The White House on Wednesday announced a billion-dollar investment in at-home rapid coronavirus tests that it said would help quadruple their availability by later this year.
By December, 200 million rapid tests will be available to Americans each month, with tens of millions more arriving on the market in the coming weeks, Jeffrey D. Zients, the White House’s Covid-19 coordinator, said at a news conference. Mr. Zients also said the administration would double the number of sites in the federal government’s free pharmacy testing program, to 20,000.
The changes reflect the administration’s growing emphasis on at-home testing as a tool for slowing the spread of Covid-19. President Biden in September said that he would use the Defense Production Act to increase the production of rapid testing kits and would work with retailers, including Amazon and Walmart, to expand their availability. He pledged $2 billion to the effort, or roughly 280 million tests.
The Biden administration’s efforts to expand testing access also received a significant boost on Monday, when the Food and Drug Administration authorized Acon Laboratories’ at-home test. Dr. Jeffrey E. Shuren, the director of the agency’s medical devices center, said the move could double at-home testing capacity in the coming weeks.
“By year’s end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022,” he said. Like tests already available from Abbott, Quidel, Becton Dickinson and other makers, Acon’s test is made to detect proteins from the virus on a nasal swab, and produces results in 15 minutes.
Rapid tests can cost as little as $10, which public health experts say can still be prohibitively expensive for some people, and are not as sensitive as P.C.R. tests. Experts have said they are still accurate in detecting the virus in someone who is in the first week of displaying symptoms, when the viral load is likely to be highest.
Some pharmacies and retailers have recently struggled to keep tests in stock, or have had to place limits on how many customers can purchase. Demand has increased with the school year underway and employees returning to many workplaces.
Last week, Ellume, an Australian company that makes a widely available at-home coronavirus test, recalled nearly 200,000 test kits because of concerns about a higher-than-expected rate of false positives. The recall did not affect most of the 3.5 million test kits Ellume has shipped to the United States.
Los Angeles will require most people to provide proof of full coronavirus vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.
The new law, which was approved by the Los Angeles City Council on Wednesday, will allow people with medical conditions that do not allow them to be vaccinated, or who have a sincerely held religious objection, to instead show proof of a negative coronavirus test taken within the preceding 72 hours.
It will take effect on Nov. 4, which city officials have said should give the city and businesses enough time to figure out how the rule should be enforced.
Some council members have expressed concern that businesses would be unfairly burdened by the requirement, and that the city’s law is inconsistent with Los Angeles County rules that apply to neighboring communities and require masks indoors, but not proof of vaccination.
Still, city leaders said at a lengthy discussion of the measure last week that they wanted to move with urgency.
“We can’t let the perfect be the enemy of the good,” Kevin de León, a council member, said at the previous meeting.
A growing number of bars and restaurants are, on their own, already checking vaccination status. And mounting evidence suggests that employer vaccination mandates have been effective in boosting immunization rates.
In California, requirements that health care workers be vaccinated have helped increase vaccination rates at major health systems to 90 percent or higher. Major corporations have said their requirements have resulted in surging vaccination rates.
Implementing rules that require people to prove their vaccination status has been complex. A number of competing electronic “vaccine passports” are available, but some people need paper verification.
In August, New York became the first city in the nation to require proof that workers and customers at indoor sites for dining, physical fitness and entertainment had received at least one dose of a vaccine.
Not long after, some cities and counties in California, including San Francisco, followed suit. The addition of Los Angeles — by far the largest city in the state, with 4 million people — significantly alters the balance.
California’s elected leaders — especially Gov. Gavin Newsom — have highlighted pandemic restrictions across the state to draw a contrast with other states, where rules are more lax and cases among unvaccinated people have strained hospitals. California has one of the lowest case rates in the nation, and 70 percent of residents age 12 and older are fully vaccinated.
Last week, Mr. Newsom announced the nation’s first requirement that schoolchildren be vaccinated, starting as soon as next fall.
New coronavirus cases, hospitalizations and deaths are falling as the United States begins to recover from a persistent summer surge that strained hospitals across the country and killed over 100,000 Americans in just three and a half months.
As of Tuesday night, virus cases in the United States had averaged more than 101,000 a day for the past week, a 24 percent decrease from two weeks ago. Reported new deaths are down 12 percent, to 1,829 a day. Hospitalizations have decreased 20 percent and are averaging below 75,000 a day for the first time since early August, according to a New York Times database.
Public health officials, however, said the pandemic remained a potent threat. Most of the Covid deaths in that span were people who were unvaccinated, and about 68 million eligible Americans have yet to be inoculated. That leaves the country vulnerable to continued surges.
“We’re not out of danger,” Ali Mokdad, a University of Washington epidemiologist who is a former Centers for Disease Control and Prevention scientist, said in an interview this week. “This virus is too opportunistic and has taught us one lesson after another.”
He worries about people dropping their use of masks and traveling more, as they have after earlier drops in new cases — actions that could help fuel a fresh surge in December and January.
The number of new daily cases in the United States has fallen 35 percent since Sept. 1, according to a New York Times database. The drop was especially stark in Southern states that had the highest infection rates during the Delta variant surge that started in June.
Florida, which averaged more than 20,000 new cases a day during much of August, is reporting fewer than 6,000 infections a day. Louisiana, which weeks ago was averaging more than 5,000 cases daily, has about 1,000 cases each day.
“This wave is petering out,” Edwin Michael, a professor of epidemiology at the University of South Florida, in Tampa, said in an interview. “If there were waning immunity, then we should be at the beginning of another wave now.”
Only 57 percent of Floridians are fully vaccinated, and Dr. Michael said his biggest worry was the greater chance for the virus to genetically mutate while people remain unvaccinated across the country. Still, he said, “this might be the last wave, pending any new variants that arrive, and the boosters will help with that.”
While there are about 20,000 fewer Covid patients hospitalized nationwide than at the start of September, many hospitals in hard-hit parts of the country remain overstretched. That is especially true in Alaska, which leads the country by a wide margin in recent cases per person. The threat of flu season could worsen matters.
Newly reported cases in Montana and Wyoming, which had reported some of the worst outbreaks in recent weeks, appear to have stabilized. In both states, less than 50 percent of the population is inoculated against the coronavirus. Montana is at 49 percent fully vaccinated, and Wyoming 42 percent. Only West Virginia, at 40 percent, has a lower rate.
Nearly 2,000 Covid-related deaths are being reported nationally each day, and the United States surpassed 700,000 deaths on Friday. About 65 percent of the eligible U.S. population is fully vaccinated against the virus.
Shortly after the pandemic erupted last year, doctors were baffled by a surge of patients, mostly teenagers and young adults, who came in complaining of chilblains — painful lesions on their toes, and sometimes also on their fingers.
The condition came to be called Covid toes. They were seen, like the loss of smell and taste, as yet another strange telltale sign of the disease, even though most of the patients tested negative for coronavirus. Physicians were hard-pressed to explain the association.
The lesions are red or purple in white people and often purplish or brownish in people of color. They cause painful burning or itching sensations and sometimes make it difficult for people to wear shoes or walk.
Now a new study from France, published in the British Journal of Dermatology, sheds some light on the causes of Covid toes. The research indicates that the lesions may be a side effect of the immune system’s shift into overdrive in response to exposure to the virus, which can damage cells and tissues in the process.
The French researchers analyzed blood samples and skin biopsies from 50 patients who had chilblainlike lesions for the first time in April 2020, and who were referred to St.-Louis Hospital in Paris. Slightly more than half of the patients had other symptoms suggestive of Covid-19, like coughing, shortness of breath and loss of smell, but all of them tested negative for the virus on PCR tests.
The samples showed high levels of Type 1 interferon, a protein that activates the body’s immune system to fight viruses, but which may also cause damage. The researchers also found high levels of an antibody that can inadvertently attack the body’s own cells.
Abnormal changes in the linings of the blood vessels may also play a role in the lesions, the study suggests.
Although the relationship between coronavirus infection and chilblainlike lesions “is still controversial,” the authors wrote, the “peaks of chilblainlike lesions concomitant with peaks of Covid-19 deaths in 2020 strongly suggest that this disorder is closely related to SARS-CoV-2 infection.”
The explanation for Covid toes is not entirely surprising; one of the hallmark features of the disease is an immune system overreaction called a cytokine storm, which may ultimately cause more illness than the virus itself.
German scientists published a paper last year saying they had found a strong localized interferon-driven response in three young men who came in with chilblains. That paper suggested that the men, who tested negative for the coronavirus, may have developed chilblains several weeks after an initial infection caused mild or asymptomatic disease, and that the interferon-driven immune response may have led to early control of the virus and prevented respiratory disease.
Dermatologists say that people with Covid toes generally do well and are unlikely to develop severe Covid, and that the symptoms reflect a healthy immune response to the virus.
The new study suggested treating Covid toes with local or systemic anti-inflammatory agents may be effective.
Canada will make vaccination mandatory as of next Tuesday for air and rail passengers, and as of Oct. 29 for federal government workers, including members of the military and the Royal Canadian Mounted Police, Prime Minister Justin Trudeau announced on Wednesday.
“We have covered a lot of ground against Covid-19,” Mr. Trudeau said at a news conference in the capital, Ottawa. “But our fight is not over.”
Public servants who are still unvaccinated and have no verified medical exemption will be put on unpaid leave as of Nov. 15, he said. The federal government estimates that more than 80 percent of its 300,450 civilian workers — more than 240,000 people — are already fully vaccinated. The military has about 95,000 regular and reserve members, and the Royal Canadian Mounted Police has about 19,00 officers.
“It’s very simple,” Mr. Trudeau said of the possibility that large numbers of government workers might miss the Nov. 15 deadline. “If you want to continue to work for the public service of Canada you need to be fully vaccinated.”
The requirement does not apply to employees of Canada’s provincial and local governments.
Canada is one of the most heavily vaccinated countries in the world — among people aged 12 or older, almost 81 percent are fully vaccinated, and almost 87 percent are at least partially vaccinated. From age 12, all can receive the Pfizer-BioNTech and Moderna vaccines, and those age 18 and over are also eligible for the AstraZeneca and Johnson & Johnson vaccines.
Still, the country is undergoing a fourth wave of the virus, with hotspots in several western areas: Alberta, where all coronavirus restrictions were lifted in June; Saskatchewan; and the very sparsely populated Northwest Territories.
Mr. Trudeau, a Liberal, first announced the plan to mandate vaccination in August, offering little detail. Most polls show overwhelming support among Canadians for mandatory vaccination.
But the prime minister’s snap election call shortly afterward — in what proved to be the vain hope that high approval ratings for his pandemic performance would give him the majority of votes in the House of Commons he was denied in 2019 — prevented implementation of the mandate. During that election campaign, Erin O’Toole, the Conservative leader, opposed mandatory vaccination even for his party’s candidates.
Mr. Trudeau confirmed during the news conference on Wednesday that the vaccine mandate for travel would apply to members of Parliament. The vaccination rules for the House of Commons must be set by Parliament, not the government, but Mr. Trudeau has mandated that his Liberal members be vaccinated.
Some unions have challenged mandatory vaccination regulations introduced by other levels of government. Earlier court decisions on other pandemic measures, however, suggest that it will be difficult to overturn such rules.
Tracking community transmission is at the heart of efforts to stop the spread of the coronavirus, scientists say, and in most states the daily dashboards showing new cases have been a critical tool for public health officials trying to track the trajectory of the virus, which has killed 700,000 Americans.
Yet for three crucial months this summer, Nebraska did not report any county-level information to the public. State officials stopped sharing counts of new coronavirus cases by county with the public on June 30, just as the Delta variant began surging in the United States.
That was by design. Gov. Pete Ricketts, a Republican who opposes both mask and vaccine mandates, allowed his emergency order to expire in June, and the state’s unusually strict privacy laws were reinstated, which he said prohibited the continued release of the data.
At the time, the number of new cases in Nebraska had reached a low in the state, and Test Nebraska, which gave free virus tests to hundreds of thousands of residents, ended its operations shortly after the emergency ended.
The virus continued to spread in the state, however, driven by the highly contagious Delta variant. Hospitalizations increased tenfold from the end of June through mid-September. New cases rose sharply in August. Deaths increased as well.
On Sept. 20, after coronavirus hospitalizations surpassed 10 percent of the state’s capacity of staffed hospital beds, Mr. Ricketts announced that county-level case data would once again be made public on a new “hospital capacity” state dashboard.
But he said the data will disappear again if the number drops below 10 percent on a 7-day rolling average. And the state is still not reporting county-level deaths.
Public health experts in Nebraska were dismayed all summer about the decision to delete the dashboard, and state legislators wrote a letter requesting that it be restored.
A handful of the state’s 93 counties continued to provide daily data on their websites throughout the pandemic because they have more than 20,000 residents.
That meant that the only real-time data on the virus across the state that doctors like Dr. David Brett-Major, an infectious disease specialist, had during July and August was watching sick people stream into the emergency department of the University of Nebraska Medical Center in Omaha.
“If the tests are only happening when the cases are more severe, then you’re not getting a broad look,” he said in a recent interview.
Susan Bockrath, the executive director of the Nebraska Association of Local Health Directors, said her group brought up the missing dashboard repeatedly with state officials, pointing out it was also a necessary tool in the campaign against pandemic misinformation.
The dashboard was removed just as Stephanie Summers, board of education president in David City, was trying to determine the best policy for students and families in her rural community one hour west of Omaha. Mr. Ricketts has told Nebraskans to get vaccinated, but declined to require masks, despite pleas from some public health officials.
“The state cannot insist on an individual’s freedom to choose to wear, or not wear, a mask, or whether or not to get vaccinated, and then also withhold the data needed for citizens to make informed decisions,” she said, adding that she fully agreed with state leaders in emphasizing those individual freedoms.
While the dashboard has mostly been restored, some doctors doubt the current testing system is capturing the reality on the ground. Two dozen doctors sent a letter in early September to Mr. Ricketts asking for the return of Test Nebraska.
“Our access to testing is so bad right now, and the turnaround so bad, that these numbers are probably vast underestimates, and not accurate just because there is not enough testing,” said Dr. Bob Rauner, chief medical officer of OneHealth Nebraska, a group of 65 locally owned medical clinics across the state.
The governor and his aides have defended their decision to stop the flow of data on privacy grounds, saying publishing county-level data could violate the state’s version of HIPAA, which prevents the release of patients’ personal health information without their consent.
Experts say privacy becomes a concern in releasing data from counties with only a handful of cases, and for that reason, states generally suppress information in jurisdictions with fewer than five cases or deaths.
Covid-19 vaccinations helped prevent tens of thousands of hospitalizations and deaths among older people in the United States in the first five months of this year, according to a new federal study of Medicare recipients.
The study, published by the Department of Health and Human Services on Tuesday, indicated that Covid-19 vaccinations were associated with 39,000 fewer deaths and 107,000 fewer hospitalizations among Medicare recipients nationwide from January through May.
Reductions in deaths were observed in all 48 states included in the study sample, and among members of all racial and ethnic groups, although the greatest reductions appeared to be among American Indians and Alaska Natives, groups that were hit particularly hard by the pandemic.
In counties with average to above-average vaccination rates, the study found that deaths and hospitalizations fell more sharply than in areas where uptake of vaccines was lower.
The study used county vaccination statistics and a sample of 25.3 million Medicare beneficiaries to estimate the impact of Covid vaccines on the entire population of Medicare recipients, about 62.7 million people. The authors found that a 10 percent increase in a county’s vaccination rate was correlated with an 11 to 12 percent decrease in Covid-19 hospitalizations and a similar decrease in infections among Medicare recipients.
New Zealand hopes to vaccinate as many as 350,000 people in a single day next week, the country’s largest Covid inoculation effort to date, as it pushes closer to reopening its economy.
Vaccination clinics will be open all day on Saturday, Oct. 16, said Chris Hipkins, the minister leading New Zealand’s Covid-19 response. The facilities will be able to vaccinate 350,000 people — about 8.3 percent of the eligible population of people 12 and older, he said.
“Like on Election Day, we’ll be asking all of our civic and political leaders to contribute to our efforts to turn people out,” Mr. Hipkins said.
New Zealand has had one of the most successful responses to the pandemic, recording just 28 deaths from the virus. And though it was late to begin its vaccination campaign, the country is now on pace to fully vaccinate about 90 percent of its eligible population by the end of November.
New Zealand is the latest country to focus its intense vaccination efforts into a single day. In August, Tunisia vaccinated more than 500,000 people in one day, and this month India said it had given 25 million shots on a single day to mark Prime Minister Narendra Modi’s birthday.
As of Wednesday, 50 percent of New Zealand’s eligible population had received two doses of the Pfizer-BioNTech shot, the only vaccine the country is using, while 80 percent had received a single dose.
New Zealand is also cutting the time between receiving a first and second dose, to three weeks, from six — a shift that means “more people can be fully vaccinated sooner, increasing our community immunity,” a health ministry official said in a statement.
The country is currently administering about 17,000 first doses and about 46,000 second doses a day, according to the most recent data. Its rate of first vaccination doses has been dwindling, down more than three-fourths from an August high of about 67,000 doses a day.
New Zealand has not set a vaccine target or a date at which to ease restrictions, although Prime Minister Jacinda Ardern said on Tuesday that the country would introduce a national vaccine certificate that would be required for entry into “high-risk settings” like summer music festivals.
A Colorado health system told a prospective kidney transplant recipient that she would not receive an organ donation if she remained unvaccinated against the coronavirus, a state lawmaker said this week.
Representative Tim Geitner, a Republican, said in a Facebook Live post on Tuesday that a local resident had received a letter from the service, UCHealth, stating that her status on the transplant waiting list had been changed to inactive.
“Unfortunately and sadly, UCHealth has said that unless and until this individual is willing to take a Covid vaccine, that they will not be able to perform this lifesaving surgery,” Mr. Geitner said.
Posting on Twitter, Mr. Geitner shared a letter from UCHealth to the patient that cited “noncompliance.” The letter, dated Sept. 28, advised the patient that she had 30 days to “begin the vaccination series” and that she would be removed from the list if she did not.
UCHealth did not immediately respond to a request for comment on Wednesday. But the health system told 9 News, a local television station, on Tuesday that organ transplant recipients and living donors were required to be vaccinated against Covid-19 “in almost all situations.”
Mr. Geitner said that the patient had about 12 percent of her kidney function left and that she had found a donor.
UCHealth told the TV station that studies had shown that transplant recipients who later tested positive for Covid-19 had a significantly higher mortality rate, of 18 to 32 percent, compared with 1.6 percent among those in the general population who tested positive.
The health system said its policy stemmed from that mortality rate and from concern that living donors could pass on the virus.
A hospital spokesman told The Denver Post that transplant patients were generally required to meet similar requirements before and after surgery, even before the pandemic. “Patients may be required to receive vaccinations including hepatitis B, MMR and others,” the spokesman told the paper in an email. “Patients may also be required to avoid alcohol, stop smoking, or prove they will be able to continue taking their anti-rejection medications long after their transplant surgery.”
The patient, Leilani Lutali, told the TV station that she had learned of the hospital’s policy as her donor was undergoing required testing. She said that she worried about how the vaccines might affect her health in the future, and that she and her donor had declined them for religious reasons.
“I’m being coerced into making a decision that is one I’m not comfortable making right now in order to live,” Ms. Lutali said.
Across New York City, many tenants who lost their jobs after the city went into lockdown are facing millions of dollars in unpaid rent. They’ve been kept in their homes by government aid programs and a state eviction moratorium that expires in January.
But the pandemic has also mobilized some tenants to take on landlords who have done little to improve their living conditions and pushed them into a new kind of activism.
At 1616 President St. in the Crown Heights section of Brooklyn, Patricia Edwards is one of a dozen residents — about half of the building’s tenants — who are withholding rent until the landlord forgives the debt owed by residents affected by the pandemic and makes repairs to a building that they say has long been neglected.
It has been years since Ms. Edwards’s top-floor apartment has felt like an acceptable home. When it rains, water leaks into the kitchen and living room. It also pours through a crack in the bathroom ceiling so big that Ms. Edwards needs an umbrella just to use the toilet.
But when the pandemic hit last year, leaving many of her neighbors struggling financially, Ms. Edwards, a retired bank employee, decided to do something she had never done: She refused to pay.