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Two top U.S. health agencies have announced tangible steps in trying to confront health issues that are byproducts of the coronavirus pandemic — plummeting childhood vaccination rates and concern about the approaching flu season.
The Department of Health and Human Services is giving permission to pharmacists nationwide to administer all scheduled shots to children as young as three — including boosters for measles and other diseases — a step that makes immunization more convenient for parents. The flu vaccine is also an available option for children.
Protecting against the impending flu season in the United States is foremost in the minds of public health officials, who worry about the confluence of cases of flu and Covid-19 hitting hospitals this fall and winter.
And the Centers for Disease Control and Prevention said on Thursday that a high-dose flu shot aimed at better protecting people 65 and older will guard against four strains of the virus this year, rather than three.
On Wednesday, Massachusetts announced that it will require all students, ranging from six-month-olds in day care centers to those under 30, to get flu shots by Dec. 31. It is the first state to institute such a sweeping requirement for the shot, which is rarely mandated in the U.S.
This year, because restrictions imposed by the pandemic have shuttered workplaces and school health clinics where millions get their shots, officials have loosened their timing recommendations, which usually point to a window from the middle of September till the end of October. Many public health experts recommend to get the shot as soon as you reasonably can.
The new emergency rule allowing state-licensed pharmacists to give federally scheduled vaccines to children ages 3 through 18 is supposed to encourage widespread immunization as schools open during the pandemic and to resolve a patchwork of state laws that govern shots and age limits.
The state of Florida reached a grim threshold on Thursday as its death toll from the coronavirus exceeded 10,000 people, according to a New York Times database.
Florida is the fifth state to report 10,000 or more deaths. The others are New York, New Jersey, California and Texas.
It was a widely expected inflection point. Florida, as of Thursday morning, had identified more than 588,000 cases, and while the number of new cases per day has declined since mid-July, the state is still identifying more than 4,700 new cases per day, on average, in the last seven-day period ending Wednesday.
Public and private-sector efforts to navigate the continuing crisis have been closely scrutinized in the United States’s third most-populous state, where a quarter of the state’s population of more than 21 million is older than 60.
Gov. Ron DeSantis, a Republican, was criticized for waiting until April 1 to issue a statewide stay-at-home order, after many states had done so. Disney World opened to visitors in July, but the Republican National Convention in Jacksonville was canceled. And last week, more than a dozen counties reopened their schools in accordance with a statewide order for all schools to offer in-person instruction by the end of the month.
The state’s most populous county, Miami-Dade, has suffered the largest number of cases, with 1 in 18 people testing positive.
Mr. DeSantis has stressed that the state’s virus crisis is largely limited to the very old. But the disease appears to be taking a relatively small but increasing toll on the young: More Floridians in the 25-44 age group died in July than had died in the previous four months of the pandemic combined, a review of Florida Department of Health data shows. Records also show the people who died from the virus in Florida among the young were disproportionately Black.
Nationwide, the pandemic has killed so many Americans that the patterns of death in nearly every state look aberrant when compared to recent history. Nationwide, 223,900 more people have died than usual from March 15 to Aug. 8, according to Centers for Disease Control and Prevention estimates.
The Food and Drug Administration has granted emergency use authorization to a coronavirus test made by a British company that gives results in about 12 minutes.
It is an antigen test, the third one of that type that the F.D.A. has authorized.
Antigen tests work by rapidly detecting fragments of virus in a sample. They are speedy, but they tend to miss more infections than do slower tests based on a technology called polymerase chain reaction, or P.C.R.
In its authorization letter to LumiraDx, the British company, the F.D.A. noted that negative results from the antigen test do not rule out an infection, and that a positive test should not be used as the sole basis for treatment.
The new test, which must be administered by a health care professional, is performed using a brick-sized device made by LumiraDx, and depends on swab samples collected from a patient’s nasal cavity. It is intended to be used for patients who have developed Covid-19 symptoms within the past 12 days; the authorization does not address using it to screening people without symptoms.
“Actionable diagnostic results at the point of care lead to better health outcomes,” said Ron Zwanziger, chief executive of LumiraDx, in a statement. The company said it would start shipping the tests by the end of August, and produce 10 million tests by December.
A spokeswoman said that LumiraDx was also seeking F.D.A. emergency use authorization for an antibody test that could be performed using the same machine. Antibody tests indicate whether someone has been exposed to the virus in the past, not whether they are currently infected.
School nurses were already in short supply in the United States, with less than 40 percent of schools employing one full-time before the pandemic. Now those overburdened health care specialists are finding themselves on the front lines of a risky, high-stakes experiment in protecting public health as districts reopen their doors amid spiking caseloads in many parts of the country.
The American Association of Pediatrics recommends that every school have a nurse on site. But before the outbreak, according to the National Association of School Nurses, a quarter of American schools did not have one at all. And there has been no national effort to provide districts with new resources for hiring them, although some states have tapped federal relief funds.
Washington State is one of the places where nurses are a rarity in school hallways, with only 7 percent of schools employing one full-time, and nearly 30 percent of districts having one available for six hours or less per week. As the lone nurse for her school district in central Washington State, Janna Benzel will monitor 1,800 students for virus symptoms when classrooms open later this month, on top of her normal responsibilities like managing allergies, distributing medications and writing hundreds of immunization plans.
“I’ll have to go to these schools and assess every sniffle and sneeze that could potentially be a positive case,” she said. “I just don’t know if I can do it alone.”
In some places, administrators have been scrambling to get more nurses into schools before the academic year. New York City, the nation’s largest district and one of the few big cities in the country still planning to physically reopen its schools on the first day back, went on a hiring spree after the city’s powerful teachers’ union said their members should not return to classrooms without a nurse in each of the city’s roughly 1,300 school buildings.
Mayor Bill de Blasio said last week that the city had finally secured enough nurses to fulfill that demand, less than a month before the scheduled start of in-person instruction.
Nursing home residents make up just 1.2 percent of the U.S. population, but they account for about 40 percent of Covid-19 deaths.
But when the virus crept into Heartland Health Care Center in Moline, Ill., on the last day of July, the nursing home was not defenseless. Heartland was the first facility to participate in a large clinical trial of a drug that might protect residents from the infection in nursing homes and assisted living facilities.
Drug companies and the federal government often avoid testing drugs in older people, even if they are the ones who need treatment most. The elderly may have a range of complicating conditions that make it difficult to tell if the drug is working, and nursing home and extended care facilities are governed by a raft of complex regulations regarding privacy and access.
Experts say the new research, sponsored by Eli Lilly and the National Institutes of Health, is among the first large clinical trials to involve nursing home residents. And the scientists are delighted.
“These patients are so underserved,” said Dr. Rebecca Boxer, medical director of clinical trials at the Kaiser Permanente Institute for Health Research in Colorado. “They do not get access to innovative new drugs and trials.”
The experimental drug is a monoclonal antibody, an artificially synthesized version of coronavirus antibodies produced by the body. In this case, the antibody was “cloned” from those found in the blood of a Seattle man, one of the first patients to survive Covid-19.
Monoclonal antibodies are one of the great hopes in the war on the virus. They already serve as the basis for effective treatments for arthritis, cancer, lupus — even Ebola. They are difficult to manufacture, however, and expensive.
Still, two companies, Regeneron and Eli Lilly, have forged ahead with clinical trials. The trial in nursing homes is pivotal to Eli Lilly’s effort to determine whether its version can stop the coronavirus.
About 1.1 million American workers filed state jobless claims last week, the Labor Department said on Thursday, an increase after two weeks of declines and a reminder that the labor market remains fragile five months into the pandemic.
“We won’t see a renewal of hiring until the pandemic is under much better control,” said Carl Tannenbaum, chief economist at Northern Trust in Chicago. “We have made substantial and rapid improvement in the last three months, but improvement from here will prove slower and more difficult.”
There were 543,000 new claims last week for Pandemic Unemployment Assistance, a separate program aimed at self-employed people, gig workers and others not covered by traditional unemployment benefits.
The crosscurrents in the economy are striking. The unemployment rate remains dangerously high at 10.2 percent, and sectors like leisure and hospitality are experiencing huge losses in employment. Hotels and airports are nearly empty and many restaurants remain closed. But home building is booming and retail sales are back to levels that preceded the pandemic. The stock market is hitting record highs.
Economists, however, warn that conditions could easily deteriorate if Washington doesn’t offer more support.
Republicans and Democrats have been unable to agree on a new coronavirus relief package to augment the CARES Act, passed in March. A $600 weekly federal supplement to state unemployment insurance expired at the end of last month, and a $300-a-week replacement engineered by President Trump is having trouble getting off the ground, with only 11 states so far participating.
“Federal support is crucial to underpinning the virtuous cycle we’ve had,” said Michael Gapen, chief U.S. economist at Barclays. “The longer negotiations stall, the more likely there will be a hiccup in spending.”
Elsewhere in the United States:
Philadelphia’s health commissioner, Dr. Thomas Farley, announced on Thursday that indoor dining will return on Sept. 8, albeit at restricted capacity. Restaurants will only be permitted to function at 25 percent their normal volume, and only four people or fewer can sit at a table. Movie theaters will also be allowed to reopen then, and indoor gatherings of up to 25 people will be permitted. Additionally, the commissioner said on Tuesday that the state was immediately opening up bowling alleys, arcades and game areas such as mini-golf, escape rooms and ax-throwing.
A survey of nearly 2,200 members of the largest federal employees’ union found that more than 70 percent of those who have returned to on-site work felt their agencies were not keeping them safe. The report, which was prepared by the union and released Wednesday, comes as many federal agencies have begun directing employees who had been working remotely at the beginning of the pandemic to return to offices. Only 56 percent of those surveyed said their employers had provided adequate personal protective equipment.
Dr. Anthony S. Fauci, the government’s top infectious disease expert, underwent outpatient surgery on Thursday morning to remove a polyp from his vocal cord, and is now resting at home. In a brief text exchange, Dr. Fauci said he underwent general anesthesia and is “doing fine.” Dr. Fauci’s voice had been showing notable strain in recent months — in part, he has surmised, because he was doing so much talking — but he had been putting off treatment because of his busy schedule.
North Dakota reported on Thursday 274 new cases, and Nevada reported 37 new deaths, a single-day record in each state.
While the moving industry is fractured among numerous small-business owners, and official statistics are tough to come by, one thing is clear: From professionals who are downsizing following a job loss, to students moving back in with their parents, to families fleeing the city for the suburbs, New Yorkers are changing their addresses in droves.
The U.S. Virgin Islands is halting visits by tourists for a month, shutting nonessential businesses and restoring stay-at-home orders, while struggling with some of the highest per capita case numbers in the United States.
The territory, which includes the Caribbean islands of St. Croix, St. John and St. Thomas, registered 165 cases over the last seven days as of Thursday, bringing the total number of cases to 869.
Those figures position the U.S. Virgin Islands behind only Texas in the ranking of states and territories where per capita cases are climbing fastest. The territory, whose economy relies heavily on tourism, had reopened for leisure visitors on June 1.
Gov. Albert Bryan Jr. announced last week that as of Wednesday, hotels and Airbnb operators are prohibited from accepting new guests for 30 days. Mr. Bryan also ordered bars, nightclubs and cabarets to shut down until Aug. 31.
The territory, which has 103,000 residents, was already trying to bounce back after being hit in 2017 by two Category 5 storms, Irma and Maria. Tourism, which accounts for a third of the U.S. Virgin Islands economy, is the territory’s largest source of employment.
Iran’s health ministry announced Wednesday that it had reached 20,000 deaths from the virus, but health experts inside and outside Iran — and even members of the Iranian Parliament — suggest that the number may be many times higher.
To understand what’s going on, Farnaz Fassihi, who covers Iran for The Times, answered some pressing questions and painted a picture of an outbreak still out of control.
What’s the situation in the country?
It’s very bad. It’s in the thick of a second surge worse than the first one in March. The majority of provinces, including the capital, Tehran, are “red zones.” Doctors are saying hospitals and I.C.U. beds are full. At the same time, there are some restrictions for public gatherings but, generally, it’s open for business.
Even by the government’s own numbers, cases are on the rise. What happened?
They opened too soon. When the virus first arrived in the country, they closed down for just two weeks during the New Year holiday in mid-March. They didn’t meet any of the benchmarks when they reopened. There’s no contact tracing. There’s no quarantine.
What are Iranians feeling?
In the early months, people were very scared. They were self-isolating and staying home and not sending their kids to school, even when the schools were still open. But I think as time has passed, like a lot of places, we see that people are becoming more reckless.
There’s also a nuanced dynamic here. This is a government that for 40 years has told people what to do, how to dress, how to behave — and many people’s mind-set is to always defy what the government says. So now, when there’s a pandemic, and the government tells them, “Stay home, wear a mask,” they’re like: “No. We don’t trust you. And you don’t tell us what to do.”
And so for Iran, I think the challenge to contain a pandemic may be greater than it is for other countries because the government is dealing with 70 million people whose default mode is to defy it.
New York State will allow most voters to cast their ballots by mail in the November general election, joining a growing list of states that have expanded mail-in voting to address the potential spread of the virus at polling places.
Gov. Andrew M. Cuomo signed a bill on Thursday allowing voters to request an absentee ballot if they cannot show up at a polling location because of the risk of contracting or spreading an illness, effectively permitting the state’s more than 12 million registered voters to vote by mail.
But with only 10 weeks until Election Day, the challenges of administering an election predominantly by mail will be especially pronounced in New York, following the state’s uneven handling of its primary just two months ago.
To ease the blow of an influx of mail-in ballots, officials are encouraging voters to cast their ballots in person at early polling sites, which open statewide on Oct. 24.
Absentee ballots will not be mailed automatically to voters in New York, as will be the case in at least nine other states. Instead, voters in New York will have to request a mail-in ballot online, over the phone, in person or by mail. Voters could immediately apply for a mail-in ballot. The deadline to apply by mail is Oct. 27, although officials are urging voters not to wait until the last minute. Ballots need to be postmarked by Election Day.
Throughout the pandemic, coronavirus-related slogans have been everywhere.
In Britain: “Stay alert. Control the virus. Save lives.”
The French issued a similar plea: “Save lives. Stay prudent.”
In the Netherlands, the government has urged people to act “together against Corona” and talked about an “intelligent lockdown.”
They’re not just catchy phrases in a time of crisis. They make a difference, and they should be readily understandable for people of all reading levels.
A study by the JAMA Network that looked at the language used in April about the pandemic on websites of international agencies as well as the governments of 15 countries found that in most cases, the language exceeded the recommended eighth-grade reading level, using complex syntax and technical terms.
All of the websites in the study — including those of the Centers for Disease Control and Prevention, the World Health Organization, and governments around the world — shared at least some information that exceeded the recommended reading level, according to the study.
Not adhering to readability standards could have a bigger influence on communities with lower health literacy, the study found, “potentially exacerbating the disparate effects of the pandemic.”
As a result, the study concluded that governments and institutions should “focus on the urgent development of plain-language Covid-19 resources that conform to established guidelines for clear communication and are more accessible to all audiences.”
Of those websites the JAMA Network examined, the information from the Netherlands used the most accessible language overall, while Italy used the most complex.
North Korea said on Thursday that the triple punches of the pandemic, international sanctions and flood damage had significantly delayed plans to improve the country’s economy.
During a meeting in Pyongyang, the capital, the Central Committee of the Workers’ Party attributed the delay to “severe internal and external situations and unexpected manifold challenges,” and noted that people’s living standards had “not been improved remarkably.”
The assessment was an unusual admission by the isolated country that its economic plans had faltered.
In 2016, when Mr. Kim adopted his economic plan, the North’s economy grew 3.9 percent, the highest since a devastating famine hit the country in the late 1990s, according to estimates by South Korea’s central bank, the Bank of Korea.
But as the United Nations tightened sanctions, the North’s economy shrank 4.1 percent in 2018, with its exports to China plummeting 86 percent.
North Korea’s economy recovered slightly last year, growing 0.4 percent, as Pyongyang invented ways of easing the pain of the sanctions, such as smuggling banned cargo across the Chinese border or between ships on the high seas.
But this year, the coronavirus forced the country to shut down the border with China, which had accounted for more than 90 percent of the North’s external trade. North Korea’s exports to China fell to $27 million in the first half of this year, a 75 percent drop from a year earlier, according to the Korea Institute for National Unification in Seoul. Imports from China dropped 67 percent, to $380 million.
In other developments around the world:
A large virus outbreak in South Korea linked to a church is spreading through Seoul and beyond, threatening the country’s success in fighting the pandemic. The Sarang Jeil Church attracts politically active conservatives who oppose the country’s liberal president, Moon Jae-in. Mr. Moon has accused his most vocal critics of spreading the infectious disease and putting the entire nation in danger; conservative activists, in turn, have accused him of trying to scapegoat the church to divert attention from his weak approval ratings.
Health officials in China issued new guidelines on Thursday that exempt residents of Beijing, the capital, from wearing masks outdoors unless they come into close contact with strangers. The country has reported fewer than 300 infections over the past week, according to a New York Times database.
India’s coronavirus crisis is now spreading to the hinterlands along its southern coastline. The country recorded at least 69,000 new cases on Wednesday, its largest daily caseload of the pandemic, and nearly a thousand deaths, according to a New York Times database and the ministry of health. The South Indian states of Andhra Pradesh, Karnataka and Tamil Nadu now account for nearly a third of new cases in the country.
In a tweet, Hua Chunying, a spokeswoman for China’s Foreign Ministry, weighed in on images of a recent pool party in Wuhan — the city where the pandemic began — that have touched a nerve in countries where many people remain under lockdown. “The city only emerges stronger,” she wrote. Global Times, a popular state-run tabloid, also said that international criticism of the party amounted to “foreign sour grapes.”
Reporting was contributed by Sarah Almukhtar, Peter Baker, Choe Sang-Hun, Kimiko de Freytas-Tamura, Julia Echikson, Nicholas Fandos, Richard Fausset, Luis Ferré-Sadurní, Robert Gebeloff, Astead W. Herndon, Jan Hoffman, Sheila Kaplan, Josh Katz, Gina Kolata, Hari Kumar, Danielle Ivory, Lisa Lerer, Dan Levin, Denise Lu, Tiffany May, Patricia Mizzei, Zachary Montague, Claire Moses, Elisabetta Povoledo, Frances Robles, Simon Romero, Margot Sanger-Katz, Julie Satow, Nelson D. Schwartz, Karan Deep Singh, Sheryl Gay Stolberg, Jonathan Wolfe and Lauren Wolfe.
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