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Total coronavirus cases in the U.S. approached four million, while state governments and federal health officials rolled out measures aimed at curbing the virus’s spread. Texas reported 197 additional deaths Wednesday, a single-day record, bringing its total to 4,348 dead, according to the Texas Department of State Health Services. The nation’s overall death toll topped 143,000, and new cases surged by more than 71,000, the sharpest daily rise since July 16, according to data compiled by Johns Hopkins University. (Hall, 7/23)

The surge in new cases across the South and Southwest has now been linked back to Americans' travel around Memorial Day and reopenings, White House coronavirus response coordinator Dr. Deborah Birx said Wednesday. (Maxouris, 7/23)

The United States has not seen back-to-back days with over 1,100 lives lost since late May. Weeks after cases began to surge, 23 states are now seeing fatalities also rise, according to a Reuters analysis of deaths for the past two weeks compared with the prior two weeks. Deaths rose by 1,101 on Wednesday to a total of over 143,000 after climbing 1,141 on Tuesday. ...Among the 20 countries with the largest outbreaks, the United States ranks sixth highest globally for deaths per capita, according to a Reuters analysis. (Shumaker, 7/22)

The summer surge in coronavirus cases is now fueling a corresponding spike in deaths, with over 1,000 recorded in just 24 hours for the first time in weeks. In California, which now has the most confirmed infections in the nation, officials are working to ensure additional hospital capacity. And Texas has an outbreak of more than 500 women at a federal prison in Fort Worth. (Sy, 7/22)

Gov. Gavin Newsom said Wednesday that 12,807 new coronavirus infections had been reported statewide in the past 24 hours — a record high — bringing California’s total to 413,576. “It’s just another reminder … of the magnitude of impact that this virus continues to have,” he said during a press briefing.The sustained surge in cases comes as coronavirus-related hospitalizations have continued to hit or approach record-breaking levels in the state. (Money, 7/22)

California on Wednesday overtook New York, the original epicenter of the U.S. novel coronavirus outbreak, as the worst-hit state for cases, according to a Reuters tally of county data. ... California deaths also set a one-day record, rising by 159. New York has recorded by far the most deaths of any U.S. state at more than 32,000 with California in fourth place with over 8,000 deaths. (Maan and Ahluwalia, 7/22)

California this week surged ahead of New York as the state with the most total cases of COVID-19 — a dubious title that prompts what would have seemed a silly question two months ago: Is New York now handling the virus better than California? The two states clearly are going in the opposite direction. As of Wednesday, more than 415,000 Californians have tested positive for the virus. That’s slightly more than in New York, a state that was devastated in March and April by the pandemic. New York still has more total infections per capita because its population (about 19.5 million) is half the size of California (about 40 million). (Bizjak and Reese, 7/22)

Key senators and White House negotiators said Wednesday they had reached a deal on a key piece of their stimulus package, setting the stage for the release of their long-awaited full proposal. Senate Appropriations Chairman Richard Shelby, an Alabama Republican, announced the "fundamental agreement" on the funding piece of the GOP plan, which would include $105 billion for schools and additional billions in funds for testing. (Mattingly, Fox and Barrett, 7/22)

After three marathon days of talks, Senate Republican leaders and White House officials expressed confidence on Wednesday evening that they had reached an agreement in principle on a proposal that would dole out more than $100 billion to schools, send additional checks directly to Americans and provide $16 billion for states to conduct testing and contact tracing. But some of the biggest issues, including what to do with enhanced unemployment insurance and Mr. Trump’s payroll tax cut idea, were not finalized. (Cochrane, Fandos and Tankersley, 7/22)

Facing a GOP revolt, Senate Majority Leader Mitch McConnell was preparing a “handful” of separate COVID-19 aid bills, according to a top lawmaker involved in the negotiations. McConnell is set to unveil the package on Thursday, according to a Republican unauthorized to discuss the private talks and granted anonymity. “Very productive meeting,” Treasury Secretary Steven Mnuchin said while exiting a session late Wednesday at the Capitol. A key holdup remains President Donald Trump’s push for a payroll tax cut, according to a Republican granted anonymity to discuss the private talks. Hardly any GOP senators support the idea. (Mascaro, 7/23)

The Republican coronavirus relief plan will extend enhanced unemployment insurance “based on approximately 70% wage replacement,” Treasury Secretary Steven Mnuchin said Thursday. (Pramuk, 7/23)

Senate Republicans are set to start unveiling at least part of their forthcoming coronavirus relief proposal on Thursday. The package will not be one bill, but instead be broken up into several bills, according to Sen. Roy Blunt (R-Mo.), a member of GOP leadership, with the goal of releasing them all on Thursday. (Carney, 7/22)

In related news —

New Jersey Gov. Phil Murphy on Wednesday called congressional Republicans’ emerging economic relief plan a “slap in the face,” saying that his state is confronting its worst fiscal crisis since the Great Depression and that the latest proposals in Washington would do nothing to address the state’s coronavirus-inflicted $10 billion budget hole. (Wood, Tornoe and Steele, 7/22)

Pharmaceutical giant Pfizer and German biotechnology firm BioNTech will supply the federal government with 100 million doses of their coronavirus vaccine under a $1.95 billion deal announced Wednesday, the administration’s largest investment yet in a vaccine that has not been proved effective. The government also has an option to acquire an additional 500 million doses of BNT162, as the vaccine candidate is called. It still must secure regulatory approval or authorization that Pfizer projects it may seek as early as October. (Denham and Johson, 7/22)

If one of the vaccines proves safe and effective in a large phase three trial and receives regulatory approval, HHS said Pfizer will begin to deliver doses to locations across the U.S. at the government’s direction. The vaccine would then be made available to Americans “at no cost,” HHS said. It’s unclear who the first doses of the potential vaccine would go to and how that decision would be made. (Moreno, 7/22)

The Trump administration’s commitment on Wednesday to purchase 100 million doses of a not-yet-finished vaccine is unusual in two ways. The private sector buys most vaccines in the United States, not the government. The drug industry has lobbied to keep things that way; private payers usually pay more for vaccines than the government does. And when the government does buy vaccines — typically on behalf of low-income children — it is almost always vaccines that have already received safety and efficacy approval from the Food and Drug Administration. (Kliff, 7/22)

"We’ve been committed to making the impossible possible by working tirelessly to develop and produce in record time a safe and effective vaccine to help bring an end to this global health crisis," Dr. Albert Bourla, Pfizer's chairman and CEO, said in a statement. Bourla added the company is "honored to be a part of this effort to provide Americans access to protection from this deadly virus." (Thorbecke, 7/22)

The Trump administration will provide nursing homes with $5 billion as they continue to deal with mounting COVID-19 infections, administration officials said Wednesday. President Trump first made the announcement at the White House, and the official policy will be announced in a forthcoming rule, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said. (Weixel, 7/22)

The move follows Democratic presidential candidate Joe Biden’s recent unveiling of a family caregiver plan that aims to greatly expand and subsidize alternatives to institutional care for frail older adults. Both men are competing for seniors’ votes against a backdrop of eroding political support for Trump among older Americans. “I want to send a message of support and hope to every senior citizen,” Trump said at the White House. “The light is starting to shine and we will get there very quickly.” (Alonso-Zaldivar, 7/23)

In related news —

Stollwood Convalescent Hospital, a Woodland skilled nursing facility devastated by 17 coronavirus deaths in the earlier months of the pandemic, will close permanently this fall. (McGough and Pohl, 7/22)

Members of a national nurses union laid pairs of shoes representing their colleagues who have died while treating coronavirus patients on the lawn of the U.S. Capitol on Tuesday. The demonstration, organized by National Nurses United (NNU), was designed to encourage Congress to invoke the Defense Production Act and mandate that U.S. manufacturing plants switch production to manufacture personal protective equipment (PPE), such as gloves and masks. (Bowden, 7/22)

More than 3,000 public health experts have signed a letter in support of National Institute of Allergy and Infectious Diseases Director Anthony Fauci following attacks on him from some within the Trump administration, according to the Center for Science in the Public Interest. Signers of the letter include former Food and Drug Administration Associate Commissioner Peter Lurie, Yale School of Public Health assistant professor Gregg Gonsalves, New York City Health Commissioner Oxiris Barbot and former U.S. Surgeon General Joycelyn Elders. (Budryk, 7/22)

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, will testify July 31 on Capitol Hill, as his relationship with President Donald Trump faces continued scrutiny and the coronavirus continues to spread across the United States. Fauci, who last testified before Congress on June 30, will be joined during a hybrid in-person/remote hearing by two other leading officials from the White House Coronavirus Task Force: Centers for Disease Control and Prevention Director Dr. Robert Redfield and Assistant Secretary for Health at the Department of Health and Human Services Adm. Brett Giroir. (Parkinson, 7/22)

Anthony Fauci, the nation’s top infectious diseases expert, said Wednesday he doesn’t think COVID-19 will ever be fully eradicated but noted it can be controlled. “I don’t see this disappearing the way SARS 1 did,” Fauci said during a livestreamed event hosted by the TB Alliance, a nonprofit focused on finding better tuberculosis treatments. (Hellmann, 7/22)

In other news from the administration —

Former Food and Drug Administration (FDA) Commissioner Scott Gottlieb signaled Wednesday that the U.S. could reach 300,000 COVID-19 deaths by the end of 2020 if the country's death rate doesn't improve. "Right now, we have close to 1,000 casualties a day, so if we don’t change that trajectory, you could do the math and see where we are towards the end of the year," Gottlieb, who served as President Trump's FDA chief, told MSNBC's "Squawk Box." (Johnson, 7/22)

The head of the Federal Emergency Management Agency (FEMA) told Congress on Wednesday the country has “a ways to go” on getting enough protective equipment for health workers fighting coronavirus, though he said the situation has been improving. “I want to be clear: We have a ways to go on making sure we have enough PPE,” Administrator Pete Gaynor said at a congressional hearing, referring to personal protective equipment. “This is not as simple as just throwing a light switch and we just magically make more.” (Sullivan, 7/22)

“Person. Woman. Man. Camera. TV.” President Trump again sought to showcase his mental fitness on television by reciting, over and over again in an interview broadcast on Wednesday evening, what he said was a sample cognitive testing sequence. For the better part of a month, Mr. Trump, 74, has made repeated appearances on Fox News to brag about acing a cognitive test he said he recently took at Walter Reed National Military Medical Center, first with Sean Hannity and again with Chris Wallace on “Fox News Sunday.” All the while, the White House has not disclosed details about when the president underwent the testing or why. (Rogers, 7/22)

As President Trump and his team began attacking former vice president Joe Biden’s mental and physical fitness this summer, Trump began pondering his own cognitive abilities. As part of his annual physical two years earlier, the president had taken the Montreal Cognitive Assessment — a 10-minute test designed to detect mild cognitive impairment such as the onset of dementia — and he believed he could weaponize his performance against Biden, the presumptive Democratic presidential nominee. (Parker and Wan, 7/22)

Related KHN Story: Creator Of Brain Exam That Trump Aced Demands New Training For Testers (Aleccia, 7/29/19)

In other election-related news —

Former Vice President Joe Biden claimed on Wednesday that Donald Trump is the first racist elected president. Speaking during a virtual town hall, Biden made the claim in response to racist remarks that the president has made to characterize the coronavirus pandemic. Trump and others in his circle have repeatedly referred to the virus as the “China virus,” the “kung flu” and the “Wuhan virus.” Biden, the presumptive Democratic presidential nominee, said, "We’ve had racists, and they’ve existed, and they’ve tried to get elected president. But he’s the first one that has.” (Choi, 7/22)

Former President Obama and former Vice President Joe Biden recently took part in a socially distanced conversation to discuss Biden's presidential bid and the future of the U.S. amid the coronavirus pandemic. Video of the conversation, which will be released in its entirety on Thursday, shows the former president and vice president arriving in masks for a sit-down conversation and talking about how the Trump administration has handled the COVID-19 outbreak. (Manchester, 7/22)

The White House is conducting contact tracing after a cafeteria worker tested positive for coronavirus, three Trump administration officials tell NBC News. The cafeteria and an eatery in the Eisenhower Executive Office Building, or EEOB, were both closed this week after the case was discovered, officials said. It was unclear how long the facility will remain closed, although some staffers were told it could remain shuttered for two weeks. (Lederman, 7/22)

There is a cafeteria in the West Wing of the White House, but dozens of the President's staffers walk to Ike's for meals. The email says they conducted contact tracing and claims no executive office staff need to quarantine due to exposure. Still, news of another positive coronavirus test on the White House grounds underscores the unique challenge staffers face as they try to keep the pandemic out of the West Wing while the President pushes to reopen the country. (Collins, 7/22)

Iowa’s Medicaid director is stepping down to take another job, state leaders announced Wednesday. Mike Randol was hired in November 2017 to oversee Iowa's privatized Medicaid program, which covers care for more than 700,000 poor and disabled Iowans. Randol had previously held the same position in Kansas, which also privatized its Medicaid program. (Leys, 7/22)

Laboratories across the U.S. are buckling under a surge of coronavirus tests, creating long processing delays that experts say are actually undercutting the pandemic response. With the U.S. tally of infections at 3.9 million Wednesday and new cases surging, the bottlenecks are creating problems for workers kept off the job while awaiting results, nursing homes struggling to keep the virus out and for the labs themselves, dealing with a crushing workload. (Perrone, Webber and Sedensky, 7/22)

As coronavirus cases have surged in recent weeks, President Trump has repeatedly said the growing case count is a result of increased testing, not a worsening outbreak. An analysis by The New York Times, however, shows the rise in cases far outpaces the growth in testing. About 21,000 cases were reported per day in early June, when the positive test rate was 4.8 percent. As testing expanded, the positive test rate should have fallen. Even if it had stayed the same, there would have been about 38,000 cases reported each day. Instead, the positive test rate has nearly doubled, and more than 66,000 cases are now reported each day. (7/22)

When the coronavirus outbreak threatened to rock Philadelphia’s predominantly Black neighborhoods, Dr. Ala Stanford knew that access to COVID-19 tests was going to be a problem. So she rented a van, loaded it up and headed to the areas of the city where residents needed tests the most. Every test conducted was free. (Kim, Vann, Bronner and Manthey, 7/22)

Anybody who has waited for hours in line for a coronavirus test, or who has had to wait a week or more for results, knows there has to be a better way. In fact, the next generation of tests will focus on speed. But what should the Food and Drug Administration do with a rapid test that is comparatively cheap but much less accurate than the tests currently on the market? A test like that is ready to go up for FDA approval, and some scientists argue it could be valuable despite its shortcomings. (Harris, 7/22)

Swiss drugmaker Roche’s testing head said on Thursday that orders for equipment to process COVID-19 tests have soared to levels it would normally see over four to five years, as some governments dispatch military aircraft to pick up gear. “The orders we’ve gotten is as high as what we would normally sell in four to five years,” Diagnostics head Thomas Schinecker said. “We even had governments that flew in with military planes to pick up instruments, because they were in such need.” (7/23)

In testing news from Montana, Vermont, North Dakota and other states —

Kaiser Health News: States Search For Ways To Deal With COVID-19 Testing Backlogs 
States frustrated by private laboratories’ increasingly long turnarounds for COVID-19 test results are scrambling to find ways to salvage their testing programs. Montana said Wednesday that it is dropping Quest Diagnostics, one of the nation’s largest diagnostic testing companies. The Secaucus, New Jersey-based company had done all the state’s surveillance COVID-19 testing — drive-thru testing that moves from community to community to help track COVID’s spread. But it told state officials last week that it was at capacity and would be unable to accommodate more tests for two or three weeks. (Volz and Galewitz, 7/23)

With air travel on a slow but steady rise in recent months, airports have emerged as a locus for COVID testing. A number of governments and lab companies have launched SARS-CoV-2 testing sites at airports around the world, offering travelers and airport personnel an opportunity to determine their infection status with, in some cases, people testing negative able to avoid quarantines mandated by their destinations. (Bonislawski, 360Dx, 7/23)

Montana has agreements to expand surveillance testing for COVID-19 a week after Gov. Steve Bullock said such testing would have to be put on hold because of a backlog at an out-of-state lab the state was using. “Surveillance testing of asymptomatic individuals is a powerful tool in helping slow the spread of the virus in our Montana communities,” Bullock said in a statement Wednesday, hours after the state announced two more deaths and 104 new cases of COVID-19. A lab at Montana State University will be able to process 500 tests per day, starting as early as next week, he said. (Hanson, 7/22)

Lindsay Liebig would ultimately be one of 65 people who tested positive last week after completing the rapid antigen test offered at a private medical clinic in the heart Manchester, Vt., a town of less than 5,000. News of an outbreak set off alarms in a state that to-date had fared well in the pandemic, registering the second-fewest cases in the country. Many local restaurants and retailers quickly shut down. The Saturday farmers market was canceled. State officials with little information scrambled to answer questions from reporters and the public as to how where the outbreak began. But in Vermont, positive antigen tests — a relatively new way of detecting an active COVID infection — require confirmation by another test: a polymerase chain reaction, or PCR, test, the gold-standard used by the government, hospitals, and professional sports teams. Of the 65 people who’d received those positive antigen tests, 48 would ultimately test negative via PCR. Liebig was one of them. (Krueger, 7/22)

North Dakota plans increased statewide testing for the coronavirus in the days leading up the reopening of the state’s 11 colleges and universities this fall, officials said Wednesday. North Dakota University System Chancellor Mark Hagerott said he was optimistic face-to-face and online classes could resume on the planned Aug. 24 school start. “We’re confident we can move forward in about a month,” Hagerott said during Gov. Doug Burgum’s weekly COVID-19 briefing. (MacPherson, 7/22)

Southwest Airlines and American Airlines now say the carriers won’t be able to transport anyone over 2 years old who won’t wear a face mask, even those with medical conditions. Travelers who can’t wear a mask should stay home, the airlines said. Even Delta and United have toughened rules and are requiring those with medical issues to get advance clearance to be without a mask or face covering. (Arnold, 7/22)

A bipartisan majority of registered voters strongly support state mandates that would fine or jail individuals if they fail to wear a mask in public, a new POLITICO/Morning Consult poll finds. The broad approval for such mandates comes as statewide mask orders aimed at stopping the spread of coronavirus are under effect in more than half of U.S. states. Increasingly, Republican governors in states like Alabama and Arkansas have issued mask mandates, while top health officials are pleading with the public to cover their faces. (Cohen, 7/22)

The president’s maskless appearance at the Trump International Hotel this week — in apparent defiance of D.C. coronavirus regulations — caught the attention of local authorities, who inspected the hotel on Wednesday to check for compliance with city rules. The investigator found no violations at the time of the visit, but the agency pledged to continue monitoring the hotel. (Nirappil and Zauzmer, 7/22)

D.C. and Baltimore expanded mask requirements Wednesday in an attempt to stave off the growing spread of the novel coronavirus in the region. D.C. Mayor Muriel E. Bowser said her order requires people older than 2 to wear a mask when they leave the house and are likely to come into contact with others. It’s one of the strictest mask ordinances in the country — and came on the same day the city recorded 102 new coronavirus cases, the highest daily number since early June. (Zauzmer, Wiggins, Hedgpeth and Chason, 7/22)

Oregon Gov. Kate Brown announced Wednesday that she is expanding the state’s current COVID-19 mask order to also apply to children 5 years and older and that she is decreasing the capacity of indoor venues from 250 people to 100. The governor said these new mandates, which go into effect Friday, are necessary to help slow the increasing spread of coronavirus. On Tuesday, the total number of confirmed and presumptive virus cases in the state topped 15,000.“When we see the numbers rise, we must respond,” Brown said. (Cline, 7/22)

With California now recording more coronavirus cases than any other state, Governor Gavin Newsom said he will extend a contract with China’s BYD Co. for hundreds of millions of masks and warned that efforts to contain the pandemic will stretch into next year. California is burning through 46 million masks per month but needs more, with domestic companies still unable to supply them at the scale required, Newsom said in a news briefing Wednesday. He’s extending a contract with automaker BYD to supply another 120 million N95 masks and 300 million surgical procedure masks. (Baker, 7/22)

Face masks are mandatory at Walmart, Target and a growing number of retailers. President Trump, who long resisted being photographed in a mask, now encourages the public to wear them and said he carries one with him. But for U.S. banks, widespread adoption has been trickier. The small pieces of cloth public health officials consider one of the best defenses against the growing novel coronavirus threat could double as a handy disguise for would-be bank robbers, they say. Face-mask requirements “create the very real risk of increases in bank robberies,” a top financial regulator said recently. (Merle, 7/22)

In related news from Indiana, Ohio, Florida, Minnesota and D.C. —

The Republican governors of Indiana and Ohio on Wednesday announced statewide mask mandates a day after President Donald Trump threw his support behind facial coverings as a tactic to stop the spread of coronavirus. More than half of U.S. states now have mask mandates in place, as top health officials plead for universal mask wearing amid a rise in coronavirus cases and deaths. (Cohen, 7/22)

When Mayor Francis Suarez of Miami contracted the coronavirus in March, schools offered in-person classes, churches held worship services and restaurants were packed with diners. A very prominent patient No. 2 in Miami-Dade County, Mr. Suarez entered isolation just hours before declaring a state of emergency in his home city. More than four months and 90,000 cases later, Mr. Suarez now finds himself overseeing a city in crisis, as Florida emerges as a new epicenter of the pandemic. (Lerer, 7/22)

Minnesota Gov. Tim Walz (D) issued a statewide mask order Wednesday that will require people to wear face coverings at all times when in indoor public settings and businesses. Walz said the requirement, which many states have already put in place, is the cheapest and most efficient way to mitigate the spread of the coronavirus and allow businesses to reopen. (Klar, 7/22)

Healthcare providers will be required to account for how they spent COVID-19 relief grants by February 2021, HHS quietly announced on Monday. When lawmakers established the $175 billion Provider Relief Fund, one of the stipulations was that healthcare providers receiving large grants would have to submit quarterly reports to HHS and to an oversight commission on their spending, starting on July 10. But HHS delayed that reporting deadline last month and said providers wouldn't have to submit quarterly reports. (Cohrs, 7/22)

Unrest is spreading among Beaumont Health doctors as the hospital system's board of directors considers a possible merger with a large out-of-state hospital system. A no-confidence petition is now circulating among some doctors who are upset with the leadership of Beaumont CEO John Fox and Chief Medical Officer David Wood Jr. and the prospect of the merger with Advocate Aurora Health, a 28-hospital nonprofit system in Illinois and Wisconsin. (Reindl, 7/22)

Hospitals in northwest Houston are cohorting COVID-19 patients to their own areas in hospitals and contracting more workers from around the country as they work to keep up with the rising cases of coronavirus. Health care professionals endeavor to prevent further spread while handling their usual day-to-day workloads. (Pryce, 7/22)

Shareholders of Community Health Systems and its spinoff Quorum Health Corp. have asked for preliminary approval of an $18 million settlement to resolve a class-action lawsuit accusing the hospital chains and several executives of artificially inflating stock prices through misleading statements. The litigation stems from several shareholder lawsuits related to Quorum's 2016 spinoff from CHS. The complaint, filed that year in a Tennessee federal court, alleges that Brentwood, Tenn.-based Quorum didn't disclose that its hospitals were underperforming and as a result its public statements were false, among other accusations. (Kacik, 7/22)

San Francisco startup Hims & Hers took a further step into the mental health realm on Thursday, rolling out a new service that connects people with providers who can prescribe and manage common medications for depression and anxiety. The new feature is part of a broader recent push by the company as it works to position itself as a full-service telemedicine provider. (Brodwin, 7/23)

Nashville, Tenn.-based HCA, the country's largest for-profit hospital operator, landed well above analysts' expectations for the second quarter, which is widely expected to be a dud for hospitals given elective procedures were largely shut off throughout April and into May. HCA's higher profit was partly from government stimulus money combined with 16.6% lower expenses—a decline that would be striking even in normal times. HCA's supply costs fell 17.5% year-over-year in the second quarter, and labor costs fell almost 9% in that time. (Bannow, 7/22)

The top executives at Novavax, one of the biotechnology companies racing to develop a coronavirus vaccine, stand to collect tens of millions of dollars in compensation even if their treatment never makes it to market. The stock options earmarked for CEO Stanley Erck and three other company officials — first reported by Reuters — are worth more than $100 million based on Tuesday’s closing stock price. They’re contingent on the vaccine making it to a Phase 2 clinical trial, which is said to be imminent, though executives would have to wait a year before taking that step. (Shaban, 7/22)

Remdesivir, the intravenous antiviral drug made by Foster City's Gilead Sciences, is currently the only medicine shown in trials to effectively treat hospitalized COVID-19 patients, reducing the median length of hospital stays by about four days. But some Bay Area hospitals say the supply is barely keeping up with demand. (Arcuni, 7/22)

A Trump administration change in the way hospitals report coronavirus data is bringing confusion and more work to medical centers and states as cases explode across the country. And hospitals that don’t get it right every day could end up receiving fewer critical drugs like remdesivir. The Trump administration uses data on coronavirus hospitalizations, drug supplies and ICU beds to allocate scarce Covid-19 treatments, as well as supplies of plasma and protective gear. But last week, the Department of Health and Human Services abruptly changed the reporting process, bypassing a long-used Centers for Disease Control system with an alternative designed to more quickly help track the virus’ spread. (Tahir and Roubein, 7/22)

Doctors emphasize there is no evidence of widespread vulnerability to reinfection and that it is difficult to know what to make of these cases in the absence of detailed lab work, or medical studies documenting reinfections. Some people could be suffering from a reemergence of the same illness from virus that had been lurking somewhere in their body, or they could have been hit with a different virus with similar symptoms. Their positive covid-19 tests could have been false positives — a not-insignificant possibility given accuracy issues with some tests — or picked up dead remnants of virus, as authorities believe happened in hundreds of people who tested positive after recovering in South Korea. (Johnson and Eunjung Cha, 7/22)

The anecdotes are alarming. A woman in Los Angeles seemed to recover from Covid-19, but weeks later took a turn for the worse and tested positive again. A New Jersey doctor claimed several patients healed from one bout only to become reinfected with the coronavirus. And another doctor said a second round of illness was a reality for some people, and was much more severe. These recent accounts tap into people’s deepest anxieties that they are destined to succumb to Covid-19 over and over, feeling progressively sicker, and will never emerge from this nightmarish pandemic. And these stories fuel fears that we won’t be able to reach herd immunity — the ultimate destination where the virus can no longer find enough victims to pose a deadly threat. (Mandavilli, 7/22)

Levels of antibodies against SARS-CoV-2, the virus that causes COVID-19, dropped dramatically over the first 3 months of infection in 34 people recovered from mild illness, University of California at Los Angeles researchers have found. Their research letter, published yesterday in the New England Journal of Medicine, said that antibody levels against the novel coronavirus decreased by about half every 73 days and, if that rate were sustained, would be depleted within about a year. (Van Beusekom, 7/22)

In related news —

One of the most promising ways to treat patients sick with COVID-19 is with the plasma of people who have recovered from the illness and whose antibodies can be used to fight off the disease. With the surge of new coronavirus cases in Texas filling up hospitals, it’s getting harder to fill orders for convalescent plasma. (Tarrant, 7/22)

As the pandemic continues, doctors and researchers are learning more about the symptoms of COVID-19. And, as it turns out, some of them -- like rashes -- may be easy to see. One of the most widely talked about skin findings related to coronavirus infection is the so-called "COVID toes" syndrome. Dr. Ginette Okoye, chair of the department of dermatology at Howard University, described these as "a reddish-purple discoloration on the toes, accompanied by swelling and pain." Like many other symptoms of the virus, COVID toes are caused by "inflamed blood vessels." (Carringon and Farber, 7/23)

As coronavirus cases continue rising at an alarming rate in parts of the U.S., the notion of parties where guests knowingly try to expose themselves to COVID-19 would seem unheard of -- yet they're reportedly happening. Such events, deemed "COVID parties" by officials, have made headlines throughout the country. (Torres, 7/23)

Fox News has parted ways with a host who dismayed fellow staffers when she came to work while visibly sick in the early days of the coronavirus crisis. Heather Childers, who had been an early morning host on Fox since 2012, was benched after the incident in late March. She was not put back on the air again — despite her public campaign on Twitter and her messages to President Trump. This week, after sources said that Childers was no longer affiliated with the network, a Fox spokeswoman confirmed her exit. (Stelter, 7/22)

Kaiser Health News and The Guardian: COVID Runs Amok In 3 Detroit-Area Jails, Killing At Least 2 Doctors 
When Diana Trueblood visited the Wayne County Jail’s medical unit in Detroit in early March, she encountered a gentle and kind physician, Dr. Angelo Patsalis. Halfway through her incarceration for a probation violation, Trueblood remembered sitting “knee to knee” with Patsalis, who pulled down his face mask to speak to her about a tuberculosis skin test. She and other inmates were not provided with face masks, she said, and they pulled up their T-shirts to shield their mouths. (Megas, 7/23)

Kaiser Health News: Listen: How The Pandemic Further Politicized Public Health
KHN Midwest correspondent Lauren Weber joined Texas Public Radio’s David Martin Davies on “The Source” call-in show to discuss her recent reporting on how politics is shaping the public health response to the coronavirus pandemic. Weber has been reporting on the issue in collaboration with the Associated Press for the ongoing “Underfunded and Under Threat” series. (Weber, 7/22)

Up to a quarter of a million people in the Washington area could be thrown into hunger because of the novel coronavirus pandemic, according to a report by the Capital Area Food Bank, even as the amount of donated food and the number of distribution sites plummet precipitously. About half of the food bank’s 450 partner groups and food pantries are closed because of the pandemic — mostly because of building closures, a loss of elderly volunteers or a lack of funding. With hundreds of thousands newly out of work, the distribution sites that remain are reporting dramatic increases in demand, ranging from 30 percent to 400 percent. (Swenson, 7/22)

According to preliminary data, drug overdoses killed nearly 72,000 Americans in 2019, a record high. Now, it appears that 2020 is on track to be even worse, as the U.S. has witnessed a startling rise in overdoses during the pandemic. William Brangham reports on how increased isolation, economic uncertainty and reduced access to care have exacerbated American addiction -- with deadly consequences. (Brangham and Fritz, 7/22)

There have been more than twice as many suspected opioid overdoses in Wisconsin during the coronavirus pandemic than during the same period last year, which likely can be attributed at least partially to the added stress and isolation many are feeling, health officials said Wednesday. Preliminary figures from Wisconsin emergency departments show that there were 325 suspected overdoses from March through July 13, compared with 150 during the same time span in 2019, according to the state Department of Health Services. (Richmond, 7/22)

It's easy to joke that the acute stresses of 2020 are enough to drive anyone to drink. But that would be a dangerous option for Shannon Urban. In addition to being an executive and a divorced mother of a 9-year-old daughter, she is also a recovering alcoholic. (Sahadi, 7/22)

In other mental health news —

Kim Kardashian West issued a statement Wednesday morning requesting “compassion and empathy” from the public following weeks of worrisome behavior from her husband, Kanye West.“We as a society talk about giving grace to the issue of mental health as a whole,” she wrote, “however we should also give it to the individuals who are living with it in times when they need it most.” West, who announced on the Fourth of July that he intended to run for president, held a campaign rally in North Charleston, S.C., on Sunday, during which he spoke ill of abolitionist Harriet Tubman and revealed he and Kardashian had seriously considered terminating their first pregnancy. For the following two nights, West sent — and, in most cases, deleted — tweets detailing a strained relationship with his family. (Rao, 7/22)

For the past two months, as winter descended on Chile, infectious-disease specialist Claudia Cortés worked tirelessly to keep a wave of critically ill Covid-19 patients alive in the hospital where she works. At the same time, she worried about what would happen when the usual wave of influenza patients arrived. They never came. (Luhnow and Uribe, 7/22)

The lack of restrooms has become an issue for delivery workers, taxi and ride-hailing drivers and others who make their living outside of a fixed office building. For the city’s homeless, it’s part of an ongoing problem that preceded COVID-19. (Brown, 7/23)

The Centers for Disease Control and Prevention (CDC) yesterday reported an outbreak of Salmonella Newport infections that has sickened 125 people, 24 of them hospitalized, in 15 states as of Jul 20. The outbreak was first identified on Jul 10, when 13 people became ill from Salmonella Newport in three states. Infected people reported starting to feel sick from Jun 19 to Jul 7.No deaths have been reported in the outbreak, which has not been linked to a specific food, grocery store, or restaurant chain. But after analyzing specimens from those infected, investigators determined the bacteria causing the illnesses are closely related genetically, meaning that there is likely a common source of infection. (7/22)

Dee Ray doesn’t learn how children feel by listening to their words. Ray, a researcher and counselor in Texas, learns by watching them play. She directs the Center for Play Therapy at the University of North Texas and often works in schools, where she sections off a 10 feet by 10 feet area in a classroom and fills the space with toys — a child sized kitchenette, puppets, a bop bag that a child who needs to work out some aggression can punch. (McClain, 7/21)

The collapse of the child care industry is hitting women of color the hardest, threatening to stoke racial and gender inequities and putting pressure on Congress to address the crisis in its new round of coronavirus aid. Black and Latina women are suffering a double-barreled blow as coronavirus-induced shutdowns batter the industry, since they dominate the ranks of child care providers and have long struggled to gain access to the services for their own kids. (Mueller, 7/21)

Kaiser Health News: Adjunct Professors: Jobs Are Low On Pay And Health Benefits With High COVID Risk
David Chatfield feels he transitioned from an unstable career in graphic design to what is becoming an even more unpredictable one in academia. The 42-year-old teaches art history as an adjunct professor at two community colleges in Aurora and Fort Lupton, Colorado. He loves teaching, even when last semester the COVID-19 pandemic doubled his workload by forcing him to teach his seven classes online and figure out how to record and upload his lectures to YouTube. (Heredia Rodriguez, 7/23)

The recession triggered by the coronavirus pandemic is one of the worst in modern American history, with more than 11 percent of workers unemployed as of the beginning of July, down from a peak of nearly 15 percent in April. In a country where many rely on their employer for health care coverage, the economic crisis has also left a significant number of Americans uninsured. According to a report released by the nonpartisan organization Families USA during the week of July 13, an estimated 5.4 million workers in the U.S. are uninsured because of job losses they experienced from February to May this year. Another recent study by the Commonwealth Fund found that among people who lost a job or were furloughed because of the pandemic, two out of five had health care through their job, and one out of five of those respondents said that they or a spouse or partner was now uninsured. (Vinopal, 7/22)

Kaiser Health News: Ever Heard Of A Surgical Assistant? Meet A New Boost To Your Medical Bills
Izzy Benasso was playing a casual game of tennis with her father on a summer Saturday when she felt her knee pop. She had torn a meniscus, one of the friction-reducing pads in the knee, locking it in place at a 45-degree angle. Although she suspected she had torn something, the 21-year-old senior at the University of Colorado in Boulder had to endure an anxious weekend in July 2019 until she could get an MRI that Monday. (Hawryluk, 7/22)

Georgia’s largest school district said it will start the school year next month with full virtual instruction. Gwinnett County Public Schools’ announcement Monday reversed a plan the district had previously announced to open with a combination of in-person and digital instruction. The district said the current COVID-19 situation required it to change plans. (Klar, 7/22)

Arizona’s school districts should be empowered to reopen campuses for the new school year based on public health data instead of committing now to specific reopening dates, the state’s top education official said. Superintendent of Public Instruction Kathy Hoffman said Tuesday evening that she outlined her priorities to Gov. Doug Ducey, who is expected to announce the next steps for school reopenings this week. Ducey, a Republican, previously delayed the start of the school year until at least Aug. 17, weeks after most Arizona schools typically reopen following the summer break. (Cooper and Christie, 7/23)

Thousands of D.C. area families that had pinned their hopes on school buildings reopening this fall must grapple with a stunning new reality: Their children will not step inside a classroom for who knows how many months to come. The announcements came rapid-fire over the course of the day Tuesday: First, Fairfax County Public Schools and Loudoun County Public Schools in Northern Virginia said they were switching to all-virtual schooling in the fall. Hours later, Montgomery County Public Schools in Maryland followed suit. The districts’ decisions will cumulatively shape the fate of more than 438,000 children and their families. (Natanson, Balingit and Stein, 7/22)

Seattle’s school district superintendent has decided against having students return to the classroom in the new year school, saying the prospect of in-person learning is impossible amid rising coronavirus infection rates. Seattle Public Schools Superintendent Denise Juneau announced Wednesday that she’s recommending a fully remote learning model when school resumes in the fall. The school board is expected to vote on how to proceed during the pandemic at its next regularly scheduled board meeting on August 12. (Ho, 7/23)

In related news from the Trump administration —

President Trump said Wednesday he would be comfortable sending his school-age son and grandchildren to in-person school this fall even as the country struggles to contain the coronavirus pandemic. Trump suggested during a news briefing that children have strong immune systems to ward off the virus and pointed to some evidence that has shown young children transmit it less easily. “Yeah, I am comfortable with that,” Trump said when asked about his own family. (Itkowitz, 7/22)

Could children actually be “stoppers” of covid-19, the disease caused by the novel coronavirus? That would be great news — if true. The interruption of school threatens to create a learning deficit — and many parents may find it difficult to return to work if children are not in classes. Let’s examine DeVos’s evidence that children do not transmit the coronavirus, as it appears to be influencing administration policy. (Kessler, 7/23)

President Donald Trump made another series of false, dubious and misleading claims at a Wednesday coronavirus briefing in which he continued to paint an overly rosy picture of how the pandemic is affecting the United States. Despite the sharp uptick in cases he acknowledged and a US death toll that now exceeds 142,000, Trump declared that "it's all going to work out. And it is working out." (Dale, Subramaniam, Cohen and Steck, 7/22)

Opening day, at last. A baseball season that was on the brink before it ever began because of the virus outbreak is set to start Thursday night when excitable Max Scherzer and the World Series champion Washington Nationals host prized ace Gerrit Cole and the New York Yankees. When it does get underway — the DC forecast calls for thunderstorms, the latest rocky inning in this what-can-go-wrong game — it’ll mark the most bizarre year in the history of Major League Baseball. (Walker, 7/23)

The state of Pennsylvania won’t allow the Toronto Blue Jays to play at PNC Park in Pittsburgh amid the coronavirus pandemic, health officials announced Wednesday, becoming the second jurisdiction to say no to the team as the baseball season begins this week. Canada already denied the Blue Jays’ request to play in Toronto because the regular-season schedule would require frequent travel back and forth from the United States, where COVID-19 cases are surging. (Gillies, Levy and Graves, 7/23)

In football news —

The NFL will require fans to wear face coverings to games once spectators are allowed back, the league confirmed Wednesday. NFL public relations official Brian McCarthy confirmed the new policy in a tweet, saying the requirement would apply throughout the league. (Budryk, 7/22)

Questions regarding testing and protocols take precedence over getting someone’s signature on the dotted line at the moment. The logistics are staggering and change so quickly, decisions made in a meeting in the morning or early afternoon can be obsolete before the day is done. (Moore, 7/22)

As the COVID-19 pandemic battered large, metropolitan areas this spring, rural hospitals prepared to be next on the frontlines. But in order to ready their facilities for a potential surge in patients, those small hospitals had to forgo many of their most profitable operations. Months later, a few rural hospitals are fighting outbreaks. But others have empty beds, further threatening their viability in an era of shrinking health care options for people living in rural communities. (Simpson, 7/22)

Gov. Ron DeSantis has followed President Donald Trump’s lead for months while he waged a local battle against the coronavirus in Florida. That loyalty was rewarded with scorn from the White House this week as scrutiny on the state’s handling of Covid-19 ratchets up in the final months of the presidential campaign. Twice in two days, Trump and his aides have put the squeeze on DeSantis, a fellow Republican. (Dixon, 7/22)

In May, Massachusetts received the lowest amount of personal protective equipment from the federal government in the U.S. relative to its count of positive cases, according to an analysis of data gathered by The Associated Press and shared with WBUR and other news outlets. The AP's data examined how the Federal Emergency Management Agency distributed PPE across the U.S. (Willmsen, 7/23)

At least 13 nuns from a single convent in Livonia, Michigan, have died since the COVID-19 pandemic began nearly three months ago. A dozen nuns in the Congregation of the Sisters of St. Felix of Cantalice died after contracting the virus between April 10 and May 10, religious officials said. Another nun from the congregation died on June 27, according to the Global Sisters Report. (Allen, 7/22)

Iowa has surpassed 800 COVID-19 deaths, state health records showed Wednesday, as confirmed cases of the virus continued to climb. The state health department’s virus tracking site showed that as of 10 a.m. Wednesday, there had been 10 more deaths reported in the previous 24 hours. That brought the state’s total deaths to 808 since the beginning of the outbreak. The site also showed another 374 cases confirmed from Tuesday to Wednesday, bringing the state’s total to 39,793. (7/22)

When coronavirus cases reached 10,000 in Louisiana on April 3, Governor John Bel Edwards called it a “grim milestone.”  According to a new study from federal researchers, the real case count in those early days of the state's outbreak was actually much grimmer. By early April, there were at least 267,000 people infected with the coronavirus in Louisiana, or about one out of every 17 residents, according to research from the Centers for Disease Control and Prevention, which was published earlier this week in JAMA Internal Medicine. (Woodruff, 7/22)

Mississippi’s leaders continued to express concern Wednesday over the impact that rapidly increasing cases of coronavirus and hospitalizations will have on the state’s health care system. The Mississippi State Department of Health reported that 490 people were hospitalized with COVID-19 on June 27, followed by 602 on July 1. On Wednesday, 942 people were hospitalized with the virus. (Willingham, 7/22)

Portland Mayor Ted Wheeler was hit with tear gas fired by federal officers late on Wednesday as he stood alongside protesters massed again outside a courthouse. The Democratic mayor strapped on goggles and coughed heavily as the noxious fumes wafted past. “It’s hard to breathe, it’s a lot harder to breathe than I thought,” Wheeler told The Washington Post. “This is abhorrent. This is beneath us.” Wheeler’s brush with chemical irritants came after he made a contentious, and at times tense, attempt to talk with protesters. (Lang, 7/23)

Navajo Nation President Jonathan Nez signed an executive order Wednesday to keep parts of the tribal government closed through mid-August, citing surges of coronavirus cases off the reservation. Executive branch divisions, departments and offices that were set to reopen July 27 will stay closed until Aug. 16. (7/23)

A leading doctor on the White House coronavirus task force reportedly warned state and local officials Wednesday that Las Vegas, among other U.S. cities, should take “aggressive” steps to address a rising number of cases. Dr. Deborah Birx cautioned officials during a private phone call, according to a report by the Center for Public Integrity, a Washington, D.C., nonprofit newsroom. Birx named 10 other major U.S. cities whose increases in percentage of tests returning positive should compel them to act, including Baltimore, Miami and New Orleans. (Johnson, 7/22)

Nebraska has seen a surge of people testing positive for coronavirus this week, according to state health officials. The state health department’s online virus tracker on Wednesday showed more than 600 new cases of the virus since the beginning of the week, including 264 cases on Monday and 343 on Tuesday. The state’s total stood at 23,190 by Wednesday. The site also shows nine COVID-19 deaths so far this week, bringing the state’s total to 310 since the outbreak began. (7/22)

Condemned inmate John Beames died on Tuesday from a suspected case of COVID-19, marking the latest death in a coronavirus outbreak at San Quentin State Prison, officials said. Beames is the eighth Death Row inmate to die from a suspected case of COVID-19. Fourteen inmates at San Quentin have died and more than 2,000 were infected as of Wednesday. (Bauman, 7/22)

Ninety-six people in connection with the Lexington Correctional Center have tested positive for COVID-19, the Oklahoma Department of Corrections reported Wednesday. Two inmates from the same unit at the correctional center went to the hospital on July 13 and 15, and both tested positive for COVID-19. After receiving the inmates’ test results, the correctional center tested 180 other inmates from that same unit, along with several staff members. The test results for 87 additional inmates and seven staff members came back positive. All of the non-hospitalized inmates are asymptomatic. (Melero, 7/23)

Idaho hospitals are seeing the highest number of patients since the pandemic began, but Gov. Brad Little’s weekly AARP town halls — during which Idahoans have the opportunity to call in and ask questions — are becoming less frequent. The one-hour phone calls, which have been one of the few ways the governor has had regularly-scheduled question and answer sessions with the public, will now occur every two weeks, Lupe Wissel, Idaho AARP director, announced on Tuesday’s call. (Frankel, 7/23)

In news from Texas —

Jessica Ortiz said she and her twin brother, Jubal, were inseparable. Even when Jubal lay dead in an open casket with plexiglass over his body -- out of fear he could still be contagious with coronavirus -- she couldn't help but lean down and touch him at his viewing earlier this month. Now, weeks later, she wears a necklace with his ashes. "He meant the world," Jessica, who is from Hidalgo County in South Texas, said, remembering her 27-year-old brother. "I just wish it wasn't him." (Killough, Lavandera and Jones, 7/22)

Nearly two-thirds of Texas voters say the spread of the coronavirus in their state is “out of control,” according to a new Quinnipiac University poll released Wednesday. Sixty-five percent of respondents said the virus is running wild in the Lonestar State, which has emerged as a new hot spot in recent weeks. Slightly less than a third, 31 percent, said the coronavirus is largely under control in the state. (Greenwood, 7/22)

The starkly divergent ways in which the coronavirus has affected neighboring communities in the Houston area — one rich and one poor — underscore how it is a magnifier of inequities. To see how the virus can largely spare one neighborhood but upend one next door, look at Bellaire, with its tidy yards and spacious homes, and Gulfton, where apartment blocks pack residents in tight. (Goodman, 7/21)

Mexican President Andrés Manuel López Obrador on Wednesday downplayed the importance of wearing face masks during the pandemic, calling his treasury secretary’s assertion that using them would be a factor in reactivating the economy “disproportionate.” López Obrador had never been seen publicly wearing a mask until he flew to Washington earlier this month to meet with President Donald Trump. (7/23)

In the weeks he spent flat on his back in his Brooklyn bunk, wracked with pain and struggling to breathe, Axayacatl Figueroa could think of nothing but the small town and the family he had left behind in Mexico. Each month, he had sent $300 or $400 to his wife and son in San Jerónimo Xayacatlán. The money was hard earned: For more than a decade, he cleaned pork, cut meat and boned chickens in the basement kitchen of a Vietnamese restaurant. But now, Figueroa had COVID-19. There was no work, and there was no money to send home. (Torrens and Verza, 7/23)

All passengers in the U.S. must prove they tested negative for Covid-19 within three days of their flight to Hong Kong, the city’s government announced Wednesday. The policy adds the U.S. to a list of “high risk places” that includes India, Indonesia and South Africa. (Einhorn, 7/22)

Puerto Rico officials announced Wednesday that all public school students will start virtual classes Aug. 17 as the U.S. territory battles an increase in coronavirus cases. Education Secretary Eligio Hernández said he was delaying the reopening of public schools for in-person classes by one month to Sept. 17, though he cautioned it is a preliminary plan that could change if cases aren’t controlled. (Coto, 7/22)

he day-to-day increase of new confirmed COVID-19 cases in the Czech Republic has surpassed 200 for the second straight day. One of the latest clusters appeared in Prague where 76 people have been infected in a nightclub. The Health Ministry says the number of infected reached 247 on Wednesday, the biggest increase since June 28. (7/23)

The proof is piling up: Many synthetic chemicals can harm your health and that of your children. Evidence has doubled in the last five years about the negative impact on our health of endocrine-disrupting chemicals in plastics, pesticides, flame retardants and other merchandise, according to a new review of recent literature. "It's a global problem. These are chemicals used in consumer products all across the world," said senior author Dr. Leonardo Trasande, chief of environmental pediatrics at NYU Langone. (LaMotte, 7/22)

Long-term malnutrition might at first seem like a medical condition with an easy fix: access to a wholesome diet rich in calories and nutrients. But many of the children on the receiving end of such interventions still struggle to grow. Even when given enough to eat, they end up shorter than their peers and are saddled with cognitive deficits, weakened immune systems and other long-term consequences that tax their brains and bodies alike. The result is a paradox that continues to vex researchers worldwide. (Wu, 7/22)

The National Institutes of Health is preparing to launch a “flurry” of large clinical trials to test new approaches to treating Covid-19, according to the agency’s director, hoping to expand what for now remains a limited arsenal of therapies to help people with the disease. In an interview, NIH Director Francis Collins characterized the studies as “really well-powered, rigorously designed clinical trials.” (Herper, 7/23)

Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. (RECOVERY Collaborative Group, 7/17)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and spread globally, prompting an international effort to accelerate development of a vaccine. The candidate vaccine mRNA-1273 encodes the stabilized prefusion SARS-CoV-2 spike protein. We conducted a phase 1, dose-escalation, open-label trial including 45 healthy adults, 18 to 55 years of age, who received two vaccinations, 28 days apart, with mRNA-1273 in a dose of 25 μg, 100 μg, or 250 μg. There were 15 participants in each dose group. (Jackson et al, 7/14)

In this randomized clinical trial that included 95 participants with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks (mean left ventricular ejection fraction, 53.8% vs 56.1%, respectively). (Jabbar et al, 7/21)

As the Ebola epidemic raged in 2014, some West Africans resisted public health guidance. Some hid their symptoms or continued practicing burial rituals — like washing the bodies of their dead loved ones — despite the risk of infection. Others spread conspiracies claiming the virus was sent by Westerners or suggested it was all a hoax. In Conakry, Guinea’s capital city, an imam was arrested for violating his quarantine, and residents protested by not letting health officials check for fevers. So the World Health Organization sent Cheikh Niang, a Senegalese medical anthropologist, and his team to figure out what was going on. (Charlie Warzel, 7/22)

I've received increasing criticism in recent weeks because I've offered more nuanced messaging on whether everyone should wear cloth face coverings in public to protect against COVID-19 transmission—messaging that some view as unacceptable. The criticism has included a recent commentary by Masks4All proponents Jeremy Howard and Vincent Rajkumar, MD, that mischaracterizes my position on cloth face coverings and misrepresents the science of personal protection for COVID-19. Again, I want to make it very clear that I support the use of cloth face coverings by the general public. I wear one myself on the limited occasions I'm out in public. In areas where face coverings are mandated, I expect the public to follow the mandate and wear them. At the same time, I have been concerned about "message creep" since the Centers for Disease Control and Prevention (CDC) first recommended in April to use cloth face coverings without providing additional context regarding their use. (CIDRP Director Michael T. Osterholm, 7/22)

I am a hospitalist in Arizona, which is one of the most infected states in the nation. COVID-19 cases are surging here. I watch, horrified, as the number of cases and deaths increases. Every day I hear "Code Blue" called overhead for someone in one of the many COVID units. I listen as colleagues notify family members that their loved one is unlikely to survive. (Brandon Bikowski, 7/23)

Life probably won’t return to normal until we have a widely distributed Covid-19 vaccine, and the good news is this may happen sooner than expected thanks to years of private investment and new cooperation between the U.S. government and drug companies. On Wednesday the Trump Administration announced a $1.95 billion advance order for 100 million doses of a promising vaccine candidate by Pfizer and Germany-based BioNTech that could be available by the end of the year. Dare to dream. The drug makers plan to begin the final phase of their clinical trials this month and seek regulatory approval as soon as October. (7/22)

This might be the most obvious thing in the world, but parents need to come to grips with the fact that their kids probably aren't going to be in classrooms this fall. There will be exceptions, sure, in places where schools do open for normal hours or something close to it. There will be kids who go part-time (this is becoming known as the "hybrid" option). But it's becoming clear that a large portion of the country's kids won't be in class and parents need to start planning for that if they haven't already. (Zachary B. Wolf, 7/22)

By the time Gov. Gavin Newsom announced that most California schools would have to start the fall semester online, the state’s seven biggest school districts, representing 17% of its students, already had announced that they were going online-only or were headed in that direction. Given the surge in COVID-19 cases, the decision was inevitable. The current situation is treacherous, and too much is unknown about where the pandemic is headed. Yes, other nations have successfully reopened their campuses, but they started with much lower infection rates than the more than 30 counties on California’s watchlist, which includes Los Angeles and Orange counties. (7/23)

On Monday, my 20-year-old daughter called. (Actually, she Face-Timed. Only boomers like me call people anymore.) She was peppily reporting the details of how her internship in North Carolina was going when she changed her tone and said: “I have to tell you guys something else.” She then let us know that her roommate was mildly sick and displaying some symptoms that could be linked to COVID-19. (Scott Maxwell, 7/22)

No child in South Carolina should be forced to be physically present in a school building in order to receive an adequate education during the upcoming academic year. Period.It’s that simple. That should be a steadfast and firm rule of thumb as our state works toward reopening our schools by this fall — and particularly as long as South Carolina continues to grapple with troubling rates of COVID-19 cases and deaths. It’s time for Gov. Henry McMaster to leave no doubt that he embraces that philosophy. (7/21)

Public schools are essential. Experts across disciplines agree that in-person school serves students better than distance learning. Students need to be with their peers. Parents need in-person school to meet childcare needs. Businesses need schools open for employees to come to work. But if schools cannot open safely, then they must remain closed. Our children’s safety must be our top priority. Numbers of COVID-19 cases are spiking across the state. If we cannot contain the virus, then we cannot expect our students to return to in-person school or demand that teachers and school workers put their lives at risk. (State Rep. Lisa Willner, 7/22)

House Democrats passed a comprehensive coronavirus relief bill in May. Republicans waited. Now, with federal economic aid expiring at month’s end, they cannot agree among themselves on a plan, let alone forge a compromise with Democrats. The GOP is out of time, and there is no reasonable alternative to continuing massive federal aid. Republicans must admit the obvious and get a bill passed, immediately. (7/22)

Congress responded to the spreading COVID-19 pandemic in March with astonishing speed (by congressional standards), enacting three bipartisan-backed measures in quick succession to increase coronavirus testing, extend sick leave to more workers and, most dramatically, inject more than $2 trillion into the collapsing U.S. economy. Senate Majority Leader Mitch McConnell (R-Ky.) has shown no such urgency since then. And now, one of the most important elements of the third measure, the Coronavirus Aid, Relief and Economic Security Act, is about to expire, slashing benefits to millions of laid-off Americans even though unemployment is worse now than in the depths of the Great Recession. The CARES Act increased unemployment benefits by $600 a week, but that support is set to end this week. (7/23)

Doctors caring for patients track vital signs of temperature, blood pressure, breathing and pulse. Public health doctors fighting epidemics do something similar — they track the most important indicators of the spread of a disease and attempts to control it. During the Ebola epidemic in West Africa, for example, with coordination from the National Security Council at the White House, the Centers for Disease Control and Prevention produced a weekly dashboard that graded how well each country was doing on the steps to stop the disease. This focused attention on where Ebola was spreading and what needed to be done to stop it. But today, the White House is not guiding our response to Covid-19, and neither the C.D.C. nor any other part of the government has been empowered to play this role. We aren’t tracking the public health equivalent of vital signs. That’s one big reason the United States is losing the battle against Covid-19. (Tom Frieden and Cyrus Shahpa, 7/21)

“Thank you for calling to check on me but I only have 10 minutes left on my phone this month, and I want to save them. Can I just keep my appointment and come in?” Our hearts broke as our patient, Betty, shared these words. By calling a patient to care for her remotely during the pandemic, we unknowingly forced a choice between Betty’s connection with the outside world or potential exposure to the coronavirus. No one should have to make such a choice. (Eboni Winford and Terri Sabella, 7/22)

After a marathon four-day summit, Europe’s leaders finally reached agreement on their coronavirus recovery plan. The resulting package isn’t all it should’ve been, and things might yet go wrong as the plan is implemented. Their deal is nonetheless an important step forward. The scheme strikes a compromise between the governments that wanted a bold new fiscal stimulus directed especially toward the European Union’s worst-hit economies, and others more concerned with maintaining fiscal discipline and avoiding the creation of a so-called transfer union. It allows the European Commission to borrow 750 billion euros and use the proceeds to help struggling economies over the next three years — allocating 390 billion euros in the form of non-refundable grants and the rest as loans. (7/22)

The economic carnage and social disruption wrought by the COVID-19 pandemic has affected virtually every part of the economy, but few sectors have suffered as much as aviation. This week alone, the three major U.S. airlines announced furloughs for thousands of staff. As Congress and the administration contemplate further measures to aid America’s faltering economy, they can’t afford to ignore aviation and its broad economic impact, including the 11 million aviation-related jobs supported by its $1.8T economy, representing 5 percent of U.S. GDP. (Megan S. Ryerson, 7/22)

We could all spend a lot of intellectual energy debating whether President Trump’s failures are due primarily to corruption or incompetence, but it would be a waste of time.Understanding that his incompetence flows from his corruption should animate the arguments against his reelection and inspire the work journalists do in making sense of the chaotic mess Trump has made of our government. (E.J. Dionne, 7/22)

President Donald Trump's new political self-preservation effort to show he has a grip on a pandemic that is killing hundreds of Americans every day is being exposed by his refusal to share the stage with scientific experts -- or the facts. On a day that laid bare his refashioned campaign strategy, Trump hammered out a tough law-and-order push, escalated a Cold War with China and tried to show he is managing the fight against Covid-19 after weeks of neglect. (Stephen Collinson, 7/23)