Earlier this month, the likelihood that the COVID-19 pandemic would actually end became a little more certain. On November 9, the pharmaceutical giant Pfizer and the German biotech company BioNTech announced that their coronavirus vaccine was more than 90 percent effective in stage three clinical trials. A week later, the pharmaceutical company Moderna also reported their COVID-19 vaccine was 95 percent effective. Both vaccines utilize a novel technology that harnesses the RNA messenger, snippets of genetic code that exist in the body that can be used to tell the immune system to produce antibodies that attack the virus itself. With those breakthroughs, a coronavirus vaccine on the market before 2021 seems more likely than ever.

So far, the disease has killed more than 1.4 million people, including 258,000 in the United States. The urgency to defeat the disease has drug companies creating a vaccine at the record pace of a matter of months—a typical time frame for vaccine development can be 10 years. On Monday, AstraZeneca and Oxford University also announced their vaccine was between 62 and 90 percent effective—depending on the manner with which the dose is given.

If these efforts resemble a race of hares, then the pace of vaccine development at Baylor College of Medicine’s National School of Tropical Medicine might be seen as the tortoise. “Officially, you could say we started working on this in January,” says Dr. Peter Hotez, the school’s dean and co-director of the Center for Vaccine Development. “You could also say we started working on this in January 2011. We couldn’t have moved so fast without doing that prior research.” The vaccine’s long development has not involved the cutting edge—and untested—technological advancements such as the mRNA method associated with other leading COVID-19 vaccines. The result is inexpensive and easily mass-produced; it also does not require elaborate sub-zero storage facilities that some of the others do. The number of doses required won’t be certain until further into drug trials.

Propelled with billions of dollars, including $4.5 billion from the US government, the Moderna and Pfizer candidates are now in stage three of clinical trials; after nearly a decade and $11 million in research, Baylor is entering stage one. According to the trade publication Fierce Pharma, Moderna received nearly $1 billion to research and develop its vaccine from the federal government through the vaccine development effort Operation Warp Speed, along with a $1.5 billion order for 100 million doses. Meanwhile, Pfizer—which wasn’t a partner in Operation Warp Speed—took $2 billion and agreed to produce 100 million doses. Effectively, these deals are part of the federal government’s efforts to immunize the population of the US, which it has said it will do free of charge. Still, questions linger about how to even distribute the Pfizer and Moderna RNA vaccines, which require storage at negative 80 and 20 degrees Celsius, respectively—a requirement others don’t face.

The higher budget projects have lucrative deals with the world’s wealthiest governments, like the United Kingdom, Canada, and Japan, to supply their populations with hundreds of millions of doses by the end of next year. But according to Dr. Jesse Goodman, a medicine and infectious diseases professor at Georgetown University who led the FDA’s response to the H1N1 virus in 2009, “that doesn’t come close to meeting the world’s needs.” In reality, a large combination of effective, inexpensive vaccines will be necessary to cover the nearly eight billion people on the planet. 

This is where the Baylor College vaccine is different from the others. It utilizes recombinant protein technology, which is typical in vaccine development but uncommon among the leading COVID-19 candidates. Technically, this means that a recombinant protein vaccine inserts an antigen—a small amount of a foreign toxin or bits of the pathogen itself—to spark an immune response. Some recombinant protein vaccines are common, like the Hepatitis B vaccine. “Advantages of recombinant protein technologies are that there are many approved vaccines using these kind of technologies,” Goodman explains. “There is large scale manufacturing capability in the world that could be brought to bear for it.” There are other vaccines in the works that also use the same recombinant protein technology, most notably from China’s Clover Biopharmaceuticals and Sanofi, which is based in France. 

Baylor College has teamed up with Biological E, a large pharmaceutical manufacturer based in Hyperabad, India, which “didn’t have to build a new factory because they already had the infrastructure,” says Dr. Maria Elena Bottazzi, NSTM’s vice dean. “They didn’t have to hire new people that you needed to train because they already had the people. All those little things add up.” It also means that the cost of the vaccine will likely be less than $1 per dose, considerably less than the almost $35 per dose Moderna vaccine. “I mean, you measure it in rupees,” says Hotez. “It’s really inexpensive.” That puts distribution deals within reach for developing countries with large populations and significant numbers of poor people. Currently, Biological E plans to produce 1.2 billion vaccine doses using NSTM’s blueprint. And depending on how Operation Warp Speed shakes out, some of those doses could end up in the US.

There are about 200 COVID-19 vaccines in development right now and experts hope that the strengths of some of them could compensate for the potential weaknesses of others. The NSTM candidate is designed to be a standalone vaccine, but it could also be used to boost the effectiveness of others, including those slated for distribution in the US. “If it is shown that one of these other Operation Warp Speed vaccines aren’t performing as we’d like, in terms of durability of protection or waning antibodies, in theory you could do a boost with [recombinant] protein [vaccines],” says Hotez.

For those who might be especially high risk—people with preexisting conditions, for instance, or seniors—recombinant protein vaccines might prove to be more effective than others, which would make the NSTM vaccine the drug of choice in certain cases, rather than a booster for an earlier vaccination. “In some ways the recombinant proteins in early studies seem to make antibody responses that may be better than some of the RNA vaccines,” says Goodman. “It’s possible in certain populations, for example, one vaccine may be better.” There are other, inexpensive vaccines. The Oxford University and AstraZeneca vaccine that uses another established vaccine technology, where a coronavirus protein is inserted into a less dangerous cold virus, may be available with 3 billion doses next year, at an accessible $4 for each injection.

During the pandemic, the search for a successful COVID-19 vaccine has become the drug industry’s version of the space race, but back in 2011, drug companies paid little attention to the broad disease category of coronaviruses, which includes the viruses behind Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), which is why NSTM began its research. The school’s specialty has been vaccine development for neglected tropical diseases. Within that category are the diseases that affect the world’s poorest populations, ailments with hard-to-pronounce names, like leishmaniasis, a sandfly-spread illness that causes skin sores to appear across the body, or schistosomiasis, “second only to malaria as the most devastating parasitic disease,” according to the CDC. Because the return on investment for large pharmaceutical companies determines the pace and participants in vaccine development, those diseases are often overlooked despite affecting millions of people per year. That’s where Hotez, Bottazzi, and their colleagues at the school come in. “We make the vaccines no one else will make,” he says. 

In 2003, a strain of coronavirus called SARS first surfaced in China. Soon, it spread to 25 other countries, infecting 8,098 people, killing 774 of them. The disease alarmed world health experts, but was successfully contained. During the following decade, SARS didn’t reappear. “The interest of the funders—even the scientific interest—was not as prominent because there was no SARS crisis,” Bottazzi says. So researchers at NTSM adopted the orphan disease and added a vaccine to their areas of inquiry. Those ten years proved essential to the school’s vaccine work this year. The genetic makeup of the SARS virus has approximately an 80 percent overlap with the most recent iteration of SARS, COVID-19. “We knew what sequence to pick, how to engineer it, how to produce it, how to scale it, and how to evaluate its quality,” Botazzi notes.

At this point, the NSTM vaccine is entering stage one clinical trials in India, where the stages of drug testing closely mirror those in the United States. If all goes according to plan, the candidate should enter phase three by February, with a similar number of vaccine subjects to the Moderna and Pfizer trials, about 40,000 people. Hypothetically, Hotez and Bottazzi say doses could see mass distribution in India and other parts of the global South by mid-to-late next year, which may lag behind the first wave of vaccines by about three months.

From there, the drug could see international distribution. Biological E is working in conjunction with COVAX, an international partnership of more than 150 countries collaborating specifically to distribute a COVID-19 vaccine to countries with low- and mid-income economies. The body acts as a sort of counterbalance to the lucrative supply deals struck between major drug companies and wealthier nations, like the US, which isn’t a COVAX member. “History has shown that in past pandemics—including recent ones like H1N1—allocation of vaccines has too often been monopolized by high-income countries,” Dr. Seth Berkley, a former CDC epidemiologist and the CEO of Gavi, a member of COVAX that advocates for equitable vaccine distribution, wrote in an email. “As swine flu swept across the globe, the vaccines that were developed ended up mostly in wealthy countries, while the rest of the world went without them. It is clear that we cannot allow this to happen again.”

Typically, success at the lab is defined as “going from discovery, through process development, manufacture, investigational new drug filings, then getting it to early- or mid- stage clinical development,” Hotez says. From there, the hope has been that a drug company would notice that the research work has already been done for them, creating enough of a financial incentive to take up the drug and bring it to market. But in this case, as in many others, the coronavirus has created new demands and new rules. Today, interest in NSTM’s work comes much more easily. “This COVID-19 vaccine may be the first vaccine [of ours] ever to actually reach full licensure,” he says.

Donald Trump Jr. is the latest member of the president’s inner circle to test positive for COVID-19.

The president’s son is asymptomatic and has been in quarantine since early this week, a spokesperson told Bloomberg.

His positive test result adds him to a long list of infected people with ties to the White House—many linked to a superspreader event associated with the nomination of Amy Coney Barrett to the Supreme Court.

Rudy Giuliani’s son, Andrew, a special assistant to the president, also announced his positive diagnosis today. Despite the continued spread of the virus among Trump’s friends and family, his administration continues flouting social distancing guidelines.

Trump Jr. is expected to be a guest speaker at Turning Point USA’s planned superspreader event next month. If his father’s behavior is any indication, catching the ’rona won’t make him change plans.

In an effort to mitigate the sting of defeat, Fox News contributor Geraldo Rivera has suggested that a forthcoming vaccine be named after Donald Trump. Such a gesture, he said on Friday, could work to cheer up our septuagenarian baby president as he continues to rely on dangerous conspiracy theories to reject political reality.

“I had an idea: With the world so divided, and everyone telling him he’s got to give up and ‘Time to leave’ and ‘Time to transition,’ why not name the vaccine after Trump?” Rivera told the hosts of Fox & Friends. “It would be a nice gesture to him.”

The fantasy went even further. Rivera imagined a future—one that presumably survived the president’s disastrous handling of the pandemic—featuring Americans saying to one another: “‘Have you got your Trump yet?’ ‘I got my Trump, I’m fine.'”

“I wished we could honor him in that way.”

The utter sincerity with which Rivera broached this idea should not be lost here; he genuinely appears to believe that Trump is not only deserving of such scientific recognition but that it could work as some kind of consolation prize for losing the presidential election. Meanwhile, more than 250,000 people in the United States have been killed by the virus—and the country’s third surge has only just begun.

**turns on Fox & Friends**

"Why not name the vaccine the Trump, make it — have you gotten your Trump yet? It would be a nice gesture to him." pic.twitter.com/K64Mw8J6Vk

— Matthew Gertz (@MattGertz) November 20, 2020

The United States is confronting its worst surge in coronavirus cases since the start of the pandemic. Governors are rushing new lockdowns into place as hospitals nationwide burst at the seams. The death toll is, yet again, setting daily records. Maybe by the time you listen to this episode of the Mother Jones Podcast, below, the US will have passed another dire milestone (of so many): a quarter of a million coronavirus deaths.

Inside our newsroom, reporters and editors are determined to put science—and the voices of scientists—at the heart of our ongoing coronavirus coverage. That’s why, early in the outbreak, we launched a series called “Pandemic Proofing America”, an evolving oral history collection featuring incisive interviews with the nation’s top scientists and public health experts. The central question we posed was this: With a scandalously enfeebled government hampering the country’s response, what are the most important steps we can take to make sure we’re better prepared next time around? Their responses were wide-ranging, often damning in their criticism of the current administration’s failures, and sometimes hopeful that we might find common purpose in listening to science.

For this episode of the podcast, the brains behind this series, Mother Jones‘s Atlanta-based Senior Editor Kiera Butler, has assembled a selection of these big thinkers to weigh in on how to survive America’s coming dark winter, and how the country can begin to imagine a pandemic-free future by combating disinformation and collaborating across disciplines, and beyond our borders. You’ll hear from top experts like Timothy Caulfield, from the University of Alberta’s School of Public Health; Laurel Bristow, from Emory University’s Vaccine Center; Ashish Jha, at Harvard’s Global Health Institute; and Andy Slavitt, President Obama’s top healthcare advisor.

For the entire showcase of nearly 20 interviews, click here. And listen to this week’s episode of the Mother Jones Podcast, starring Kiera Butler, below:

On Monday morning, shortly after the biotech company Moderna announced promising news about the efficacy of its COVID vaccine, Ivanka Trump went on Twitter to blow some minds:

Fact Check: This Moderna /NIH vaccine is literally the one that President @realDonaldTrump partnered with Moderna to create on January 13, 2020… I repeat January 13th, 2020.

Just be happy. This is great news for America and for the world! 🇺🇸 https://t.co/Oq9UTwOfet

— Ivanka Trump (@IvankaTrump) November 16, 2020

Let’s pick up the pieces of our brains and recall what was literally happening back in January. Early in the month, intelligence and health officials were becoming increasingly alarmed by a novel coronavirus spreading in China. Yet at the time, as officials later told the Washington Post, “Trump’s advisers struggled to get him to take the virus seriously.” Trump received his first in-depth briefing on the virus from Secretary of Health and Human Services Alex Azar on January 18. (During the call, the president reportedly was more interested in discussing when a ban on flavored vaping products would end.) The first COVID-19 case in the United States was reported on January 20. Asked about the coronavirus publicly for the first time two days later, Trump declared, “We have it totally under control. It’s one person coming in from China.”

While there is now ample evidence that Trump knowingly downplayed the seriousness of the coming pandemic from the start, Ivanka would have us believe that behind the scenes, her father was taking it super seriously and being astoundingly proactive. So proactive, in fact, that he joined up with a much-hyped yet unproven biotechnology company to kickstart a COVID vaccine one week before the virus had hit American soil and four months before he would announce Project Warp Speed. Trump’s children have ascribed many unlikely qualities to him, but clairvoyance is a new one.

So what exactly was Ivanka talking about? It turns out that Moderna did get started on its COVID vaccine on January 13, two days after China released the virus’ genetic sequence. A document filed with the Securities and Exchange Commission explains that on that date, the company’s researchers “finalized the sequence for the SARS-CoV-2 vaccine” and it “mobilized toward clinical manufacture.” That step was taken in collaboration with the Vaccine Research Center, which is under the National Institutes for Health (NIH). Even if Trump wasn’t personally involved, can’t he take credit for his administration’s role in this moment?

It’s not that simple. Moderna’s partnership with the feds to develop messenger RNA technology, which its coronavirus vaccine is based on, began long before the novel coronavirus flared up. The Pentagon funded the company’s mRNA research in 2013, and the federal government gave it $125 million to develop a mRNA-based Zika vaccine in 2016. Its COVID-related work on January 13 appears to have been completed under an already existing research agreement with the NIH, according to a review by the consumer advocacy group Public Citizen.

In short, Trump didn’t swoop in to launch the Moderna-NIH COVID vaccine partnership. Rather, his administration piggybacked on an ongoing collaboration whose initial agreements were signed in—checking the fine print—November 2015. Maybe Ivanka should have added, “Thanks, Obama.”

This story was published originally by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica‘s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

The promise of antigen tests emerged like a miracle this summer. With repeated use, the theory went, these rapid and cheap coronavirus tests would identify highly infectious people while giving healthy Americans a green light to return to offices, schools and restaurants. The idea of on-the-spot tests with near-instant results was an appealing alternative to the slow, lab-based testing that couldn’t meet public demand.

By September, the US Department of Health and Human Services had purchased more than 150 million tests for nursing homes and schools, spending more than $760 million. But it soon became clear that antigen testing—named for the viral proteins, or antigens, that the test detects—posed a new set of problems. Unlike lab-based, molecular PCR tests, which detect snippets of the virus’s genetic material, antigen tests are less sensitive because they can only detect samples with a higher viral load. The tests were prone to more false negatives and false positives. As problems emerged, officials were slow to acknowledge the evidence.

With the benefit of hindsight, experts said the Trump administration should have released antigen tests primarily to communities with outbreaks instead of expecting them to work just as well in large groups of asymptomatic people. Understanding they can produce false results, the government could have ensured that clinics had enough for repeat testing to reduce false negatives and access to more precise PCR tests to weed out false positives. Government agencies, which were aware of the tests’ limitations, could have built up trust by being more transparent about them and how to interpret results, scientists said.

When health care workers in Nevada and Vermont reported false positives, HHS defended the tests and threatened Nevada with unspecified sanctions until state officials agreed to continue using them in nursing homes. It took several more weeks for the US Food and Drug Administration to issue an alert on Nov. 3 that confirmed what Nevada had experienced: Antigen tests were prone to giving false positives, the FDA warned.

“Part of the problem is this administration has continuously played catch-up,” said Dr. Abraar Karan, a physician at Harvard Medical School. It was criticized for not ensuring enough PCR tests at the beginning, and when antigen tests became available, it shoved them at the states without a coordinated plan, he said.

If you tested the same group of people once a week without fail, with adequate double-checking, then a positive test could be the canary in the coal mine, said Dr. Mark Levine, commissioner of Vermont’s Health Department. “Unfortunately the government didn’t really advertise it that way or prescribe it” with much clarity, so some people lost faith.

HHS and the FDA did not respond to requests for comment.

The scientific community remains divided on the potential of antigen tests.

Epidemic control is the main argument for antigen testing. A string of studies show that antigen tests reliably detect high viral loads. Because people are most infectious when they have high viral loads, the tests will flag those most likely to infect others. Modeling also shows how frequent, repeated antigen testing may be better at preventing outbreaks than highly sensitive PCR tests, if those tests are used infrequently and require long wait times for results. So far, there are no large scale, peer-reviewed studies showing how the antigen approach has curbed outbreaks on the ground.

People need to realize that without rapid testing, we’re living in a world where many people are unknowingly becoming superspreaders, Karan said. About 40 percent of infections are spread by asymptomatic people with high viral loads, so antigen tests, however imperfect, shouldn’t be dismissed, he said.

Even those who are more skeptical said they can be helpful with a targeted approach directed at lower-risk situations like schools, or outbreaks in rural communities where PCR is impractical, rather than nursing homes where a single mistake could set off a chain of deaths.

It is “completely irresponsible” to take a less-accurate test and say it applies to all situations, said Melissa Miller, director of the clinical microbiology lab at the University of North Carolina.

There’s no precedent for the government to bet this much on a product before it’s been thoroughly vetted, said Matthew Pettengill, scientific director of clinical microbiology at Thomas Jefferson University. “They put the cart before the horse, and we still can’t see the horse.”

The Government Quickly Embraced an Unproven Test

During a public health crisis, the FDA can issue emergency use authorizations to make tests available that might otherwise have been subjected to many months of scrutiny before being approved. The three most popular antigen tests in the US, from Abbott Laboratories, Quidel and Becton, Dickinson, commonly known as BD, had to submit far less proof of success than is usually required.

FDA gave the first authorization to Quidel on May 8 based on data from 209 positive and negative samples. BD got its permit July 2 with a total of 226 samples and Abbott in late August with 102. Outside of a pandemic, the agency might otherwise have required hundreds more samples; in 2018, BD’s antigen test for the flu provided data on 736 samples.

There’s no excuse for the small pool of data, particularly for Abbott, Pettengill said. At the start of the pandemic, the FDA authorized PCR tests based on as few as 60 samples because it was difficult to find confirmed cases. By the time Abbott got its authorization in August, it was “a completely different ballgame.” Abbott’s validation document states the company collected swabs from patients at seven sites. Given the case counts over the summer, it should have only taken a few days to collect many hundreds of samples, Pettengill said.

Abbott didn’t respond to requests for comment. Quidel pointed ProPublica to an article in The New England Journal of Medicine that explained how regular antigen testing can contain the pandemic by identifying those who are most infectious.

“We have full confidence in the performance” of our test, Kristen Cardillo, BD’s vice president of global communication, said in an email. BD “completed one of the most geographically broad” clinical trials for any antigen test on the market, she added, by “collecting and analyzing 226 samples from 21 different clinical trial sites across 11 states.”

The day after the Abbott test was authorized, HHS placed a huge bet on it, buying 150 million tests.

Then, it gave institutions like nursing homes advice on how to use them off-label, in a way in which they were untested and unproven.

The three tests are authorized for the most straightforward cases: people with COVID-19 symptoms in the first week of symptoms. That’s how they were validated. They produced virtually no false positives that way and were 84 percent to 97 percent as sensitive as lab tests, meaning they caught that range of the samples deemed positive by PCR.

Yet HHS allowed their use for large-scale asymptomatic screening without fully exploring the consequences, Pettengill said.

A recent study, not yet peer reviewed, found the Quidel test detected over 80 percent of cases when used on symptomatic people and those with known exposures to the virus, but only 32 percent among people without symptoms, The New York Times reported.

The HHS encourages nursing homes that can’t get access to PCR tests to use antigen tests, even on asymptomatic people. The agency suggested repeat testing to reduce false negatives but didn’t mention false positives.

An October survey found that nearly a third of nursing homes had left the federally provided antigen tests untouched, The Wall Street Journal reported. Staff cited time-consuming paperwork for federal reporting requirements and skepticism about their accuracy.

“I think a lot of the trust was lost, unfortunately,” Karan said.

“Be Prepared for Some ‘Pressure'”

As antigen tests began to give false positive results in nursing homes, state public health officials in Vermont and Nevada pushed back. But HHS officials overruled their concerns and pressured them to keep using the tests.

In July, an urgent care clinic in Manchester, Vermont, discovered that, of 64 patients (mostly asymptomatic) who the Quidel test said were positive, only four, all symptomatic, got a positive PCR result. As reported by the Vermont alt-weekly Seven Days, Quidel said the fault lay with the PCR tests. The FDA also pointed a finger at the PCR “without any foundation of evidence,” Levine, the state health commissioner, told ProPublica.

There was a potential problem related to the PCR machine’s software, but Vermont’s state lab retested the samples after upgrading the system and found no change in results, Levine said. State officials also conducted pop-up testing in the Manchester region and found just a handful of positives out of 1,600 tests, he said, proving that there was no outbreak in the community.

Levine said his health agency ended up labeling the 60 samples as “discordant” instead of “false positives” and left them out of the official case count. “We didn’t want hard feelings,” he said. “I do think this administration wanted to show it was doing something … and this [antigen test] is one way to demonstrate that.”

The federal government defended Quidel again in early October. The Times reported that Nevada’s Health Department ordered nursing homes to stop using all antigen tests after reviewing results from 3,725 tests. Nursing homes had double-checked 39 samples the BD and Quidel tests flagged as positive, but 23 of them tested negative via PCR. Nevada’s letter noted that it only learned about the problem because the state chose to go above and beyond federal guidelines: The FDA had said there was no need to double-check positive results. State officials told nursing homes to continue using PCR to fulfill testing requirements.

Cardillo, the BD spokesperson, said a “very small number” of the 11,250 nursing homes using BD tests reported higher than expected false positives, and “we are conducting thorough investigations into those cases.”

When an official from the Centers for Medicare & Medicaid Services asked why the state adopted a ban, a Nevada health facilities inspector said false positives could put nursing home residents at risk, according to emails obtained by ProPublica via a public records request.

If someone tests positive on an antigen test, the nursing home may sequester the patient with other residents who are truly infected, the Nevada official, Bradley Waples, wrote. If that person later has a negative PCR test, then the faulty diagnosis will have placed them “in danger of contracting the virus by introducing them to a room full of actual positive residents.”

His email didn’t explain whether anyone had been infected that way. A spokesperson from the Nevada Health Department declined to comment.

In one nursing home, the antigen tests found seven positives out of 35 samples, yet all seven tested negative by PCR, Waples wrote. Two other states had reported similar false positive problems, he added.

“Thanks Brad,” the CMS official replied. “It’ll be interesting to see what HHS does with this information. Be prepared for some ‘pressure.'”

That pressure arrived two days later in a letter from HHS, where Assistant Secretary Brett Giroir ordered Nevada to rescind the ban. You “must cease immediately or appropriate action will be taken against those involved,” he wrote. Nevada complied.

Giroir’s letter cited some of the key arguments for antigen tests, including their ability to detect those who are most infectious. Yet the agency’s reasoning glosses over many unknowns. Some people can become acutely ill without ever showing high viral loads, or only doing so briefly, said Miller, the North Carolina scientist. Those with lower viral loads may still be able to infect others, and the data is murkier for asymptomatic people, she added.

“I’m not saying it’s right or wrong, but we’re not fully understanding how these tests perform in certain populations, and yet they’re being used,” Miller said.

“It’s a test, yes, but there are people on the other side of that test,” she added. If you have a family member in a nursing home that’s getting false positives, it takes time to confirm results by PCR, Miller said. “These are days in which the residents and their families have an incredibly high level of anxiety and worry about their loved ones.”

America Needs a National Antigen Testing Plan

The initial vision of giving every American at-home tests every day has been slow to materialize. Many of the available antigen tests require machines to read the results or someone who’s trained to administer the test. Some states aren’t even reporting their antigen results, so it’s unclear when they’re used or how they complement PCR.

“We need a federal plan for who gets tested, with what tests … when, how often, and what data should be reported back, and what those data pieces mean,” said Dr. Rebecca Lee Smith, an epidemiology professor at the University of Illinois.

So much remains unknown about the best way to use antigen tests, Smith added. If you have a million tests, is it better to test a million people once, or test half a million people who are at high risk twice, or test essential workers five or 10 times? “It’s how you use the tests, not just how many tests you have.”

The US has never had a national testing strategy, said Dr. Ranu Dhillon, an expert on rapid testing and global health equity at Boston’s Brigham and Women’s Hospital. The administration’s haphazard approach to antigen tests is an extension of that larger failure, he said.

While there have not been well-publicized examples of false negatives that have led to outbreaks, one risk that’s been overlooked until recently is the probability of false positives in low-prevalence communities—places where few people have the virus, Miller said.

Even if a test is very “specific” (providing few false positives), it can flag more false positives than true positives. This happens for both PCR and antigen tests, but if antigen testing scales up to tens or hundreds of millions of tests a month, communities and institutions could get overwhelmed, Miller said.

One paper from August found that if a quarter of American school kids were tested three times a week with an antigen test that’s 98 percent specific, it would produce 800,000 false positives a week that need to be double checked by PCR tests. (For reference, the US is processing an average of 1.4 million tests per day, nearly all of them PCR).

Miller said she’s received confused phone calls from doctors asking for advice. She helped a state task force create a flowchart that explains how to interpret antigen results and when to do repeat testing. “But why are 50 states doing this,” instead of a single clear message from the administration? Miller asked.

Karan, the Harvard physician, said federal officials need to set expectations. An employer who can’t afford PCR might welcome antigen testing, because catching 80 percent of infected workers would be better than catching none at all. Meanwhile, anyone who gets a single negative result shouldn’t use it as an excuse to go to a bar, he said, and they should understand they might test positive a couple days later. This is particularly crucial for the many who plan to rely on antigen tests results to clear them for Thanksgiving gatherings.

Smith said any testing plan must be paired with a strong program of contact tracing, isolation and quarantine. The reality in this country is that “just telling someone they’re positive has not been enough. There has to be a cultural shift.”

As Reuters reported, Slovakia drove down its infection rate through a mass antigen testing program that imposed strict quarantine rules. The country tested 65 percent of its population in one weekend, then repeated the tests in hot spots a week later. Anyone who refused testing had to stay home, while those who tested negative got certificates that let them participate in public life.

That approach wouldn’t be feasible in the US, Smith said. “We need to instead think about empowering and supporting people to abide by isolation and quarantine.”

This story was originally published by the Food and Environment Reporting Network (FERN).

While the Occupational Safety and Health Administration (OSHA) has been heavily criticized for its handling of workplace COVID-19 outbreaks, California and a handful of other states have implemented more rigorous workplace safety regulations that experts say better protect food and farm workers from the virus.

Regulators in California and Oregon have fined agricultural employers more than $400,000—twice as much as the fines handed out so far by federal OSHA—for workplace violations linked to the pandemic. About half the states, like California and Oregon, have their own OSHA offices, and half are regulated under federal OSHA.

Labor and workplace safety experts say that federal OSHA’s enforcement should more closely resemble those states’ use of fines, stiffer regulations, and new legislation that boosts employers’ requirements to protect workers as the pandemic enters its eighth month.

“At the federal level, it’s seriously disappointing and dangerous the way the head of the Labor Department has been running OSHA,” says Mara Ortenburger, director of communications and research at Worksafe, a California-based organization that promotes safety rights in the workplace. “In contrast, in California, despite being understaffed, we are in much better shape.”

Federal OSHA has been criticized for months for investigating few worker complaints during the pandemic. The agency has levied only small fines against just a few employers in the agriculture sector, despite thousands of cases and hundreds of deaths among workers. According to the Food and Environment Reporting Network’s COVID-19 database, more than 1,400 food and farm facilities have had confirmed cases of COVID-19 and nearly 72,000 workers have contracted the virus. At least 327 have died.

In California, Ortenburger says, advocates and regulators have worked quickly to address a host of new questions employers have faced during the pandemic, especially those in sectors, like agriculture, that have seen a high number of outbreaks. 

“If a worker at a plant gets sick from COVID, employers were asking, is that on us to report?” she says. “What if they got sick at home?”

In response, the state strengthened Cal/OSHA recording and reporting requirements, mandating that employers report all serious injuries, illnesses, or deaths occurring at work, according to the agency’s website.

California legislators also passed a law, set to go into effect Jan. 1, that will require employers to notify all workers of any potential workplace exposure to COVID-19. It would also allow Cal/OSHA to shut down a worksite that exposes workers to the disease, and issue citations for serious violations without advance notice. And it would require employers to notify local public health agencies of all workplace outbreaks.

Cal/OSHA has already levied nearly $400,000 in fines against food and farm employers for workplace safety violations linked to COVID-19. In October, five were fined—Olson Meat Company ($9,000), DL Poultry Inc. ($36,000), Overhill Farms Inc. ($110,000), Pitman Family Farms ($18,000), and Duncan Family Farms ($5,060)—for not flagging and correcting unhealthy conditions or work practices related to COVID-19.

Data from FERN’s map of California outbreaks shows a total of 3,825 confirmed cases on farms, 1,339 at meatpacking facilities, and 1,242 at food processing plants in the state.

Oregon OSHA has also taken tougher measures to penalize employers during the pandemic than its federal counterpart. It fined National Frozen Foods in Albany $2,000 for failing to implement physical distancing to protect workers from spreading the coronavirus, according to the agency’s site. It also published a draft mandatory workplace health rule on Oct. 23 that would clarify reporting requirements for employers.

Federal OSHA has taken comparatively little action in response to COVID-19 outbreaks at food and farm facilities. In September, the agency cited Smithfield Foods with a $13,494 proposed penalty for failing to protect employees at its Sioux Falls, South Dakota, plant from exposure to the coronavirus. Nearly 1,300 workers contracted the virus at that meatpacking plant in a spring outbreak, and four died.

On Oct. 23, OSHA announced two more minor actions: Conagra was hit with a $2,121 fine linked to a 42-case outbreak at its plant in Marshall, Missouri, and JBS was fined $13,494 over a 348-case outbreak at its plant in Green Bay, Wisconsin. Labor advocates say the fines were too small to have any real impact on what are multibillion-dollar companies.

Some states with the highest case counts among workers in the food and farm sector, including South Dakota, Colorado, and Florida, are under federal OSHA enforcement, meaning they are subject to the agency’s enforcement decisions.

Federal OSHA has also not heeded pleas from workers’ advocates and Democratic lawmakers for an emergency temporary workplace standard, which would create enforceable safety guidelines for employers during the pandemic. Some states, like Virginia and Michigan, have passed workplace standards that are stronger than the federal voluntary guidelines.

Mark Lauritsen, director of the food processing and meatpacking division of the United Food and Commercial Workers union, told FERN that he wanted to see federal action in the form of an enforceable emergency standard for meatpacking workers. “I don’t want guidelines,” he said. “I want standards. It has to be in every facility in the United States.”

Peter Dooley, safety and health senior project coordinator at the National Council for Occupational Safety and Health, a Massachusetts-based organization, said that federal OSHA’s lack of enforcement has put food workers at very high risk since the beginning of the pandemic. “The whole industry has really been very ill-prepared to protect workers,” he said.

Throughout the pandemic, workers in food and farm settings have reported unsafe working conditions, including limited access to personal protective equipment, inability to obtain paid time off, and lack of access to testing. Federal OSHA has completed few inspections in response to worker complaints. 

OSHA also recently stopped issuing news releases announcing workplace violations and citations, per a Sept. 24 memo from Deputy Secretary Patrick Pizzella instructing OSHA to instead share a weekly summary of proposed penalties.

That lack of information could itself make workplaces more dangerous, experts say. Researcher Matthew S. Johnson, an assistant professor at Duke’s Sanford School of Public Policy, published a study on June 18 demonstrating a 73 percent improvement in compliance by other facilities after company names are revealed in OSHA press releases.

On Monday, the race among pharmaceutical companies to complete a vaccine effective against COVID-19 reached a critical new stage. Pharmaceutical company Pfizer and German-based biotechnology firm BioNTech announced that their joint vaccine appeared to be more than 90 percent effective in test trials, a result that surpassed earlier disclaimers from researchers that a potential coronavirus vaccine might be only 60 percent effective.

If the vaccine continues to show promise, Pfizer anticipates that by the end of the year, it could produce 50 million doses, enough for 25 million recipients to receive the two-dose protocol—ramping up to more than 1.3 billion in 2021. “This is a historical moment,” Kathrin Jansen, head of vaccine research and development at Pfizer, told the New York Times. “This was a devastating situation, a pandemic, and we have embarked on a path and a goal that nobody ever has achieved—to come up with a vaccine within a year.”

What’s more, Pfizer is not alone. One drug company, Moderna, is deploying the same novel messenger-RNA technology as did Pfizer and BioNTech. Other vaccine candidates rely on a manmade virus rather than mRNA to instruct the body to target the coronavirus. 

If Pfizer’s production plan continues and meets the standards laid out by the Food and Drug Administration, “vaccinations might start in the second week of December,” says John Grabenstein, vice president of the American Pharmacists Association and former head of US Department of Defense military immunization program. The speed with which Pfizer and BioNTech have developed the vaccine is unprecedented, and there remain a number of steps the company must go through to prove its safety and efficacy—both globally and in the US—before it’s made available to the public. Grabenstein says a vaccine before 2021 is only realistic “if several assumptions all come to pass,” including speeding through regulatory hoops and efficient scaling up of drug into the hundreds of millions of doses.

The FDA has indicated that it wants two full months of safety data on the volunteers who have received Pfizer’s vaccine. Originally there were supposed to be 30,000 subjects but later that number was increased to more than 40,000—38,955 of whom have taken both of the vaccine’s two doses—though, as with most research protocols, half of the vaccine doses are placebos. (Pfizer says it will continue to monitor its volunteers for a total of two years.) Initially, Pfizer wanted to wait until 32 of its subjects contracted COVID-19, then see how many of them had received the real vaccine; the larger the percentage of infected volunteers in the placebo group, the more effective the vaccine appeared to be. At that point, Pfizer would start submitting data to the federal government, continuing its tracking until 164 volunteers tested positive. To have a more robust data set, the company ultimately agreed to wait until it had 96 infected volunteers, rather than 32. The drug company will still track positive subjects until it reaches 164 for this section of its data collection.

When announcing the efficacy of its vaccine, the company said it plans to submit that safety data, along with an application for an emergency use authorization—which fast tracks the drug and makes it temporarily available—by the third week of November.

Once Pfizer and BioNTech submit that safety data, “FDA has to read it, FDA has to convene an advisory committee, CDC reads it, CDC convenes an advisory committee,” Grabenstein says, a process that could take several more months. The HPV vaccine, for example, was tested for almost a decade before it entered the market. Scott Gottlieb, a former Trump administration FDA commissioner who sits on Pfizer’s board told the Washington Post that even if the vaccine is approved before the end of 2020, that the general public would not have access until summer or autumn of next year. Plus, the FDA won’t just be appraising the trial data, but also Pfizer’s capacity to actually manufacture the vaccine. “Manufacturing glitches come up all the time,” Grabenstein says. “Usually behind the scenes, and nobody notices.”

Manufacturing hurdles are one thing, but distribution is another. Pfizer’s vaccine candidate must be stored at ultra cold temperatures, negative 80 degrees Celsius, according to the New York Times. If it ends up being the primary tool used to immunize the population from the disease, there is the crucia question of transportation. “There’s no getting around it. These have stark temperature demands that will constrain access and delivery,” J. Stephen Morrison, senior vice president of the Center for Strategic and International Studies, told the Times in September.

To put to rest public concerns that the vaccine has been produced dangerously quickly—more than 60 percent of Americans recently polled are concerned the vaccine will be approved along political, not scientific, lines—Pfizer is adding additional endpoints to its analysis, including instances where data is collected to determine the drug’s effects. “The final analysis now will include, with the approval of the FDA, new secondary endpoints evaluating efficacy based on cases accruing 14 days after the second dose as well,” Pfizer’s press release noted. “These secondary endpoints will help align data across all COVID-19 vaccine studies and allow for cross-trial learnings and comparisons between these novel vaccine platforms.”

In large part, the public mistrust surrounding the vaccine is a combination of an increasingly strong anti-vaxx movement on the extremes of the left and the right political spectrum, and another serious consequence of the Trump administration’s pandemic strategy of downplaying the disease, making unrealistic promises on solutions, discrediting science, and publicly chastising health officials who urge caution in the face of those unrealistic expectations. “I think the US government has not been communicating enough with the public in a way that is reassuring,” Grabenstein says. 

On Monday morning, as news of the potential vaccine hit Twitter, Mike Pence chalked up the progress to Pfizer’s participation in Operation Warp Speed—the government’s vaccine development partnership.

As Pence claims credit, Pfizer says it did NOT join in the administration's partnership.

Pfizer head of vaccine development Dr. Kathrin Jansen told the NY Times: “We were never part of the Warp Speed … We have never taken any money from the U.S. government, or from anyone.” https://t.co/GScL3vodx9

— Geoff Bennett (@GeoffRBennett) November 9, 2020

Pfizer is not a member of Operation Warp Speed. In fact, the drug company struck an almost $2 billion deal in July with the federal government to produce 100 million vaccine doses, but not to develop the vaccine itself. In September, Pfizer CEO Albert Bourla explained his reasoning on NBC’s Face the Nation. “When you get money from someone that always comes with strings,” he told host Margaret Brennan. “They want to see how we are going to progress, what type of moves you are going to do. They want reports. I didn’t want to have any of that…I wanted to keep Pfizer out of politics, by the way.”

But politics were inevitable. Shortly after the Pfizer’s announced its findings and the vice president tried to grab credit for the administration, Trump tried a different approach: Claim the timing of the announcement was delayed to thwart him.

The @US_FDA and the Democrats didn’t want to have me get a Vaccine WIN, prior to the election, so instead it came out five days later – As I’ve said all along!

— Donald J. Trump (@realDonaldTrump) November 10, 2020

It’s true that if Pfizer had stuck with its original plan to submit its findings to the FDA after only 32 subjects tested positive for the disease, the study would likely have wrapped up last month. But with its decision to wait until Monday, when it had 96 cases to submit, Pfizer’s trial stands on more robust ground, statistically speaking.

As Pfizer continues to turn its findings over to the FDA for the eventual emergency-use authorization, allaying the suspicions of the large number of Americans who are concerned with of how the vaccine was created becomes the next big challenge. A September poll by Kaiser Family Foundation found that only two thirds of respondents indicated they trusted FDA’s sister agency, the CDC—a 17 percent drop from April. The same poll showed that less than half of Americans would take a vaccine available before the election. And though that’s no longer a concern, there’s still trust to regain. Not to mention, the monumental effort necessary to distribute a treatment capable of addressing a worldwide pandemic. “There’s a real disconnect between vaccine producers and the headlines that come out about a vaccine approved by Christmas,” Emma Hodcroft, a molecular epidemiologist at University of Bern in Switzerland, told the Wall Street Journal on Tuesday. “A little bit more realism about the time frame for vaccinating the population would be helpful.” 

As the world grapples with the devastation of the coronavirus, one thing is clear: The United States simply wasn’t prepared. Despite repeated warnings from infectious disease experts over the years, we lacked essential beds, equipment, and medication; public health advice was confusing; and our leadership offered no clear direction while sidelining credible health professionals and institutions. Infectious disease experts agree that it’s only a matter of time before the next pandemic hits, and that one could be even more deadly. So how do we fix what COVID-19 has shown was broken? In this Mother Jones series, we’re asking experts from a wide range of disciplines one question: What are the most important steps we can take to make sure we’re better prepared next time around?

Throughout the course of the pandemic, epidemiologist Gregg Gonsalves, who is on faculty at both Yale School of Public Health and Yale Law School, has distinguished himself as a voice of reason on the political and social dimensions of the crisis, advocating for equity in testing and treatment. An expert on infectious disease modeling, Gonsalves began his career in the 1990s during the HIV/AIDS epidemic working extensively with activist organizations including ACT UP and the Gay Men’s Health Crisis to advocate for treatment. His history of HIV/AIDS work has given him a unique perspective on the art of effective science communication—and he’s emerged as a sharp critic of the Trump administration’s coronavirus response. “@realDonaldTrump would have had every scientist by his side if he had ever been serious about #COVID19,” he tweeted recently. “He turned to quacks, charlatans. Even a few hours after his defeat you can see what a real response might start look like without him.” I caught up with him to discuss the challenges that the Biden administration faces—not just in addressing the public health implications of the pandemic but also the legacy of anti-science messaging from the Trump administration.

On Biden’s coronavirus plan: The three co-chairs of Biden’s coronavirus task force [Yale physician Marcella Nunez-Smith, former US Surgeon General Vivek Murthy, and former FDA commissioner David Kessler] are superb. The Biden plan is good. It stresses all the right public health components, the need to have paid sick leave and economic support for businesses. But we’re going to need something much more substantial in terms of economic relief. The job numbers haven’t rebounded for women or for communities of color. Their plan mentions support for gig workers, but somehow it misunderstands the level of stress that people are experiencing.

A lot of people are subsidizing the wealthy getting to stay home. Grocery store workers who I see are often elderly women. They come across hundreds of people in a day. Our lives are being subsidized by people who are economically disadvantaged. We must figure out a way to help people survive based not on their gross annual income. We might consider paying people to stay home and isolate. If the choice is stay home or eat, it’s not much of a choice. All the behavioral economists say that you have to make the correct choices easy for people. So far we’re not doing that.

Our biggest explosive outbreaks are in prisons and jails. What are we going to do about that? Biden’s plan doesn’t say anything about that or about dealing with warehouses or meat processing plants.

It’s incumbent upon public health people to push as hard as they can, because it’s not about Republicans or Democrats, it’s about survival. Mitch McConnell doesn’t have a generous bone in his body, but this isn’t about politics, it’s about survival.

On how to heal the CDC: There are some amazing career people at the Centers for Disease Control, but how many people have left over the past four years because they just couldn’t take it anymore? It’s about rebuilding. They’ve been beaten down. Robert Redfield was such an utter disaster in the role [of CDC head]. As for a new head, [former New York City health commissioner] Mary Bassett would be up there for me. Mary understands that public health isn’t just about bugs and drugs, it’s about who we are as a nation. It’s really important to have someone who understands that this is a social and economic crisis as well as an infectious disease crisis. CDC people know this. It’s fine to have a physician in the post, but it needs to be someone who understands that it’s not just a biomedical problem. 

On the irreversible damage from Trump: Trump poisoned the well on the pandemic response with his malfeasance and undermining of science. If there were no Trump, and we started from the baseline before 2016, we would have been in better shape. But now COVID-19 is raging across the country. We’ve had eight months of relentless anti-science rhetoric. We’re going to pay the price of that. Most people don’t know someone who is sick. All they know is, I lost my job and my kid is home from school. So talking about the economy and getting people back to work relentlessly is actually very clever. Biden can’t just issue a plan or present this as a public health crisis. People need to feel like their most immediate problems are being taken care of, too.

We have more COVID than ever before, and we’re going into the winter. People are starved for social interaction, and the holidays are coming up. These holidays are central to American life. Biden gets inaugurated in the middle of January, we’re losing two months. The Department of Health and Human Services is basically a ghost town, so many people have left. Biden is going to have to fill all these career positions.

Tony [Fauci] and to a lesser extent Deborah Birx have been marginalized. Tony is a civil servant so it’s hard to fire him. The main problem is that [White House COVID-19 adviser] Scott Atlas is going to be here for the next few months. The man is basically saying “Do nothing.”

On the vaccine trust deficit: Before COVID-19, we had vaccine hesitancy in the United States that was bipartisan. Now this dynamic is on steroids. Even on the left, you have, “Is this a Trump vaccine? Does it really work?” We could see an Emergency Use Authorization during the lame duck, but the distribution will all be under Biden. There will have to be a full-scale communications effort to convince people to take it. Most people will understand that the vaccine will help them not have to be distant from their families anymore. But people on the far right and far left will likely remain there.

On what Biden can do simply by changing the tone in the White House: Even without any legislation, we won’t have someone spouting misinformation from the White House anymore. He’s not going to be the charlatan-in-chief that Trump has become. He won’t be pushing hydroxychloroquine. You’ll get some truth-telling that it’s not going away tomorrow, that this is going to be a long haul, and that we’re going to have to come together. I don’t think this is about him being a Democrat. Both Presidents Bush would have been similarly inclined. This will go a long way, because right now, it’s really about how we behave with each other. It takes encouragement, which is what the president is supposed to do.

On Wednesday, the country reported 100,000 new cases of the coronavirus, marking the highest single-day case count since the start of the pandemic, according to data from the COVID Tracking Project. 

The US is currently reporting more cases of the coronavirus than any other country in the world. By comparison, India, which has a population that exceeds that of the US by about 1 billion, reported a peak of 97,894 new cases in one day in September before the infection rates began to drop.

While the third wave of the pandemic in the US has proven to be more severe than the previous two, President Trump has continued downplaying the severity of the coronavirus, disregarding social distancing guidelines and holding rallies until the last day of the election season.

For more, be sure to watch the Mother Jones video tracking 100 days of the president’s coronavirus denials, as well as our extensive timeline chronicling the travails of the superspreader in chief. 

President Trump’s attacks against Dr. Anthony Fauci—which last month saw the president label him and other health officials “idiots”—have come to this: the president is hinting that he’ll fire the country’s leading expert on infectious diseases shortly “after the election.”

“Don’t tell anybody, but let me wait until a little bit after the election,” Trump told supporters at a Sunday rally in Opa-Locka, Florida, as chants of “Fire Fauci” broke out. He added, “I appreciate the advice.” 

Trump doesn’t have the power to directly sack Fauci—he’d need to get Fauci’s supervisor to do it—but as my colleague Dan Friedman noted back in April, the president could dramatically restrain his role as a member of the White House’s coronavirus task force. But the suggestion is the latest sign of the rapidly deteriorating relationship between Trump and Fauci, who, despite the president’s barely contained animosity, remains trusted by an overwhelming majority of Americans. In the final weekend before the election, as the United States continues to shatter infection records through a third wave of the pandemic, Fauci ratcheted up his criticism of Trump’s handling of the crisis, telling the Washington Post that the country “could not possibly be positioned more poorly.” The White House quickly pounced on the interview, baselessly accusing Fauci of being politically motivated.

As stunning as Trump’s suggestion to unseat one of the nation’s top scientists might be, targeting a voice committed to sharing unwelcome news about the virus is a move in lockstep with his closing campaign message: Ignore the over 225,000 deaths and embrace my deadly coronavirus denial. We’ll see how Americans feel about that soon enough.

Crowd chants “Fire Fauci” during Pres. Trump’s campaign rally in South Florida: “Don’t tell anybody, but let me wait until a little a bit after the election,” the president says in response. “I appreciate the advice.” https://t.co/rlgU1dKT2A pic.twitter.com/Mqa2RwbP3i

— ABC News (@ABC) November 2, 2020

As the third coronavirus wave in the United States continues to shatter records, Scott Atlas—who became a top White House adviser on the pandemic, despite a curiously thin resume for the task—has issued an apology for appearing on RT, a news outlet controlled by the government of Russia.

“I recently did an interview with RT and was unaware they are a registered foreign agent,” Scott Atlas said in a tweet claiming he had been “taken advantage of.” The Daily Beast first reported on Atlas’ Saturday interview, in which he decried coronavirus lockdowns as an “epic failure” and blamed such policies for killing people. “We’ve had 230,000 lives roughly lost from the virus and certainly many lost from the policy of shutdowns,” Atlas said during the interview.

The incident hits at two of the Trump administration’s worst scandals: its botched coronavirus response and ties to Russia. In recent months, President Donald Trump has embraced Atlas—who has previously blasted mask use and made other controversial claims—as his other coronavirus advisers, namely Dr. Anthony Fauci, voice sharper and more direct condemnation over Trump’s continued incompetence in handling the pandemic.

“All the stars are aligned in the wrong place as you go into the fall and winter season, with people congregating at home indoors. You could not possibly be positioned more poorly,” Fauci told the Washington Post on Friday, prompting the White House to baselessly claim that Fauci, the US government’s leading expert on infectious diseases, was politically motivated.

The White House is already attempting to distance itself from Atlas’ RT interview, according to CNN’s Jim Acosta. But the episode is unlikely to draw any serious repercussions, as Trump himself appeared on the outlet during the 2016 presidential campaign.

Senior WH official tells me Doctor Scott Atlas did not have approval from the WH before going on RT. Atlas did it “on his own” without seeking approval from WH. Senior aides have raised concerns that Atlas would appear on the Russian outlet, the official said.

— Jim Acosta (@Acosta) November 1, 2020

The first thing I notice when I log on is Ms. Washington’s purple witch hat. Just a few Zoom squares away, there’s a background of a spooky Halloween scene, complete with a Jack-o-Lantern scarecrow and a glowing crescent moon. It’s festive and sweet, but far from the normal Friday before Halloween for the 18 fifth graders led by co-teachers Ms. Washington and Ms. Vega.

Later in the day, during “Fun Friday,” the students share pumpkin art. During lunch, they watch Hotel Transylvania.

Still, it is just another day at virtual school, the teachers moving fluidly between online platforms in an interlocking digital dance. Zoom for video chat. Google Classrooms to share docs and quizzes. Benchmark for reading. Khan Academy and GoMath for math. Videos embedded in Google Slides.

I am logged on as a guest of Zoe Oden, a 10-year-old who loves being in the middle of the action. Her dad built her a desk in the dining room—it’s a vantage point from which she has a direct line of sight to all the most trafficked areas of the house: the kitchen table, the backyard, the hallway, and the living room. “Everybody walks by and says hi,” Zoe tells me with a smile. 

Seeing Zoe in class, it is no surprise she’s a straight-A student. She is usually one of the first ones to raise her hand. When her group is down a student to play a part in a scene they are reading out loud, Zoe volunteers to read for two parts, which she does with feeling. In math class, she explains so clearly why decimals need to be rounded to the tenth place that it sounds like she could have been reading straight from a textbook. When the teacher asks the students about some activities they like that don’t depend on being plugged in, Zoe says that she likes to sit outside and read a book. Her favorite book is Michelle Obama’s Becoming. 

Zoe and her four siblings all attend AIMS, a K-12 college prep charter school in Oakland, California. They have been doing virtual school from home since mid March. With coronavirus cases on the rise across the country, there’s no end in sight to the virtual classes like those I attend on Friday.

I am not totally sure what to expect when I join in; much has been written about how uneven virtual learning has been so far, and complicating matters more, Oakland has been experiencing rolling power blackouts. But it is surprisingly…smooth and hands-on. Independent work time is interspersed with lectures, quizzes, and group activities. 

The kids keep themselves muted unless they are speaking. They hold their hands up in the Zoom screen when they want to speak. They nod or give thumbs up when their teacher asks the group a question. Occasionally someone’s little sibling will toddle into the background. Sometimes the internet will cut out and the teacher will lose a student’s video, or a student’s voice will sound glitchy and robot-like when they try to answer a question. By the end of the hour-and-a-quarter classes, some kids start to lose concentration. One starts eating a snack. Then, just in time, class adjourns for a ten-minute break. 

When Zoe first started attending AIMS, her mom drove Zoe and her two older siblings about two to three hours to school each way, depending on the Bay Area traffic. But for Zoe’s mom, who used to be a teacher at the school and is now a parent coordinator at AIMS, it felt worth it. She loves the fact that her five kids could all go to the same school because it’s K-12. She was impressed with the school’s academics. And, importantly for Zoe’s parents, the school is diverse. Zoe and her siblings are African American and Latino. 

“I have a lot of diverse friends and everybody’s nice,” says Zoe. She tells me she feels supported at school. “Everybody cares.”

AIMS was founded in 1996 as a charter school for American Indian children. The original curriculum included classes like basket weaving. Over time, the school expanded its demographics and became one of the most diverse schools in Oakland. It started climbing the Great Schools charts in academic performance, especially among students from underserved populations. Like public schools, AIMS operates with state and federal funds and is tuition free, but it’s exempt from public schools’ curriculum. The elementary school has about 440 students, with about 80 fifth graders split across three classes. This year, there were 75 kids on the waitlist to get into AIMS’ kindergarten class. This is all to say that while observing on Friday, I got a window into one remote learning experience; AIMS may not necessarily be indicative of broader experiences in Zoom learning. When schools closed last March, AIMS administrators were quick to purchase online programs like Benchmark, Learning Farm, Quill, math using Go Math!, and Seesaw. They converted their textbooks to a digital library. They secured Chromebooks and hotspots for families who needed devices and internet connections. This year AIMS purchased 100 new Chromebooks for a one-to-one Chromebook-student ratio. 

And it’s worked well so far for the Odens. Zoe’s mom describes the process as having been pretty seamless. While living in a house with five kids can get chaotic—I can attest to one lunch-time converasation during which little voices chimed in from the background, and Zoe’s little brother wandered into the Zoom frame randomly wearing a sombrero—but overall, Zoe and her siblings have gotten a routine going. Her two teenage siblings work upstairs in their rooms, while Zoe and the two little ones work downstairs with their mom. When Zoe has to speak in class, she just lets her mom know that she’s unmuting herself. Her mom usually works right next to her little brother, who is in first grade. The kids use their parents’ bedroom and close the door when they need to take a test. 

Just like virtual learning at AIMS is probably not typical, Zoe isn’t exactly typical either. She has a sunny disposition and the tendency to see the glass half full. She actually likes being the middle child because she gets to experience being both an older kid and a younger kid. Her favorite subjects are Mandarin and math, though she finds decimals a little tricky sometimes. Least favorite subjects? She doesn’t have any. When I ask her if she prefers at-home or in-person schooling, she tells me she prefers them both. She misses seeing her teachers and friends and school administrators in person. She misses being around the front desk, where everybody hangs around and talks, and the two front-desk receptionists who used to say hello to her every morning. 

But, she admits virtual schooling has its perks. She notes the quick commute. Plus, she says, “For virtual school you can sit in your own house. You can also wear whatever you want,” she tells me, adding for emphasis: “Whatever you want.”

On Halloween Friday, that means Zoe is wearing a black hoodie. She was going to dress up as a cheerleader this year, but since trick-or-treating is not pandemic-friendly, she decided not to bother with a costume. On actual Halloween night, normally Zoe and her siblings would get dressed up in costume and go trick-or treating all together with their parents, using pillow cases as candy bags, and hitting up the houses in their neighborhood before coming home and beginning to trade. “Every year, as soon as we get home from trick-or-treating, we open our bags and say, ‘Hey, I’ll give you my gummy bears for your Reeses,'” says Zoe. She is always on the lookout for Skittles, Baby Ruths, and Ferrero Rochers—her favorites. 

But this year, like class, and like so many things, Halloween will look a little different in the Oden household. Zoe is staying home with her siblings, eating candy, and watching Halloween movies. Casper the Friendly Ghost, The Addams Family, and Hocus Pocus are on the docket. 

As Americans head to the polls amid a massive surge in coronavirus cases and an increase in COVID-19 deaths, President Donald Trump is responding to the resurgent pandemic by brazenly lying about it. Campaigning around the country at rallies experts say are likely to spread the virus, Trump has taken to falsely asserting that the United States is “rounding the corner” on COVID. But even that lie pales in comparison to the whooper the president offered on Friday morning. 

“Deaths WAY DOWN,” Trump tweeted. That’s false.

More Testing equals more Cases. We have best testing. Deaths WAY DOWN. Hospitals have great additional capacity! Doing much better than Europe. Therapeutics working!

— Donald J. Trump (@realDonaldTrump) October 30, 2020

Over the last two weeks, the national average of daily deaths that local medical examiners attribute to COVID-19 has increased by 16 percent. That’s according to the New York Times COVID data tracking project, which is assembled by journalists compiling data directly from state and local health agencies. 1,004 deaths attributed to COVID were reported on Thursday, bringing the seven-day average (the average of reported deaths on each of the last seven days) to 811, up from 701 on October 15. Confirmed US deaths attributed to COVID now total about 229,000. (A separate metric, the CDC’s tally of excess deaths compared to how many people generally die during this stretch in a normal year, suggests that COVID caused far more deaths, nearly 300,000 through just early October.) Johns Hopkins’ COVID-19 tracking project, which separately compiles local data on the virus and reports slightly different numbers, shows the same general trend as the Times, an independent corroboration that deaths are in fact rising. Since September 12, COVID cases have been increasing throughout the US, with especially sharp rises in the Midwest. The spike in cases also means that deaths are likely to increase even further in coming weeks. People who die of COVID tend to succumb weeks or more after contracting the virus.

It’s possible that Trump’s tweet misstated a claim he and his backers have often made. Ignoring the absolute number of COVID deaths, they have focused on the fatality rate for Americans who have contracted COVID. And there is evidence that substantial improvement in treatment of the disease means a lower percentage of people who fall ill from the coronavirus are dying. But COVID deaths are increasing in spite of those advances. 

Trump may also have been echoing an assertion made last night by his son, Donald Trump Jr. Appearing on Fox News, Trump Jr., twice, made the false claim that Covid deaths are down to “almost nothing.”

Jr. claims Coronavirus death numbers are down to “almost nothing” pic.twitter.com/NGMDLYkdsD

— Acyn Torabi (@Acyn) October 30, 2020

While remarking that “people are truly morons,” Trump Jr. helpfully cited the source of his error. “I put it up on my Instagram a couple days ago, because I went through the CDC data, because I kept hearing about new cases. But I was like, why aren’t they talking about deaths?” he said. “Oh, oh: because the number is almost nothing.”

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Why isn’t the ACTUAL data from the CDC being discussed? Why is the media only talking about cases going up (because we are testing) more but the real numbers that matter namely the death rate are way down. Chart one shows actual deaths and the trend going way down. 2nd slide shows that the number of new cases and number of deaths per week are no longer correlated. In other words, while there have been increases in new cases per week, there has actually been a steady decrease in deaths per week. I guess they can’t rule you with fear if they tell you the truth. all data from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/10232020/specimens-tested.html and https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

A post shared by Donald Trump Jr. (@donaldjtrumpjr) on Oct 27, 2020 at 2:59pm PDT

The chart Trump posted does at first glance appear to show COVID deaths declining sharply. But as the Washington Post noted, that is because the chart excludes data on deaths in recent weeks. The actual CDC chart that Trump’s post cites says: “Counts will not include all deaths that occurred during a given time period, especially for more recent periods.” That means the chart does not show a decline in deaths. It shows a lack of data. Johns Hopkins and the Times, because they do not wait for CDC data, have more current information.

The Trumps’ false claims about deaths are just the most egregious among the deluge from Team Trump in the final days of the election. These falsehoods are part of an apparent, stunningly cynical presidential strategy of lying about the pandemic in the hope that some Americans will be fooled for long enough for Trump to eek out reelection, despite the probability that the misinformation will cause more sickness and death. 

President Trump’s tweet this morning also repeated his familiar assertion that more tests result in more cases. That is literal nonsense, a failure to accept the principle, which babies learn, of object permanence. Something you can’t see still exists. People have COVID regardless of whether tests confirm they have it. Trump presumably intended to make the marginally less infantile claim that more tests result in the detection of more cases, so the spike in new reported cases—including about 91,000 on Thursday—is a mere result of more testing. But that, too, is wrong. Many states track daily tests, and those show that while testing is generally increasing, the rise in infections is far steeper.  “The data show that cases are going up. It’s not just a function of testing,” Admiral Brett Giroir, the Trump administration’s coronavirus testing czar, said in an interview on NBC’s Today show Wednesday. “Yes, we’re getting more cases identified, but the cases are actually going up. And we know that, too, because hospitalizations are going up.”

Out on the trail, Trump is still at it. At a rally in Michigan on Friday, he told backers that a vaccine will be available in “a couple of weeks.” It won’t. Dr. Anthony Fauci, the top US government infectious diseases expert, said on Thursday that health officials will know “sometime in December whether or not we have a safe and effective vaccine,” creating a chance to vaccinate high-risk Americans “by the end of December or the beginning of January.” But most Americans will have to wait far longer. And Fauci warned that life will likely not return to normal “until the end of 2021 at least.”

The United States is in the middle of its third coronavirus wave—a nascent surge that has already broken daily infection records—but President Trump is loudly insisting that the pandemic is on the brink of extinction. That patently false claim comes as Trump complains that the media is playing up the virus in order to sink his reelection campaign. “You won’t be hearing so much about it,” after the election, he asserted on Tuesday, once again falsely claiming that the media and his political opponents are only interested in using the pandemic to destroy him. 

Here are three samples from the last two mornings:

Until November 4th., Fake News Media is going full on Covid, Covid, Covid. We are rounding the turn. 99.9%.

— Donald J. Trump (@realDonaldTrump) October 27, 2020

ALL THE FAKE NEWS MEDIA WANTS TO TALK ABOUT IS COVID, COVID, COVID. ON NOVEMBER 4th, YOU WON’T BE HEARING SO MUCH ABOUT IT ANYMORE. WE ARE ROUNDING THE TURN!!!

— Donald J. Trump (@realDonaldTrump) October 27, 2020

The Fake News Media is riding COVID, COVID, COVID, all the way to the Election. Losers!

— Donald J. Trump (@realDonaldTrump) October 26, 2020

It’s a stunning closing message as the presidential race enters its final week. But it tracks with every instance of Trump’s deadly coronavirus denial, his efforts to downplay the virus, and his false, politically motivated promises that have punctuated his administration’s catastrophic response over nine months. Meanwhile, more than 225,000 people have died from the virus in the United States, and the outlook for the third wave is looking increasingly grim.

This story has been updated.

Arkansas Gov. Asa Hutchinson, a Republican, called on more people to start wearing masks in his state. The statement comes as Arkansas faces a staggering uptick in positive test results and deaths from COVID-19.

“Primarily, it’s [the] individual responsibility of our citizens to do what is necessary and pull together,” Hutchinson said on CBS News’ Face the Nation. “Increase usage of masks.”

NEWS: Arkansas Republican Governor @AsaHutchinson calls for "increased usage of masks." WATCH –>

"It's individual responsibility of our citizens to do what's necessary and pull together" #maskup pic.twitter.com/25BHlmgGer

— Face The Nation (@FaceTheNation) October 25, 2020

In July, Hutchinson signed an executive order requiring face coverings in the state. Arkansas has been one of only a handful of red states to implement such mandates, as the Trump White House continues to politicize the issue of wearing masks in order to curb the spread of the virus.

 

 

At least five people in Vice President Mike Pence’s inner circle have tested positive for the coronavirus, according to a report from CNN. That tally includes some of his closest advisors, including his chief of staff Marc Short and an advisor named Marty Orbst. Yet Pence, the head of the White House’s coronavirus task force, is continuing with in-person campaigning and refusing to quarantine. 

Other staffers are concerned more people in Pence’s orbit will get the virus. “They’re scared,” a source familiar with the situation told CNN.

The news comes weeks after President Donald Trump and several members of his White House staff tested positive for the virus, including advisor Hope Hicks and press secretary Kayleigh McElhaney. Trump spent several days in the hospital, and miraculously continues to downplay the severity of the virus. Meanwhile, the virus is surging in many parts of America. On Saturday, there were at least 871 new coronavirus deaths in the United States, and more than 78,000 new cases were reported, according to a tally kept by the New York Times.

 

 

The United States recorded its highest one-day total of new coronavirus cases on Friday, according to tracking data collected by Johns Hopkins University. The additional 83,757 infections shattered a record previously set when new virus cases exceeded 77,000 per day in July. 

To mark the grim milestone, President Trump took to Twitter and blamed the media for reporting on the third major wave of coronavirus cases in the United States. 

The Fake News is talking about CASES, CASES, CASES. This includes many low risk people. Media is doing everything possible to create fear prior to November 3rd. The Cases are up because TESTING is way up, by far the most, and best, in the world. Mortality rate is DOWN 85% plus!

— Donald J. Trump (@realDonaldTrump) October 24, 2020

Here are the facts: the United States, which has just over 4 percent of the global population, has more than 20 percent of the world’s coronavirus cases. Since January, Trump has repeatedly deflected and ignored advice from scientists and intelligence officials about the threat of the virus. Even after he was hospitalized while dealing with his own coronavirus infection earlier this month, Trump has continued to falsely claim that the flu is worse than COVID-19 and that his own experimental treatment is a sign that a “cure” is imminent. His refusal for months to wear a mask, and his advisers’ willingness to enable him, resulted in a likely super-spreader event at the White House where more than two dozen people close to Trump, including lawmakers and journalists, tested positive for COVID-19.

Nearly every day brings more news of coronavirus infections on Capitol Hill or among lawmakers on the campaign trail. On Saturday morning, Sen. Kelly Loeffler (R-Ga.) announced that two staffers in her Washington, DC office had tested positive. Loeffler, who tested negative on Friday, is “more energized than ever,” her spokesperson said in a statement. 

The California prison that was the site of one of the most severe COVID-19 outbreaks in the United States must cut its population by more than a third, a state appeals court ruled on Tuesday night. 

In a scathing opinion, California’s First District Court of Appeals found that the California Department of Corrections and Rehabilitation has showed “deliberate indifference” to the health of people imprisoned at San Quentin State Prison outside San Francisco. A three-judge panel found that the department violated the Eighth Amendment’s prohibition on cruel and unusual punishment when it failed to immediately follow public health experts’ recommendation to halve the prison’s population. The court ordered CDCR officials to reduce the prison’s population to 1,775 people in order to allow for more social distancing inside its grounds. The corrections department could downsize the prison by releasing prisoners or transferring them to other state prisons.

Twenty-eight prisoners died and about three-quarters of the people incarcerated in San Quentin became infected with the coronavirus this summer after untested prisoners from a Southern California prison struggling with its own outbreak were brought in. In early June, after the first handful of prisoners there tested positive, public health experts toured the prison and issued an urgent memo calling for its population to be reduced by half as soon as possible.

“By all accounts, the COVID-19 outbreak at San Quentin has been the worst epidemiological disaster in California correctional history. And there is no assurance San Quentin will not experience a second or even third spike,” Presiding Justice J. Anthony Kline wrote in the opinion.  “Failure to immediately adopt and implement measures designed to eliminate double celling, dormitory style housing and other measures to permit physical distancing between inmates is morally indefensible and constitutionally untenable.”

As I reported this summer, San Quentin was particularly vulnerable to an outbreak due to its age, design, and crowding:

In the North and West cell blocks, which hold about 1,600 people—including 300 with four or more COVID-19 risk factors, according to the public health experts—windows are welded shut. Air is recirculated among five tiers of two-person cells, passing freely through grates or bars that open onto narrow walkways. James King, an activist with the Ella Baker Center who was released from San Quentin in December, describes the North and West cell blocks as “concrete boxes” where illness routinely spread in waves. “We used to joke and call it that we were living in a petri dish,” King says. 

The lower-security dormitories at San Quentin are also packed, as is a gymnasium filled with rows of bunks that the public health experts said was at a high risk for a “catastrophic super spreader event.” Prisoners in the dorms share toilets, sinks, showers, and phones. (CDCR says that access to phone calls, and showers is staggered to allow for disinfecting between each use.) “I got one person who lives about eight inches away from my face,” says Kerry Rudd, who lives in a San Quentin dorm of about 100 people. “And of course the person on the bunk below me, he lives about four feet from me.”

As of October 14, CDCR had reduced the number of people incarcerated in San Quentin’s to 2,898, in part through a series of release programs announced by Gov. Gavin Newsom in July. In his order, Kline recommended the state further expand its release programs to include prisoners serving time for “a violent crime as defined by law.” That could potentially include some of the roughly 30 percent of San Quentin prisoners serving life sentences.

“Given the length of their minimum sentences, lifers are much older than non-violent offenders at the time they become eligible for parole and receive a release date,” Kline wrote in his order. “Most have by then ‘aged out’ of criminal behavior and present less of a threat to public safety.”

In a statement to Politico, a representative for the state corrections department said it “respectfully disagree[s] with the court’s determination, as CDCR has taken extensive actions to respond to the COVID-19 pandemic” and added that the state currently has its lowest prison population in “decades.” The court’s order takes effect on November 4.

As colder weather sets in, experts are warning that the next coronavirus surge has arrived. On Friday, the United States recorded 69,000 new infections—the highest daily total since July 30. This latest peak is concentrated in rural communities in the upper Midwest and follows a spring surge in the Northeast and a summer surge in the South. Experts are now worried about a rising number of cases coinciding with flu season as families gather indoors during the holiday season and winter months.

“There’s a growing sense of coronavirus fatigue out there,” Dr. William Schaffner, an epidemiologist at Vanderbilt University, told CNBC. “People really want to get back to the old normal.” But ignoring public health guidelines could have dire consequences; some states are already feeling the impacts of the latest surge in cases.

In Wisconsin, Democratic Gov. Tony Evers opened up a field hospital for coronavirus patients with more moderate symptoms to ease the crowding in intensive care units in the state’s hospitals. North Dakota’s case load has reached record highs and state officials are beginning to worry about hospital capacity. In Minnesota, where 18 cases were associated with a Donald Trump campaign event, coronavirus infections have also reached new highs.  

The latest surge comes just weeks before the election. The Trump administration remains wholly uncommitted to responding to the coronavirus, even as the president’s poll numbers sink, in part, due to his handling of the pandemic. Even as deaths top 217,000 and the third wave threatens to be worse than the first two, Trump continues to downplay the severity of the virus. “The light at the end of the tunnel is near,” he told a crowd of supporters in Florida on Friday. “We are rounding the turn.”