NEW YORK -- The U.S. surpassed 1 million confirmed coronavirus cases in just the first 10 days of November, with more than 100,000 infections each day becoming the norm in a surge that shows no signs of slowing.
Governors across the nation are making increasingly desperate pleas with the public to take the fight against the virus more seriously.
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In a prime-time speech hours after Wisconsin set new records for infections and deaths, Democratic Gov. Tony Evers announced that he was advising people to stay in their houses and businesses to allow people to work remotely, as well as requiring masks and limiting the number of people in stores and offices.
Minnesota's governor ordered bars and restaurants to close at 10 p.m., and Iowa's governor said she will require masks at indoor gatherings of 25 or more people, inching toward more stringent measures.
The wave of cases across the U.S. is more widespread than the surges that happened in the spring, mainly in the Northeast, and then in the summer, primarily in the Sun Belt. But experts say there are also reasons to think the nation is better able to deal with the virus this time around.
"We're definitely in a better place" when it comes to improved medical tools and knowledge, said William Hanage, a Harvard University infectious-disease researcher.
Newly confirmed infections in the U.S. are running at record highs of more than 100,000 per day, pushing the running total to more than 10 million and eclipsing 1 million since Halloween.
Several states posted records Tuesday, with more than 12,000 new cases in Illinois, 7,000 in Wisconsin and 6,500 in Ohio.
Deaths are climbing again, reaching an average of more than 930 a day.
Hospitals are getting slammed. And unlike the earlier outbreaks, this one is not confined to a region or two. Cases are on the rise in 49 states.
"The virus is spreading in a largely uncontrolled fashion across the vast majority of the country," said Dr. William Schaffner, an infectious-disease expert at Vanderbilt University.
While deaths are still well below the U.S. peak of about 2,200 per day in April, some researchers estimate the nation's overall toll will hit about 400,000 by Feb. 1, up from about 240,000 now.
But there is also some good news.
Doctors now better know how to treat severe cases, meaning higher percentages of the covid-19 patients who go into intensive care units are coming out alive. Patients have the benefit of new treatments, namely remdesivir, the steroid dexamethasone and an antibody drug that won emergency-use approval from the Food and Drug Administration on Monday.
The FDA cleared the experimental drug from Eli Lilly for people 12 and older with mild or moderate covid-19 not requiring hospitalization. It's a one-time treatment given through an IV.
The therapy is still undergoing additional testing to establish its safety and effectiveness. It is similar to a treatment President Donald Trump received after contracting the virus last month.
Early results suggest the drug, called bamlanivimab, may help clear the coronavirus sooner and possibly cut hospitalizations in mild to moderate cases.
In addition, a vaccine appears to be on the horizon, perhaps around the end of the year, with Pfizer this week reporting early results showing that its experimental shots are a surprising 90% effective at preventing the disease.
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DISPUTE IN BRAZIL
Meanwhile, Brazil's health-regulation agency has halted clinical trials of the potential coronavirus vaccine CoronaVac, citing an "adverse, serious event."
Critics of President Jair Bolsonaro said they feared the decision -- posted Monday night on Anvisa's website -- was motivated not by science but by the leader's political hostility to the country and state involved in producing the vaccine candidate.
The potential vaccine is being developed by Chinese biopharmaceutical firm Sinovac and in Brazil would be mostly produced by Sao Paulo's state-run Butantan Institute. About 10,000 volunteers are taking part in the phase-three tests in one of the nations hardest hit by covid-19.
Sao Paulo state health authorities said in a news conference Tuesday that Anvisa sent a single email saying the tests should be halted. They also said the incident with one of the trial volunteers was unrelated to the trials.
"Such news coming the way it did causes our surprise, insecurity and, in our case, indignation," said Dimas Covas, the head of the Butantan Institute.
He said it was "impossible" that the volunteer's incident had any relation to the tests.
Anvisa did not describe the Oct. 29 event that prompted the halt. But its president, Antonio Barra Torres, a close ally of Bolsonaro, denied Tuesday that politics was involved, calling it a "purely technical decision."
"This no joke," Torres said. "Clear, precise and complete documents need to be sent to us, which did not happen."
He said trials will resume only after an independent international review of the case.
Covas said on TV Cultura late Monday that a volunteer had died, but on Tuesday he said he had just been giving a hypothetical example and could not confirm details about the case for ethical reasons.
Sinovac issued a short statement Tuesday in China saying it was in touch with Brazilian authorities and insisting, "The clinical study in Brazil is strictly carried out in accordance with GCP requirements and we are confident in the safety of the vaccine," referring to Good Clinical Practice, a set of international standards for ethics and data quality in clinical research.
Separately, a senior U.S. government official said Tuesday that the World Health Organization has not shared enough information about its planned mission to China to investigate the animal origins of the coronavirus.
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Garrett Grisby of the U.S. Department of Health and Human Services said that the criteria for the WHO's China mission had not been shared with other nations. He spoke during a weeklong meeting of the health agency's member countries.
"The [terms of reference] were not negotiated in a transparent way with all WHO member states," he said via videoconference, referring to the mission's criteria. "Understanding the origins of covid-19 through a transparent and inclusive investigation is what must be done."
In recent months, a long-planned WHO-led team seeking to investigate the coronavirus's animal origins in China has stalled. Although pandemic travel restrictions and the focus on stemming the number of new coronavirus cases have complicated matters, some scientists worry that China has still not provided key details about what research is ongoing.
The U.S. objections came as an independent panel commissioned by the WHO to evaluate its management of the global covid-19 response said it's considering whether the U.N. health agency has enough power and financing to stop future pandemics.
Former New Zealand Prime Minister Helen Clark, who co-chairs the panel, said the group was especially interested in establishing an accurate chronology of the first coronavirus alerts and what responses were taken.
"The Independent Panel will do its best to shed light on what has happened, is still happening and why," Clark said Tuesday. "We are asking whether WHO has the right mandate, the right powers, the right capacities and the right financing to deliver on pandemic preparedness and response."
U.S. RESURGENCE
In the U.S., experts are increasingly alarmed about the virus's resurgence in places such as Massachusetts, which has seen a dramatic rise in cases since Labor Day, blamed largely on young people socializing.
Republican Gov. Charlie Baker is warning that the health care system could become overwhelmed this winter, and he recently ordered restaurants to stop table service, required many businesses to close by 9:30 p.m., and instructed residents to stay home between 10 p.m. and 5 a.m.
Meanwhile, political leaders in a number of newer coronavirus hot spots are doing less. In hard-hit South Dakota, Gov. Kristi Noem has made it clear she will not institute a mask requirement and has voiced doubt in health experts who say face coverings prevent infections from spreading.
Even higher case and death rates have been seen in North Dakota, where many people have refused to wear masks. Gov. Doug Burgum has pleaded with people to do so, and he praised towns and cities that have mandated masks. But he has avoided requiring masks himself.
In Tennessee, counties that have not required wearing masks in public are on average seeing covid-19 death rates double or more compared with those that instituted mandates, according to a report released Tuesday.
The Vanderbilt University School of Medicine study focused on three groups of counties: 11 early adopters with mask mandates as of July 10; 17 late adopters with mandates implemented after July 10; and 67 that never adopted a requirement.
Researchers found the early- and late-adopting groups saw death rates that had been increasing start to drop within a few weeks of implementing requirements, while the group with no requirements continued to see death-rate increases.
The early adopters on average had a rate of about a death a week per 100,000 people as of the first week in October; late adopters' death rate was about two; and the counties without mask mandates had a rate of four, according to the report.
The analysis comes as new case counts rise in Tennessee, where Republican Gov. Bill Lee has opposed a statewide mask mandate, stressing personal responsibility. He has instead allowed counties to decide whether to require masks.
The study follows related research by Vanderbilt late last month, which found sharper increases of covid-19 patients in Tennessee hospitals in recent weeks in areas without mask mandates.
"There's no doubt there's a correlation between mask-wearing and lower hospitalizations," Lee told reporters Tuesday.
Separately, a university report released Monday said that more Texas jail and prison inmates and staff members have been infected and killed by covid-19 than those of any other state's criminal justice system.
At least 231 inmates and staff members have died of covid-19 in Texas prisons and jails, according to the report by the Lyndon B. Johnson School of Public Affairs at the University of Texas.
The study also found that Texas inmates and staff members tested positive for the virus that causes covid-19 at a 490% higher rate than the state's general population. Also, nine Texas inmates approved for parole died in prison before their release.
Federal prison facilities and Immigration and Customs Enforcement facilities were excluded from the analysis, the university said in a statement.
"Covid-19 has had a devastating impact on prisons and jails across the country, and especially in Texas," said Michele Deitch, the study's lead author and a criminal justice policy expert at the school. He added that the data shows "the urgency of taking steps to reduce the risks of additional covid deaths in Texas prisons and jails."
However, the Texas Department of Criminal Justice, which operates the prison system, contends the report does not tell the whole story.
"While this report attempts to capture the impact of the virus on the prison population, what is noticeably absent is a discussion of the [Texas Department of Criminal Justice's] first in the nation, sustained, and aggressive mass asymptomatic testing campaign," said department spokesman Jeremy Desel. "To date, more than 65,000 employee and 219,000 inmate tests have been carried out. This is far more than any other correctional system in the country."
Information for this article was contributed by Matthew Perrone, Marilynn Marchione, Mauricio Savarese, David Biller, Huizhong Wu, Jamey Keaten, Maria Cheng, Terry Wallace, Jonathan Mattise and Kimberlee Kruesi of The Associated Press.
