get us so far.”

When the virus first came to Washington, the eastern part of the state was not hit as badly as Seattle, a liberal city with legions of tech workers who dutifully stayed home. But lockdown measures were not as effective in Yakima, a much less affluent county where more than 60 percent of people work in meat- or fruit-packing plants or other essential jobs.

The county is home to a large Hispanic population, which officials have said is more at risk for the coronavirus because of crowded living conditions where the virus can easily spread or limited access to health care. Many people live paycheck to paycheck, and if they were able to get up and go to work, they did.

By mid-May, people who worked in Yakima’s fruit-packing facilities had started to get sick. Terrified of working on crowded assembly lines or in warehouses that were not regularly cleaned, many went on strike, even as the virus spread outside the buildings’ walls.

The Matson Fruit Company in Selah, Wash. More than 60 percent of people in Yakima work in meat- or fruit-packing plants or other essential jobs.Credit…Jovelle Tamayo for The New York Times

Cases hit a peak in early June, according to Dr. Teresa Everson, the health officer for the Yakima Health District, just as more workers were cramming into processing facilities for the beginning of Washington’s busy cherry-picking season.

Still, only a third of those in the county wore masks, according to one survey from health officials. In the past few weeks, infectious people have gone to at least 20 family gatherings, 15 birthday parties, two baby showers and two weddings, Dr. Everson said. Some businesses were even reluctant to work with her office, which was trying to track cases and do contact tracing.

“There are a few large employers that persistently do not return our phone calls and do not want to work with us,” Dr. Everson said…

Just a few weeks ago, the state was confident that it could reopen schools in the fall, allowing many parents to go back to work and fuel the state’s economic recovery. But amid mounting opposition from educators and health experts, those plans look increasingly unlikely. And on Tuesday, Mr. Inslee said that no counties would be allowed to loosen lockdown restrictions for at least two weeks.

In Seattle, still the heart of the state’s outbreak, many people are resigned to the precautions they envision for the foreseeable future. On July 4, families wearing masks grilled tortillas, played on swings and enjoyed the parks — many feet away from anyone else. Salons took customers’ temperatures before letting them in. At Target, people lined up six feet apart at the cashier.

“Mask usage is changing very rapidly in my state,” he said. “What we’re asking people to do, they are doing.”” (E)

“New York, once the center of the coronavirus pandemic, has so successfully stemmed the outbreak that its death and hospitalization rates have plummeted and it has among the lowest infection rates in the country.

But the state and its neighbors are facing a disquieting new threat: Can they keep the virus suppressed when it is raging across the South and West?

Officials and public health experts are especially concerned that infected travelers from any of the nearly 40 states where the outbreak is spiking could set off new clusters in New York. Gov. Andrew M. Cuomo on Monday imposed more restrictions on travelers from states with high infection rates, but it is not all clear that they will be followed — or are even enforceable.

Tens of thousands of people enter New York daily through its airports, highways and train stations, and compliance largely depends on the whims of visitors and of residents returning home.

Mr. Cuomo has warned it is almost inevitable that the virus will seep back into the state, much the way it came to New York through flights from Europe in February. He has also raised concerns that some New Yorkers might let their guard down and blamed local governments for not enforcing mask-wearing and social-distancing measures.

But his focus lately has been on trying to keep the virus from re-entering New York: Travelers from 22 states where cases have increased must now quarantine for two weeks upon arrival in New York. And beginning Tuesday, travelers arriving at New York airports will be required to fill out a form with their personal information and planned whereabouts, or face a $2,000 fine.

Epidemiologists said they were skeptical that the measures would work.

“I think it’s going to be incredibly hard to keep the virus out of New York State,” said Isaac Weisfuse, a former New York City deputy health commissioner. “I think that these types of travel restrictions may be somewhat helpful, but we should assume that they’re not going to be airtight.”

But Dr. Weisfuse, an adjunct professor at Cornell University’s master of public health program, and other epidemiologists said New York was better positioned to deal with a surge in cases this time around.

They said that government officials had a better understanding of the virus and that doctors in New York had learned invaluable lessons from treating the disease. People in New York, where more than 400,000 people were infected and more than 30,000 died, are keenly aware of the risks and, for the most part, of the importance of wearing masks. The state has also dramatically ramped up its testing capacity, processing about 60,000 tests per day.

“I don’t anticipate that in New York, we’re going to have a second wave that is going to look like what we have in Texas and Florida,” said Dr. W. Ian Lipkin, director of the Center for Infection and Immunity at the Mailman School of a Public Health at Columbia University. “We can’t become complacent, and I don’t think we will. I am cautiously optimistic.”

In July, New York averaged about 10 virus-related deaths a day, a huge drop from the 799 deaths over a 24-hour period at the peak of the outbreak in April. About 790 people are hospitalized, down from nearly 19,000 people a few months ago when hospitals were nearly overrun.

But New York officials are readying for a spike, however big or small, as states like Florida continue to report record number of cases — more than 12,000 on Monday — and others, like California, impose sweeping rollbacks of their reopening plans, forcing many businesses to close again.

Officials in New York — unlike in Connecticut and New Jersey, which also implemented a quarantine requirement — have sought to proactively enforce the quarantine order. The state instituted fines of up to $10,000 and made it legal to order people to self-isolate, if necessary.

But no fines or mandatory isolation orders have been issued in New York City since the order took effect on June 25, according to a city spokeswoman. Instead, both state and city officials have urged travelers to take the order seriously and are hoping visitors will comply voluntarily, as with similar executive orders mandating masks and social distancing.

Mr. Cuomo himself has acknowledged the difficulty of enforcing the mandate and the government’s limited reach, likening enforcement to “trying to catch water in a screen.”

“New York’s problem is we have the infection coming from other states back to New York,” Mr. Cuomo, a third-term Democrat, said on Monday, noting the state is not “a hermetically sealed bubble.”

Officials estimate about 12,000 people visit New York daily from the states on the quarantine list, which is updated regularly according to certain virus health metrics. The quarantine currently applies to travelers from a broad swath of mostly the West and South where cases have skyrocketed, including California, Florida and Texas. On Tuesday, Minnesota, New Mexico, Ohio and Wisconsin were added to the list and Delaware was removed.” (F)

“Monday brings a new stage of activity to the city, allowing some places to reopen outdoors, while many activities inside, like restaurant dining, will still be forbidden.

Mayor Bill de Blasio said the city would allow some outdoor entertainment venues like zoos and botanical gardens to reopen with limited capacities but that restrictions would remain on indoor activities.

We are moving forward with Phase 4 on Monday. Now, the state of New York is finishing some work today into this afternoon on the specifics, and they’ll have a formal announcement later on. But I can give you the broad outlines now of what we’ve talked about with the state. Let’s focus first on outdoors, again, outdoors has proven to be the area where we’re seeing a lot of things work successfully. So, we’re going to restart the low-risk outdoor arts and entertainment activities. This means things like botanical gardens and zoos, for example. They can reopen but at reduced capacity, 33 percent capacity. Production of movies, TV shows — that can proceed. The, obviously, something that matters to a lot of us, sports coming back. But again — without audiences. Indoors is where we have concerns. Some indoor activities can exist with the proper restrictions. But there’s going to be care when it comes to indoors. Each and every situation is going to be looked at very carefully, very individually. So some will not resume in Phase 4, certainly not right away. That continues to be, first of all, indoor dining. That could have started earlier. We’ve said that’s not happening. That continues to not happen. That is very high risk. And we’ve seen that around the country. Museums, not yet. Malls, not yet. Still closed for now. We’ve got to strike a balance, and we’ve got time to look at the evidence, watch what’s happened around the country, watch what’s happening here in the city, and make further decisions on some of these pieces. And we’ll do that very carefully with the state of New York.

Amid concerns about a coronavirus resurgence, New York City will enter a limited fourth phase of reopening on Monday, allowing some art and entertainment venues, like zoos and botanical gardens, to open for outdoor activities at a limited capacity, officials announced on Friday.

But stringent restrictions will remain on indoor activities: Gyms, malls, movie theaters and museums will remain shuttered, and indoor dining will still not be allowed.

“We’ve got to strike a balance, and we’ve got time to look at the evidence,” Mayor Bill de Blasio said at a news conference. “Watch what’s happening around the country, watch what’s happening here in the city and make further decisions on some of these pieces, and we will do that very carefully with the State of New York.”

Officials are increasingly concerned about the possibility that visitors from other states will spread the virus in New York, once the epicenter of the pandemic. Last month, Gov. Andrew M. Cuomo put in place an executive order that requires travelers from  states with high infection rates to quarantine for 14 days upon arrival.

But Mr. Cuomo said on Friday that the order might not be enough to fend off the virus, and reiterated that he was troubled by reports of New Yorkers, especially young people, letting their guard down and eschewing social-distancing and mask-wearing measures.

The governor announced new regulations on Thursday meant to crack down on outdoor drinking and mingling outside bars and restaurants. The new rules ban establishments from selling alcohol to customers who do not also buy food.

“It is inevitable that there will be a second wave,” Mr. Cuomo, a third-term Democrat, said in a conference call with reporters on Friday. “But the second wave is going to be the confluence of the lack of compliance and the local governments’ lack of enforcement, plus the viral spread coming back from the other states. It is going to happen.”

He added, “Just because it is not there today does not mean it’s not going to happen.”

New York City is the last part of the state to enter the final phase of reopening — a feat Mr. Cuomo described as “a hallmark.” Phase 4 permits groups of up to 50 people and indoor religious gatherings to operate at one-third of maximum capacity. Restrictions will also be eased to allow the resumption of outdoor film production and professional sports without audiences.

But concerned about the virus’s spreading more rapidly in dense and crowded New York City, Mr. Cuomo said that Phase 4 of reopening in the city would not restore any additional indoor activities — even though other regions of the state further along in reopening have done so, for example, by allowing indoor dining at up to half capacity.

Museums have also been permitted to open in upstate areas, and malls have been allowed to get back to business as long as they put in place specialized air filtration systems that can filter out virus particles.

The lack of uniformity in what is being allowed in different parts of the state has raised complaints from some buiness owners and patrons. Mr. Cuomo said the state would revisit the city’s relatively curtailed Phase 4 as the “facts change.”

The limits on indoor dining were a devastating blow for the city’s thousands of restaurants, many of which were expecting to supplement revenues from outdoor dining with the expected return of indoor dining at a reduced capacity.

Many restaurants are not making enough money with just takeout and outdoor dining, and are struggling to pay their current and back rent. Restaurants in neighborhoods like Midtown Manhattan that have been emptied of office workers are struggling more than those in residential neighborhoods.

“Extending the time frame for outdoor dining is critical, but long term, it won’t sustain the industry without financial support that needs to come from the federal government,” said Andrew Rigie, the executive director of the New York City Hospitality Alliance.

The cautious approach also upended the plans of several cultural institutions in New York City, including the Metropolitan Museum of Art and the Museum of the City of New York, both of which had announced intentions to reopen in a few weeks.

Still, four city zoos and the New York Botanical Garden have already announced they will open to the public at limited capacity by the end of the month.

Those openings are sure to give New York an added semblance of normalcy, even as small businesses and restaurants have struggled to operate on slim margins since the broad shutdown in mid-March.

Offices, hair salons, barbershops and construction sites have all opened, albeit with restrictions on capacity, strict cleaning requirements and mandatory social distancing.

More than 8,600 restaurants have set up outdoor dining operations, Mr. de Blasio said. The city will close off an additional 40 blocks to allow even more dining capacity, the mayor said, and extend the use of sidewalks and streets for outdoor dining through Oct. 31.

“A lot of people thought that ‘How could this place, this crowded, energetic place, possibly do shelter in place or social distancing or face coverings?’” said Mr. de Blasio, a Democrat. “Well, you proved to the world it could be done the right way, and that’s why we are now on the verge of Phase 4.” (G)

“State health officials confirmed 742 new coronavirus cases in Washington on Wednesday and 17 additional deaths linked to COVID-19.

According to the Department of Health, at least 372 patients are currently hospitalized with COVID-19 illnesses across Washington — an increase of 19 from the day before. Dr. Kathy Lofy, the state health officer, said the daily average for hospital admissions, while still well below the peak, is about double where it was in mid-May. The state continues to closely monitor hospital activity and occupancy, coordinate transfers and reprioritize distribution of protective gear to frontline workers as needed.

More than 4,884 new illnesses have been confirmed in Washington over the last seven days, representing a statewide case rate of 561.4 per 100,000 residents, according to the Centers for Disease Control and Prevention’s case tracker. The highest rate of cases by population continues to be seen in central Washington counties, particularly in Franklin, Adams and Yakima.

While a portion of the increase can be attributed to recent boosts in testing, other concerning trends continue to play a role.

“While we are doing more testing, we know that the number of cases is not simply due to more testing, but also a rate of increase in disease transmission as well,” said John Wiesman, the state secretary of health.

In King County, the effective reproductive number, a figure used to estimate how many people are infected by someone with the illness, is at 1.7 — above the target of one.

Wiesman said the state’s guidance on preventing the spread remains the same but must be followed by all to be effective: keep physical distance from others, interact with as few people as possible, maintain a “personal bubble” of a few people and wear face coverings in public spaces.

At least 43,046 people have now tested positive for COVID-19 in Washington. Nearly 734,000 Washingtonians have been tested for the virus, with 5.9 percent of tests coming back positive.

During a weekly telebriefing with reporters Wednesday, state health leaders pointed to early success in mask use in three counties where transmission rates have been alarmingly high.

Before the governor’s statewide mandate requiring masks inside businesses went into effect this month, it was required in just three counties with a large increase in cases: Benton, Franklin and Yakima. As the rules were put in place, the state asked each county to conduct surveys to track how well residents were complying with the directive.

A few weeks ago, Benton and Franklin counties had a 58 percent compliance rate. In the last week, that figure grew to 95 percent. In Yakima County, just 35 percent of those surveyed said they wore face coverings when the survey began. The latest results showed their rate of compliance also grew to 95 percent.

The state secretary of health said preliminary findings in Yakima County have coincided with a nearly 60 percent drop in transmission rates since early June.

A recent report from the Bellevue-based Institute for Disease Modeling shows significant progress must be made to curb the spread of the coronavirus if schools are to successfully reopen in the fall.

According to researchers, efforts to reduce spread in school buildings will not sufficiently suppress transmission on its own, if the rate of infection remains where it is now.

The report finds that community-wide mitigation efforts, including limited mobility, must improve before schools open in September, or risk triggering “exponential growth” in COVID-19 activity.

“Under a scenario in which mobility in the community increases to 80% of pre-COVID levels, none of the mitigating strategies in schools we explored would be able to reduce the effective reproductive number to one or below, meaning the epidemic will grow,” the authors wrote.” (H)

“Washington could be in for another round of coronavirus restrictions, Gov. Jay Inslee said Thursday, during a news conference where he announced a limit of 10 people at social gatherings in Washington counties that are further along in the reopening process.

Inslee’s announcement came as Washington set a new record for confirmed cases of the new coronavirus, with state health officials Thursday reporting 1,267 new cases and six additional deaths. The tally clocked in at nearly twice the average number of cases per day in the past two weeks.

Throughout Friday, on this page, we’ll be posting Seattle Times journalists’ updates on the outbreak and its effects on the Seattle area, the Pacific Northwest and the world. Updates from Thursday can be found here, and all our coronavirus coverage can be found here.

Washington Gov. Jay Inslee added a new state rule this week as COVID-19 cases surge in the state: There will now be a 10-person limit on social gatherings for counties that are in the third phase of Washington’s four-part coronavirus reopening plan.” (I)

“Under the “Safe Start” plan, individual counties are able to apply to the secretary of health to move between the phases or add new business activities. Counties are currently prohibited from applying to a new phase until at least July 28.

When applications are allowed, they must be submitted by a county executive. If a county does not have a county executive, it must be submitted with the approval of the County Council/Commission.

The Secretary of Health evaluates each application based on how their data compares to certain targets. Click here for a complete breakdown.

An individual county’s ability to respond to outbreaks, increased deaths, health system capacity and other factors are also considered.

The Secretary of Health can approve the plans as submitted, approve with modifications or can deny the application.

Here’s a breakdown of what is allowed in each phase:

Phase 1

High-risk populations: Continue to stay home, stay healthy.

Outdoor: Some outdoor recreation (hunting, fishing, golf, boating, hiking).

Gatherings: Religious organizations can now hold outdoor services with up to 100 people. Proper social distancing should be practiced and attendees should wear face coverings.

Travel: Only essential travel.

Business/Employers: Essential businesses open, including existing construction that meets agreed-upon criteria, landscaping, automobile sales, retail (curb-side pick-up orders only), car washes, pet walkers.

Phase 2

High-risk populations: Continue to stay home, stay healthy.

Outdoor: All outdoor recreation involving fewer than five people outside your household (camping, beaches, etc.)

Gatherings: Gather with no more than five people outside your household per week. Indoor religious gatherings can be held at 25% capacity or with less than 50 people, whichever is less.

Travel: Limited non-essential travel within proximity of your home.

Business/Employers: Remaining manufacturing, new construction, in-home/domestic services (nannies, housecleaning, etc.), retail (In-store purchases allowed with restrictions), real estate, professional services/office-based businesses (telework remains strongly encouraged), hair and nail salons/barbers, restaurants <50% capacity, with table sizes no larger than 5.

Phase 3

High-risk populations: Continue to stay home, stay healthy.

Outdoor: Outdoor group recreational sports activities (5-50 people), recreational facilities at <50% capacity (public pools, etc.). Beginning Monday, gatherings in phase three will be capped at no more than 10 people.

Gatherings: Allow gatherings with no more than 50 people.

Travel: Resume non-essential travel.

Business/Employers: restaurants <75% capacity/table size no larger than 10, bars at <25% capacity, movie theaters at <50% capacity, government (telework remains strongly encouraged), libraries, museums, all other business activities not yet listed except for nightclubs and events with greater than 50 people.

Phase 4

High-risk populations: Resume public interactions, with physical distancing

Outdoor: Resume all recreational activity.

Gatherings: Allow gatherings >50 people.

Travel: Continue non-essential travel.

Business/Employers: Nightclubs, concert venues, large sporting events, resume unrestricted staffing of worksites, but continue to practice physical distancing and good hygiene.

The state is using certain metrics to evaluate when and how to lift various restrictions. The five metrics being used are: COVID 19 disease activity; testing capacity and availability; case and contact investigations; risk to vulnerable populations, and health care system readiness.” (J)

“Leaving the nation’s coronavirus fight to individual states has created gaping holes in the public health response that have allowed the infection rate to soar and death rates to rise once again.

While countries like New Zealand and Germany have taken a unified national approach to fighting the virus — and are enjoying the fruits of a successful mitigation strategy — the Trump administration’s federalist philosophy has helped create chaos across the South and West.

Cash-strapped cities and states trying to create their own testing, tracing and public awareness campaigns from scratch are desperate for federal support as they grapple with questions about whether it’s safe for people to return to school and work, along with bars and beaches.

“Every governor is out there on his or her own working to build the same programs that are being built next door,” said Reed Schuler, a senior advisor to Democratic Washington Gov. Jay Inslee. “The federal government’s efforts range from a little bit of backup to not even being present.”

This dangerous new chapter of the coronavirus outbreak is intensifying calls from politicians and public health experts across the country for a set of national strategies to combat the virus.

The nursing home industry has been pushing for looser regulations for years. And they got what they wanted at the start of the pandemic. But now, advocates say lax standards are fueling the virus’ spread.

Arkansas’ entire congressional delegation — all Republicans — wrote Vice President Mike Pence this week asking the federal government to address shortages of chemical reagents needed to analyze coronavirus tests.

And New York Gov. Andrew Cuomo, a Democrat, expressed his frustration with the federal government’s pandemic response on Tuesday. “The White House doesn’t get it,” he tweeted. “Until we control this virus as a nation, the economy can’t fully recover. Where is the national plan?”

Rep. Greg Stanton (D-Ariz.), who represents hard-hit Maricopa County, expressed similar frustration. “How can you have national success without having a national plan?” he said. “How do you fight the worst pandemic in 100 years without a coordinated strategy?”

A White House official rejected such criticism. “We’re in a much better position now than we were at the beginning of the pandemic in terms of [personal protective equipment], ventilators, testing capacity, and vaccine and therapeutics development,” the official said.

The situation today is not as dire as it was in March and April in some ways. There are no shortages of ventilators, and doctors have more experience treating the virus. The country’s testing capacity has grown exponentially, and the death rate is lower thanks to concerted efforts to protect seniors and other vulnerable groups.

But with cases still rising, public health experts say much more federal support and leadership are needed to bring the outbreak under control — and keep it that way.

“We shut down the country for three months and we could have used that time for all kinds of planning and preparing, and we did not use it at all,” said David Eisenman, the director of the UCLA Center for Public Health and Disasters.

Once-isolated outbreaks have grown into a national calamity concentrated in the South and Sunbelt where governors took early victory laps. Now the virus is spreading northward into the heartland and industrial Midwest, erasing the progress made in March, April and May while the country was locked down.

With the death toll rising, several governors have reimposed restrictions on businesses and public life — a move they once described as a last resort. School districts in Arizona, California and North Carolina are delaying their return to in-person learning, despite the president’s threats to cut federal funding for districts that don’t fully reopen.

In many ways, the White House has positioned itself as a consultant to states as they battle the virus. Federal officials, including Vice President Mike Pence, have warned that the government’s Strategic National Stockpile is only a stopgap — and that states themselves are primarily responsible for securing masks, gowns, gloves and chemicals for testing on the open market.

Pence, White House coronavirus coordinator Deborah Birx and others have also gone on listening tours in states where cases are climbing the fastest. Federal officials have also worked to increase the country’s testing capacity from hundreds of thousands to millions of samples per week.

But the lack of stronger federal oversight has made it hard to maintain some of those gains.

Commercial labs like Quest Diagnostics, which are handling about half of all tests, have not been able to keep up with the spike in demand. It now takes a week for people to get their results in some places, and labs say they are having trouble getting basic supplies.

Oregon Gov. Kate Brown says her state’s testing capacity has been overwhelmed by the recent surge in infections. The state is now averaging more than 270 new coronavirus cases a day — a three-fold increase compared with a month ago.

“We could certainly use an assist from our federal partners,” Brown said. But her administration has been frustrated by the lukewarm responses it has received from the Trump administration.

Her next-door neighbor, Inslee, is one of several governors to call for a national testing strategy. In recent weeks, Washington state has struggled to buy enough swabs to collect patient samples and chemical reagents to test them.

And the federal government’s failure to fully use the Defense Production Act to increase available supplies and coordinate their distribution has put states like Washington in the “horrible position” of competing against one another, Schuler said.

“We have an obligation to the residents of Washington to ensure our labs are fully supplied, but we don’t want it to come at the expense of a less successful state,” he said.

In its letter this week to Pence, the Arkansas congressional delegation said that the ongoing shortages of testing reagents have prompted the state to consider abandoning its requirement for people to be tested for Covid-19 before undergoing elective surgery.

The testing problems are also hampering the country’s scattered and overwhelmed contact tracing efforts. Nationwide, there are fewer than a third of the 100,000 contact tracers that the Association of State and Territorial Health Officials estimates are necessary to contain the outbreak.

Nearly six months into the pandemic, some states are still struggling to get their programs off the ground. Others have abandoned location-tracking apps that were supposed to help scale contact tracing to unprecedented levels.

“You need federal leadership, and that’s been lacking,” said former CDC Director Tom Frieden, who, for months has been calling for the federal government to expand testing and provide support for people asked to quarantine at home.

Eisenman said the federal government should have used the spring lockdown to appoint expert commissions to address issues such as setting up contact tracing, distributing testing supplies and returning children to school safely.

Testing and contact tracing are the cornerstones of the test-trace-isolate strategy that governments have used to thwart infectious disease outbreaks since the 19th century. But many understaffed and underfunded local health departments have not been able to adequately expand the small workforces they usually use to track outbreaks of measles and sexually transmitted infections to combat the coronavirus pandemic.

Alabama only has about 200 contact tracers to investigate the more than 1,000 coronavirus cases diagnosed there each day. Most of those workers have been reassigned from other public health duties, such as restaurant inspections and immunizations. They are currently trading off in 10-day rotations between tracking coronavirus cases and their other work — meaning both are suffering. And with schools in the state set to reopen next month, the burden will only increase.

Ricardo Franco, an assistant professor of medicine at the University of Alabama at Birmingham, says the shortage of tracers is allowing the state’s outbreak to spiral out of control.

“If you asked me what we need, I would say we should have 5,000 contact tracers,” he said. “That would be the responsible thing to do.”

Washington state, which was among the first states hit by the virus, says that only 7 percent of the gowns, gloves and face shields it has handed out came from the federal government. The state has had to compete with other states and countries to purchase the rest itself.

“It’s jaw dropping that after what we’ve been through, we didn’t have hundreds of millions of face masks and other PPE stockpiled around the country,” said Irwin Redlener, founding director for the National Center for Disaster Preparedness at Columbia University.

Even as governors who once scoffed at fears they reopened their economies too quickly begin to reimpose restrictions, the White House is still struggling to put out a consistent message about the threat posed by the virus and how best to combat it.

Trump on Monday attacked his own administration’s public health officials, retweeting messages that suggested the CDC is lying about the virus and concern about the pandemic is overblown for political reasons, prompting top officials to defend themselves on national television.

John Henderson, president and CEO of The Texas Organization of Rural & Community Hospitals, said the lack of coordinated national coronavirus messaging has been compounded in states like Texas where governors, following Trump’s lead, took a laissez faire approach until cases skyrocketed.

“There’s just been a leadership void at the federal level,” he said. “We have pushed everything down to the states and then conservative states, like Texas, have just pushed all that decision-making down to the local level. … Every day that we go with a crisis and without a plan is another day lost.” (K)

“White House Press Secretary Kayleigh McEnany on Thursday emphasized that schools reopening this fall shouldn’t be contingent on science surrounding coronavirus, but then claimed the “science is on our side here” as the pandemic continues unabated.

In response to a question about what President Donald Trump would say to parents who have kids in school districts that may be online-only, McEnany said: “The president has said unmistakably that he wants schools to open. And when he says open, he means open in full, kids been able to attend each and every day at their school.

“The science should not stand in the way of this,” she added, saying it is “perfectly safe” to fully reopen all classrooms.

McEnany then claimed “science is on our side,” citing one study that said the risk of critical illness is less than the seasonal flu in children. She also quoted former Stanford Neuroradiology Chief Dr. Scott Atlas, who has appeared on Fox News to call the debate around reopening schools “hysteria.”

“We encourage localities and states to just simply follow the science, open our schools,” she continued.

The Trump administration has been pushing to reopen schools under the premise that children under the age of 18 “are at very low risk” if they catch the virus.

Some experts have expressed concerns about returning to classrooms because of the risk students could carry the virus home to older relatives. Education professionals have also expressed worry they may be in harms way.” (L)


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