9 states' virus deaths hit 1-in-1,000 mark

U.S. cases top 13 million, straining hospitals

Melrose Mac Service coordinator Josh Smart (left) helps out Eric Hall make a contact-free purchase through a plastic-glass wall Friday at the store in Burbank, Calif. Los Angeles County, the nation’s most populous, has announced a new stay-home order taking effect Monday that advises residents to stay home “as much as possible” and to wear a face covering when they go out.
(AP/Damian Dovarganes)
Melrose Mac Service coordinator Josh Smart (left) helps out Eric Hall make a contact-free purchase through a plastic-glass wall Friday at the store in Burbank, Calif. Los Angeles County, the nation’s most populous, has announced a new stay-home order taking effect Monday that advises residents to stay home “as much as possible” and to wear a face covering when they go out. (AP/Damian Dovarganes)

In nine states, more than 1 in 1,000 people have now died of coronavirus-related causes, while daily covid-19 deaths nationwide are climbing to levels not seen since early in the pandemic.

The list reflects the far-reaching toll of the crisis, spanning early hot spots such as New York, Southern states hit hard in the summer and rural parts of America with increasingly strained hospitals. And it is growing.

On Friday, South Dakota became the latest to hit this grim marker, with others on the cusp as the country surpassed 13 million known coronavirus cases during a holiday season upended by the pandemic. Even with travel significantly down from last year, millions of people went through airport checkpoints in the days leading up to Thanksgiving, and governors Friday urged people not to let their guards down during Black Friday shopping.

Thanksgiving's contributions to the coronavirus's spread may not be apparent until next week, when reporting becomes more regular again and when people who may have gotten infected at family gatherings get test results. Officials' calls to minimize travel and large get-togethers were made as the nation is routinely breaking records for new coronavirus cases and hospitalizations, leaving state and local leaders with tough decisions about how to respond.

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A cold-weather surge in cases and the strain on hospitals have prompted a new round of painful business closures and stay-at-home orders, with even some long-reluctant Republican governors embracing statewide mask orders and stricter social-distancing measures. But leaders' actions vary widely.

In South Dakota, Gov. Kristi Noem, a Republican, remains resistant to a statewide mask mandate and has given her blessing to mass gatherings. Hospitalizations in the state exploded in September after remaining close to or below 100, peaking earlier this month at more than 600.

The crush of patients now straining the health care system in South Dakota is emblematic of the pandemic's worsening onslaught around the country as winter approaches, sending more people indoors, where the virus is more likely to spread. The country logged more than 2,200 new deaths Wednesday, the highest daily increase since May 6.

The United States's record-setting daily case numbers are an undercount of the virus's actual reach: A new study from researchers at the Centers for Disease Control and Prevention estimates that just 1 in 8 infections nationwide were reported through the end of September. While roughly 7.2 million infections were reported in that time frame, the CDC estimates that the true number may have been closer to 52.9 million.

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Health officials asked people who gathered with others for Thanksgiving to get tested. Leana Wen, an emergency physician and health-policy professor at George Washington University, said on CNN that they should spend time outdoors if they're still around relatives and then self-quarantine when they return home.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, predicted that Christmas and New Year's celebrations will be as subdued as Thanksgiving.

"If the surge takes a turn of continuing to go up and you have the sustained greater than 100,000 infections a day and 1,300 deaths per day and the count keeps going up and up ... . I don't see it being any different during the Christmas and New Year's holidays than during Thanksgiving," he told USA Today in an article published Friday.

ASTRAZENECA QUESTIONS

Hope may be in sight: Officials say vaccine distribution could begin as soon as December, pending regulatory approval.

But in that optimism, questions are swirling about the vaccine developed by pharmaceutical company AstraZeneca with the University of Oxford, one of three early contenders for approval from the Food and Drug Administration. Critics suggested the company was less than transparent and wondered whether its results would survive scrutiny.

AstraZeneca chief executive Pascal Soriot said his company was likely to run a new trial to test the most positive portion of its data, which reported 90% effectiveness when a small group of people mistakenly received only half the initial dose of a two-dose regimen.

Katherine O'Brien, director of immunization, vaccines and biologicals for the World Health Organization, said that while AstraZeneca's data shows promise, there are many ways the findings could still be undercut and that experts need access to the underlying data to draw conclusions about the trial's results.

"It's too early for us to say anything about what we make of the data and what is needed next," O'Brien said Friday at a news briefing. "What we really need to see is more than a news release."

Until a vaccine is widely available, government officials across the United States are scrambling to impose new restrictions to curtail the spread while avoiding wholesale shutdowns like those in the spring. In the past week, Nevada, New York and the District of Columbia area, among other regions, have seen tightened rules on public gatherings.

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Some jurisdictions implemented especially stringent rules for Thanksgiving weekend, including San Antonio and Bexar County, Texas, where residents are not allowed to gather outside their homes between 10 p.m. and 5 a.m. unless they are traveling to or from a business. In Pennsylvania, Gov. Tom Wolf, a Democrat, shut down liquor sales in bars and restaurants Wednesday night, putting the kibosh on a popular annual nightlife event.

Republican Florida Gov. Ron DeSantis, in contrast, on Tuesday extended an executive order that bans city and county governments from enforcing mask ordinances or limits on restaurant capacity.

But most governors have been striking a cautious tone, urging residents to wear masks and maintain social distance from others, despite pandemic fatigue.

"Please support Ohio businesses on #BlackFriday!" tweeted Ohio Gov. Mike DeWine, a Republican. "Online, delivery, or contactless pickup are your safest shopping options, but if you do shop in person, remember that social distancing/mask-wearing are essential! These measures will help prevent #COVID19 spread while you shop."

CAMPUS DILEMMAS

St. Michael's College in Vermont managed to keep coronavirus cases at bay for almost two months this fall, with students tested upon arrival and once every three weeks.

But in mid-October, cases at the small liberal arts school started to climb. The outbreak was linked to an ice rink more than 40 miles away. The college shifted to all-remote learning and closed the campus to visitors. By November, 76 of the roughly 1,400 students on campus had tested positive, the school said.

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"It was very concerning to experience the spike in cases that we did after so many weeks of surveillance tests with no positives," President Lorraine Sterritt said.

When students return for the spring semester, St. Michael's will begin testing them weekly. The college also may require students to move to a separate residence hall when they are told to quarantine.

The coronavirus presented huge challenges for the fall semester for U.S. colleges that opened the academic year with in-person learning, including some that took a battering from outbreaks. Those not joining the growing number that will offer only virtual learning are assessing how they would bring students back after the winter holidays while the country faces crushing rates of infections.

Schools that are bringing students back are adjusting testing protocols, introducing new screenings, and eliminating spring breaks to discourage students from traveling to help keep campuses open.

Other schools big and small think it's still possible to keep a pandemic-era residential college experience.

California Polytechnic State University in San Luis Obispo plans to add saliva testing that will be processed on campus and will allow it "to test many more people much more quickly -- our current estimate is 4,000 tests per day by mid-January," President Jeffrey Armstrong said in a campuswide message.

Colby College in Maine wants to add some rapid antigen tests to twice-weekly tests for students, faculty and staff members. It also did away with the one-week spring break, replacing it with two mini-breaks in March and April.

"We'll program stuff for the campus so people get a break," Chief Financial Officer Douglas Terp said.

More schools are expected to require students to get tested before they arrive on campus rather than when they arrive, said Barbara Mistick, president of the National Association of Independent Colleges and Universities.

Institutions like Syracuse University in New York abandoned in-person learning earlier than planned this fall but are planning on a resumption of campus life next semester.

But a growing number of schools will stick with virtual instruction through the spring.

"We are seeing a rapid rise in colleges and universities announcing they will move to remote learning for the remainder of this semester and for the spring," said Lynn Pasquerella, president of the Association of American Colleges and Universities.

VACCINE PRIORITIES

Large hospital systems are grappling with how best to decide which health care workers will be vaccinated first, a daunting task when it's unclear which shots they'll get, how many and when they'll arrive.

The first covid-19 vaccine could be cleared for U.S. use as soon as next month, with Pfizer Inc. and BioNTech SE's candidate already under review and Moderna Inc.'s shot not far behind. Federal officials have signaled that health care workers and older Americans at high risk should be vaccinated as step one in what could set off months of fraught decisions involving other key priority groups.

But following those initial guidelines could prove difficult. With 21 million health workers in the U.S., there almost certainly won't be enough doses to reach them all at once. That's forcing hospitals to categorize their workers based on best-guess distribution estimates, a task made even more complex for some systems by a patchwork state-by-state approach.

Minnesota's Allina Health system, which employs 15,600 workers who have direct contact with patients in Minnesota and Wisconsin, is estimating it could get 3,000 to 4,000 doses initially. The plan: Prioritize those who interact directly with coronavirus patients by listing each worker by their job type and the units they work in.

"We're looking at all employees, where they work, what their roles are and what their exposure risk is," said Ryan Else, a doctor who is overseeing the coronavirus response in Allina Health's hospitals.

Health systems that operate across state lines face an even bigger challenge. While states are taking cues from federal guidelines, they are developing their own priority lists, creating a situation in which some employees in one state might get vaccinated before their peers in another.

"How fair does that feel to people in the same system?" said Amy Compton-Phillips, a doctor and chief clinical officer at Providence, which operates 51 hospitals, as well as clinics and medical offices across seven states.

Like Allina, Providence plans to vaccinate workers based on their roles in an attempt at fairness. The health system will notify workers when it's their turn to get vaccinated. It is also creating an appeal process if people think groups were misclassified. "When things are in short supply, you make really hard decisions. They don't feel good," Compton-Phillips said.

Federal officials initially plan to send 6.4 million doses across the country, said Gus Perna, Operation Warp Speed's chief operating officer. More doses will then be sent out weekly, with the goal of distributing 40 million doses by the end of the year, Perna said.

Shipments will be divvied up across states based on the size of their adult populations, and not in response to any virus surges, U.S. Department of Health and Human Services Secretary Alex Azar said.

​​​​​Information for this article was contributed by Marisa Iati, Hannah Knowles, Jacqueline Dupree, Lena H. Sun, Brittany Shammas and Miriam Berger of The Washington Post; by Lisa Rathke and Michael Casey of The Associated Press; and by Angelica LaVito of Bloomberg News.

Emily Travanty (left) and Sarah Totten of the Colorado Department of Public Health and Environment conduct coronavirus tests Friday in east Denver. More photos at arkansasonline.com/1128covid/.
(AP/David Zalubowski)
Emily Travanty (left) and Sarah Totten of the Colorado Department of Public Health and Environment conduct coronavirus tests Friday in east Denver. More photos at arkansasonline.com/1128covid/. (AP/David Zalubowski)

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