#SootinClaimon.Com : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

https://www.nationthailand.com/lifestyle/30396717?utm_source=category&utm_medium=internal_referral

Trump campaign flouted agreement to follow health guidelines at Duluth rally, documents show

Health & BeautyOct 25. 2020President Donald Trump throws hats to the crowd as he arrives for a campaign event at the Duluth International Airport on Sept. 30, in Duluth, Minn. MUST CREDIT: Washington Post photo by Jabin Botsford 

By The Washington Post · Shawn Boburg · NATIONAL, HEALTH, POLITICS, WHITEHOUSE, HEALTH-NEWS 
The start of President Donald Trump’s rally was still hours away when it became clear his campaign would not keep its promise.

In the days leading up to the Sept. 30 event in Duluth, Minn., local officials had privately pressed the campaign to abide by state public health guidelines aimed at slowing the spread of the novel coronavirus, documents show. In response, the campaign signed an agreement pledging to follow those rules, limiting attendance to 250 people.

On the day of the rally, however, Trump supporters flooded onto the tarmac at Duluth International Airport. They stood shoulder to shoulder, many without masks. 

“We have been notified that the 250 person limit has been exceeded,” an airport representative emailed a campaign official late that afternoon. “This email serves as our notice of a contract violation and we are requesting you remedy the situation.”

The warning went unheeded – and unanswered.

Held two days before Trump was diagnosed with covid-19, the rally was attended by more than 2,500 people, airport officials estimated.

The Duluth event shows the dilemma local officials face as Trump turns to his signature rallies in the closing weeks of the campaign: They can enforce local guidelines intended to protect the public, and risk antagonizing the campaign and its supporters, or they can look the other way as the campaign holds massive gatherings at a time when coronavirus cases are surging in many states.

Emails and other documents obtained by The Washington Post through open-records requests show that Duluth officials insisted on adherence to the rules, and the campaign responded by making commitments it ultimately did not keep. The documents also show that local officials suspected the campaign would violate the agreement, but shied away from enforcing public health orders for fear of provoking a backlash.

“We will not incite an incident by unilaterally taking physical action to close the event,” the airport’s executive director, Tom Werner, wrote to the airport’s appointed board members the morning before the event.

Minnesota public health officials have traced 19 coronavirus cases to a pair of Trump rallies held in the state in September, three of them to the event in Duluth. 

A spokesman for the Trump campaign did not respond to a request for comment.

In a statement, the Duluth Airport Authority said it takes state health mandates seriously. “It was made clear to the Trump Campaign, in the lead up to the event, that compliance with the State of Minnesota’s current public health executive orders was an expectation of the DAA,” the statement said.

In the early months of the pandemic, Trump refrained from holding large gatherings. That changed in June, when he hosted an indoor rally in Tulsa against the advice of local public health officials. With the novel coronavirus raging, Trump has now resumed daily campaign rallies. As of Friday, he had held 14 events in the previous 12 days, often defying limits on crowd size and requirements for social distancing – and sometimes mocking those rules.

Airports are the campaign’s venue of choice for these campaign stops. Because airports are often run by local government entities, their public records provide a window into the private negotiations that take place before the events.

In early September, the Reno-Tahoe Airport Authority told one of its tenants it could not hold a planned 5,000-person Trump rally in a hangar leased at Reno-Tahoe International Airport, citing the state’s 50-person crowd limit, according to a letter obtained by The Post.

Airport officials in Reno publicly said at the time that the decision had nothing to do with politics, but the Trump campaign hit back, saying “Democrats are trying to keep President Trump from speaking to voters.” Trump rescheduled at another Nevada airport that agreed to host the event.

In late September, emails show, the campaign approached Duluth airport officials about holding a rally there. Local officials in the Democratic stronghold almost immediately expressed concerns.

The region was already beginning to see a spike in coronavirus cases. And Minnesota Gov. Tim Walz, D, had issued an executive order in June limiting outdoor gatherings to 250 people.

The campaign initially told city officials it expected up to 9,000 people, according to a Sept. 25 email the local fire chief, Shawn Krizaj, sent to his deputies. Krizaj wrote that he was trying to work with airport officials and the campaign to ensure the rally complied with the governor’s cap on public gatherings.

The following day, City Council member Joel Sipress emailed the city’s Democratic mayor, Emily Larson. “Whether the event is indoors or outdoors, under the law the attendance must be limited to 250 people,” he wrote.

Larson responded that she was still getting more information about the event but added: “We have been explicit and clear on this with them.”

Sipress, a Democrat, also wrote to two airport authority board members that he believed the airport was “legally obliged” to ensure the campaign obeyed the state’s limit. The Duluth Airport Authority, or DAA, has a seven-member board appointed by the mayor.

As airport officials fielded emails and calls, Werner, the airport’s executive director, sought to assure the members of the DAA. He wrote that he would require the campaign to sign a written agreement pledging to follow public health orders.

“That’s all DAA can do,” he said in an email on Sept. 27. “We do not have the resources for enforcement at the event. We will rely on the City’s emergency management and police for strict enforcement.”

The emails show that city officials looked to the state to step in and enforce the governor’s order.

Krizaj, the city’s fire chief, spoke to state officials about the rally but was told they were “not going to actively enforce” the 250-person cap and were “washing their hands of it,” according to a Sept. 28 email Werner sent to airport board members. 

In an interview with The Post, Krizaj confirmed that officials in the state’s Department of Public Safety said they would not enforce the governor’s order.

“The message was, ‘It was going to be up to local jurisdictions,’ ” he said.

The Minnesota Department of Public Safety said in a statement that it did not have the authority to enforce the governor’s order. A spokesman for the state’s Department of Public Health said it when it has learned about plans for large events it has “worked to make sure the organizers understand both the executive order requirements and the public health guidance.” The agency also has limited authority to enforce the state guidelines at rallies, said spokesman Doug Schultz.

In his email to board members, Werner wrote that the state balked at enforcing the crowd limit partly because of a provision exempting federal workers conducting official business.

“They said, practically we’ll have a hard time proving POTUS is not acting in his official capacity during his visit, even though we know it’s a campaign. . . . Bottom line, the State will not provide any help here,” Werner wrote.

The following day, Werner and the campaign signed an agreement, a copy of which was released to The Post. It shows the airport was to provide space for the rally, parking, circulation and staging and support facilities for a $20,000 fee. It includes a clause citing the state’s public health emergency and specifying that compliance with the governor’s executive orders is required.

Werner informed the airport’s board members that he had also signed a nondisclosure agreement that would prevent him from discussing details of the agreement with board members or others. “All airports have had to sign them who have seen rallies at their facilities,” he wrote. 

Werner declined to comment on the nondisclosure agreement for this story. A clause in the contract he signed prohibited him from disclosing the campaign’s “confidential information” but includes few details about the parameters. There was no separate nondisclosure agreement, according to the DAA’s attorney, Steven Hanke.

The morning of the rally, Werner told the airport’s board that he would reinforce his plea to the campaign to keep the crowds small.

“I will make another appeal to the campaign, this morning, asking for their plan to comply with the 250 person cap on crowds,” he wrote. The records do not show whether the campaign responded. 

“If they violate the cap, the security guard will inform DAA senior staff and move on to other duties,” Werner wrote to board members.

Airport personnel would then inform the campaign by email, Werner explained. He also said the airport would later send a formal letter to the campaign, but he said he couldn’t elaborate on that due to the nondisclosure agreement. 

“Of course, it is possible things will go just fine,” he wrote. “However, I want to outline the steps in case things go a certain way.”

That afternoon, an airport board member wrote to Werner asking how many people were expected at the rally that night.

Werner said the most recent estimate from the campaign was 1,000. “Perhaps the rain will keep folks home,” he added.

That evening, the crowd filtered in, triggering the contract violation notification from the airport.

Airport officials estimated that between 2,500 and 3,000 people showed up, according to emails. 

Krizaj told The Post that city officials expected that the campaign would encourage social distancing and masks. “We were kind of under the impression that there would be a little bit more enforcement from campaign staff and volunteers, which we did not see,” he said.

“It’s really hard to stand up to a president who insists on holding an event that puts the health of your community at risk because presidents have a lot of power,” said Sipress, the city council member.

A little more than 30 hours after the rally, Trump’s diagnosis prompted a flood of media inquiries about the rally and the airport’s decision to host it, records show. Airport officials said nothing about the contract requirement or the violation, only issuing the same statement provided to The Post for this story.

Documents show that the DAA had prepared a public statement before the rally, for possible release afterward, saying: “We are disappointed the Trump campaign did not comply.” That line was ultimately not included in DAA’s statements to the media.

On Oct. 5, Hanke, the attorney for the airport, sent the campaign a formal letter asserting that it had breached the agreement’s 250-person limit. The letter also said the Trump campaign had not paid the airport the $20,000 fee for hosting the event. 

Two weeks later, officials won’t say whether that fee has been paid. “That information is covered under our nondisclosure agreement and cannot be released,” a spokeswoman for the airport said in an email.

#SootinClaimon.Com : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

https://www.nationthailand.com/lifestyle/30396715?utm_source=category&utm_medium=internal_referral

WHO report: Tuberculosis is a huge worldwide threat. The pandemic could make it worse.

Health & BeautyOct 25. 2020

By Special to The Washington Post · Erin Blakemore · NATIONAL, HEALTH, HEALTH-NEWS 
In 2019 alone, an estimated 10 million people worldwide got tuberculosis, a deadly bacterial disease that usually affects the lungs. An estimated quarter of the world’s population has a TB infection. Most aren’t actively sick – yet.

People with TB have a 5% to 15% risk of getting ill. Still, the highly contagious disease was one of the top 10 causes of death worldwide last year and is the leading infectious killer worldwide, according to the World Health Organization, the United Nations’ public health agency. 

In a new report, WHO provides a global update on the state of TB and the fight against the disease, which is both preventable and curable.

The report paints a dire picture of a disease that remains a public health crisis. Just eight countries – India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa – account for two-thirds of the world’s TB cases. And because many carriers of the disease are not yet ill, it can go untreated until it’s too late.

Tuberculosis incidences are falling, the agency says – between 2015 and 2019, cases were reduced by about 9 percent. But that still falls short of WHO’s targets.

The coronavirus pandemic is expected to make things worse. 

Large drops occurred in TB diagnoses between January and June. Due to the economic effects of the pandemic, WHO models predict that cases could annually increase by more than 1 million in the next five years if resources continue to be diverted to covid-19, the disease caused by the coronavirus.

The stark report has positive news however. Funding for TB prevention, diagnosis and treatment has doubled since 2006, and seven high-burden countries reached their death reduction milestone. And people living with HIV are more likely than ever to be given preventive treatment for tuberculosis, which is the leading killer of people with HIV worldwide.

#SootinClaimon.Com : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

https://www.nationthailand.com/lifestyle/30396681?utm_source=category&utm_medium=internal_referral

America is poised to enter into its worst stretch yet of the pandemic

Health & BeautyOct 24. 2020President Donald Trump and Democratic presidential candidate Joe Biden participate in the final presidential debate on the campus of Belmont University on Oct. 22, 2020, in Nashville, Tenn. MUST CREDIT: Washington Post photo by Jabin Botsford 

By The Washington Post · William Wan, Jacqueline Dupree · NATIONAL, HEALTH, POLITICS, HEALTH-NEWS 

America on Friday hit its highest daily number of coronavirus case since the pandemic began, recording at least 81,400 new infections and surpassing the previous record set during the summertime surge of cases across the Sun Belt.

The rising numbers puts the nation on the precipice of what could be its worst stretch to date in the pandemic with some hospitals in the West and Midwest already overwhelmed and deaths counts beginning to rise.

The current surge is considerably more widespread than the waves from last summer and spring. The unprecedented geographic spread of the current surge makes it more dangerous, with experts warning it could lead to dire shortages of medical staff and supplies. Already, hospitals are reporting shortfalls of basic drugs needed to treat covid-19, the disease caused by the novel coronavirus.

And it’s not simply a matter of increased testing identifying more cases. Covid-19 hospitalizations increased in 38 states over the past week and are rising so quickly that many facilities in the West and Midwest are already overwhelmed. The number of deaths nationally has crested above 1,000 in recent days.

The last time the country hit a new daily record for coronavirus cases – 76,533 on July 17 – just four states accounted for more than 40,000 of those cases: Arizona, California, Florida and Texas.

On Thursday, the daily number of cases reached 73,686. But this time, it’s 14 states accounting for that same lion’s share of cases. And 22 states have broken their records for single-day highs of cases in the past two weeks.

More than 170 counties across 36 states were designated rapidly rising hotspots, according to an internal federal report produced Thursday for officials at the Department of Health and Human Services and obtained by The Washington Post.

“One key way we got through previous waves was by moving health-care workers around. That’s just not possible when the virus is surging everywhere,” said Eleanor J. Murray, an epidemiologist at Boston University.

Equally alarming, Murray said, is that no one knows how high this wave will grow before peaking.

“We are starting this wave much higher than either of the previous waves,” she said. “And it will simply keep going up until people and officials decide to do something about it.”

More than 8.3 million Americans so far have been infected with the coronavirus, and at least 222,000 have died, according to a database maintained by The Post.

The high case numbers of recent days have stoked concerns because the country has not even hit the stretch of holidays and cold weather, which experts have long warned will send cases soaring even higher. More interactions could mean more transmission during celebrations of Halloween, Christmas and the New Year. The winter’s cold, dry air will also help the virus stay stable longer, even as it drives people to hunker down together indoors.

On Thursday, Chicago Mayor Lori Lightfoot, D, announced new restrictions on businesses. Hours later, White House coronavirus response coordinator Deborah Birx warned that closing public spaces may not be enough.

“It won’t be as simple as closing public spaces,” Birx said, pointing to increased gatherings in people’s homes. “What has happened in the last three to four weeks is that people have moved their social gatherings indoors.”

In some areas of Wisconsin, 90 percent of hospital intensive care unit beds are full, the office of Gov. Tony Evers, D, said. The first patient was admitted Wednesday to a makeshift field hospital erected at a state fairgrounds.

Hospitals from Missouri to Idaho are starting to reach capacity. On Thursday, America had more than 40,000 current covid-19 hospitalizations – the first time that level has been reached since August. In the past three weeks, 34 states saw sizable increases in hospitalizations, and the number has more than doubled in Connecticut, Montana, New Mexico and Wyoming.

In Utah, leaders are trying to open a field hospital at an exposition center. State epidemiologist Angela Dunn warned that the health-care system is at capacity, hospital staff are exhausted, and Utahans are getting scared.

“You know, I just, I don’t know what to do anymore,” Dunn said at a Thursday news conference, pleading for residents to be more cautious. “I’m really not trying to scare anyone. I’m just trying to inform you of what’s going on.”

Experts said the problem facing many hospitals this winter won’t be finding enough beds. It will be ensuring that hospitals have sufficient specialized staffing.

“Creating beds is relatively easy, but what do you do when you outstrip ICU nurses, doctors and teams?” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

In recent months, health-care workers have been able to lower mortality rates – the ratio of patients who die once infected. Much of that progress has come through hard-earned expertise by ICU staff – new approaches and knowledge about how to combat the virus, such as when to use ventilators, the adoption of treatments such as steroids and proning patients, which helps with breathing by shifting them onto their abdomens.

But the hard-won battle to lower mortality rates could be imperiled as hospitals are overwhelmed and staffing gets stretched, Osterholm said. And as the pandemic has seeped into rural swatches of the Midwest, skeleton staffs at smaller hospitals are shrinking further as doctors and nurses fall ill.

A report this week by Osterholm’s center showed shortages in 29 of the 40 basic but critical drugs often used for covid-19 patients. That includes antibiotics, sedatives like propofol that are used to calm patients during intubation and heart medication such as norepinephrine. And because of the widespread nature of the infections, hospitals are finding it harder to draw from excess supplies of such drugs elsewhere.

The nation’s growing fatigue with the pandemic will likely make it even harder to contain a wintertime wave, specialists fear.

Even as hundreds of people are dying each day, “there’s this false sense of calm right now,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. “We have the president saying, ‘We’re rounding the corner.’ We have state leaders openly defying public health guidances.”

Inglesby pointed to plans and metrics many states laid out last spring for reopening. “That’s been completely disregarded in many places,” he said.

In North Dakota – among the hardest-hit states – Gov. Doug Burgum, R, put the onus on individuals to wear masks and avoid gatherings.

“It’s not a job for government,” Burgum recently declared.

At Thursday night’s final presidential debate, President Donald Trump claimed the virus was “going away” and “we’re learning to live with it.” His Democratic rival, former vice president Joe Biden, responded, “We’re learning to die with it.”

Experts say rapid action is needed by leaders and residents to tamp down virus transmission.

“It’s been framed as this false choice between full shutdowns and doing nothing, but that’s not the case,” said Inglesby, who urged people to wear masks and avoid large gatherings.

Politicians also need to stop minimizing the risk posed by the virus and start discussing openly with the public the hard decisions and trade-offs that lie ahead, Murray said. Is it, for example, worth keeping bars open if it means having to close schools?

“I worry sometimes about being too pessimistic,” she said. “We are not making predictions and saying this dark winter is somehow inevitable. We’re trying to warn people this is how it will be if we don’t do something about it.

“But it doesn’t have to be that way.”

#SootinClaimon.Com : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

https://www.nationthailand.com/lifestyle/30396680?utm_source=category&utm_medium=internal_referral

Johnson & Johnson, AstraZeneca coronavirus vaccine trials set to resume

Health & BeautyOct 24. 2020

By The Washington Post · Carolyn Y. Johnson · NATIONAL, HEALTH, HEALTH-NEWS 

The Johnson & Johnson coronavirus vaccine trial, paused earlier this month due to an unexplained illness in a participant, is preparing to restart after investigators concluded the man’s stroke did not appear to be related to the vaccine, according to two individuals familiar with the trial who spoke on the condition of anonymity.

The AstraZeneca vaccine trial, on hold in the United States since early September, also got the greenlight Friday to restart from the Food and Drug Administration, according to a company statement.

When a potential adverse event occurs during a clinical trial, the testing is typically stopped so that an independent data and safety monitoring board can thoroughly investigate and determine whether the problem was likely related to the vaccine. Rules around clinical trials and patient privacy usually restrict details from being released, but the tremendous scrutiny of the coronavirus vaccine trials has led many experts to call for greater transparency in disclosing and explaining the reasons for such halts.

In the Johnson & Johnson trial, which was paused on Oct. 12, a man who received a vaccination suffered a stroke that may have been triggered by an infection. To conclude it was not likely to be related to the shot, investigators probed not only the medical details of the event, but also examined a safety database of 100,000 people who have received vaccines that use the same underlying technology.

The investigation found “no clear cause” of the incident, according to a company statement. It also found no evidence the vaccine triggered the event, the details of which were not disclosed by the company. The independent board that monitors the trial recommended lifting the pause.

“With the information which we gathered to date and the information from external experts, the company found no evidence the vaccine candidate caused it,” Paul Stoffels, chief scientific officer of Johnson & Johnson said in an interview. He did not offer any details of the illness, citing patient privacy.

The company is testing the only vaccine that aims to protect people with a single shot; other prospective vaccines require a return visit and second shot three to four weeks after the first to trigger a protective immune response.

It was the second late-stage vaccine trial put on hold in recent weeks; the vaccine being developed by AstraZeneca and the University of Oxford was halted on Sept. 6 after a British participant developed a neurological problem. While the AstraZeneca study had resumed in the rest of the world, it did not get clearance to restart in the U.S. until Friday.

AstraZeneca spokeswoman Michele Meixell did not provide further information on the illness, but said the FDA reviewed data from the trials running around the world before concluding it was safe to restart. She said the company was adding a new expert panel “to provide advice on diagnosis and causality assessment of neurological events,”in addition to continuing standard company oversight and the independent data and safety committee.

Pausing and unpausing clinical trials happens routinely, and experts have said that the public should be confident the process worked as intended to protect the health and safety of participants.

“We see this all the time during clinical research,” said Carlos del Rio, an infectious diseases physician at Emory University School of Medicine. “As long as the data and safety monitoring board has reviewed the data and says its OK to proceed, we proceed.”

But whether the temporary halts — particularly the prolonged pause of the AstraZeneca trial — dampens volunteers’ interest in participating remains to be seen.

“We are excited to get this trial back up and running,” said William Hartman, a principal investigator of the AstraZeneca trial at the University of Wisconsin Hospital and Clinics. “It is too soon to tell whether participant enthusiasm will approach what it was prior to the pause. We certainly hope it will.”