November 19 coronavirus news

The coronavirus pandemic is getting so bad, so quickly, across the United States that an influential academic modeling group has hiked its forecast of deaths considerably.

The Institute for Health Metrics and Evaluation at the University of Washington School of Medicine now predicts 471,000 people will die from Covid-19 by March 1.

That’s up from its forecast of 438,941 just a week ago.

The group said their forecast "assumes that 40 states would reimpose social distancing mandates as the daily death rate exceeds 8 per million."

If states do not do this, the "death toll could reach 658,000 by March 1,” they added. 

This increased death forecast is even taking into account that the US has improved the infection-fatality ratio with better treatments.

“Our analysis suggests that after controlling for age, sex, comorbidities, and disease severity at admission, the hospital-fatality rate has declined by about 30% since March/April,” it said. Obesity is a major factor in the fatality rate, it said.

Japan reported its highest number of daily Covid-19 cases for the second consecutive day, with 2,397 infections on Thursday, according to the country's Health Ministry.

There were 21 deaths also reported, the Health Ministry said.

Despite the continued spike, Japan's Chief Cabinet Secretary Katsunobu Kato said imposing a state of emergency is not necessary.

Kato added that the weekly infection average has doubled in the past two weeks and said the government needs to be at maximum alert.

"We would like to pursue the economic and social activities while taking thorough implementation of basic prevention measures," the secretary said.

The total number of virus cases nationwide now stands at 125,979 and 1,956 deaths.

Rising cases: Tokyo, Osaka and six other prefectures also posted record high numbers from Thursday. 

Tokyo reported 534 new cases Thursday -- surpassing the 500 mark for the first time. Osaka reported 338 new cases.

The data Pfizer and BioNTech have released so far on their Covid-19 vaccine candidate “are really exciting and give us great hope,” US Food and Drug Administration Commissioner Dr. Stephen Hahn said Thursday.

The companies said this week the data from the clinical trials show the potential coronavirus vaccine is 95% effective in preventing disease and that they plan to file for an emergency use authorization from the FDA on Friday.

Hahn said the agency needs to see the raw data on the vaccine.

“So what will be submitted to us is raw data around the clinical trial that would support a claim for safety and effectiveness of the vaccine, which of course is our primary responsibility here, with an emergency use authorization or an outright approval,” he said.

That’s not the only thing the agency reviews.

After the FDA receives the application, Hahn said the agency will set a date for a meeting of the Vaccines and Related Biological Products Advisory Committee, or VRBPAC. A source told CNN this week the date had already been set, for December 8, 9 and 10. But Hahn said a date has not yet been set. 

Once the application is submitted to the FDA, agency scientists review it and come to their own conclusions, Hahn said.

Hawaii has tightened a program that allowed out-of-state visitors to avoid quarantine, just over a month after it was first put into place.

“We’re taking this added safety precaution now in response to the dramatically increasing number of Covid-19 cases in the continental United States and around the world,” said Hawaii Gov. David Ige. 

Currently, travelers from the US and Japan can avoid a full 14-day quarantine if they get a Covid test before traveling, and it comes back negative at any point during their stay.

But starting next Tuesday, visitors must have their negative result in-hand before they get on the plane in order to move around freely in Hawaii.

Anyone who arrives in the state without a negative coronavirus test already filed must adhere to the full 14-day quarantine, even if a negative result comes back before the quarantine period is over. 

Even though the rules are being tightened, the quarantine exemption program itself is expanding. Starting in mid-December, the program will also be available to travelers from Canada. All eligible fliers must take a Covid-19 test within 72 hours of travel from a provider designated by the state.

The United States has reported 182,601 Covid-19 cases so far on Thursday, according to Johns Hopkins University, the highest one-day total since the pandemic began.

The previous daily high was on November 13, with 177,244 cases.

The US has also reported 1,964 Covid-19 deaths so far on Thursday. At least 11,710,084 Covid-19 cases, including 252,484 deaths, have now been reported nationwide

The numbers are not the final count for the day, however, and could rise further.

The totals include cases from all 50 states, the District of Columbia and other US territories, as well as repatriated cases.

CNN is tracking the US cases:

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Tracking Covid-19 cases in the US

Mexico has reported a total of 100,104 deaths from Covid-19, the country's Health Ministry said Thursday during its nightly health news conference. 

Mexico is the fourth country to surpass 100,000 coronavirus deaths after the United States, Brazil and India. 

According to John Hopkins University, Mexico has a 9.8% case-fatality rate of Covid-19, the second highest rate in the world.

The Health Ministry also reported 4,472 new Covid-19 cases on Thursday, bringing the total number of infections in Mexico to 1,019,543.

CNN is tracking worldwide cases:

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Tracking coronavirus' global spread

The rural hospital system in the United States is struggling to manage the Covid-19 pandemic.

The spike of cases in rural America in the past few weeks has been a “challenge on a number of levels,” said Tom Morris, associate administrator for rural health policy in the federal government’s Health Resources and Services Administration. Morris made the comments Thursday during the National Institutes of Health rural health seminar. 

Rural hospitals are small: Of the 2,000 hospitals considered to be rural, about 1,700 have 50 beds or fewer and 1,300 of them have 25 beds or fewer, said Morris, whose agency is part of the Health and Human Services Department.

“We’re not talking about large facilities. We’re not talking about a lot of ICU capacity,” Morris said. “In a lot of these hospitals, they’re able to offer an ICU of one or two beds. So, they have very limited inpatient resources.”

Limited work force: The rural medical work force needed to care for Covid-19 patients is extremely limited, he said, as is the supply chain that would provide protective equipment. Many of these hospitals are also “financially vulnerable,” Morris said. 

Hospitals are closing: Morris said the Trump administration has given $150 million to the 1,700 50-bed rural hospitals to help with the extra costs of the pandemic. Rural hospitals, health clinics and community health centers also got an extra $11 billion to offset the losses they were facing due to the pandemic. But still, 17 rural hospitals have shut this year, adding to the 130 rural hospitals that have closed since 2010.

“We have many more rural hospitals that are at a financial risk and have been for quite some time,” Morris said, “The pandemic has not made any of that easier.”

The World Health Organization has updated its ongoing guidance on Covid-19 medications to advise against using the antiviral drug remdesivir to treat hospitalized patients, no matter how severe their illness may be.

According to the update, published in the medical journal the BMJ on Thursday, current evidence does not suggest remdesivir affects the risk of dying from Covid-19 or needing mechanical ventilation, among other important outcomes.

WHO's new update comes about a month after the company Gilead Sciences, the maker of remdesivir, announced that the US Food and Drug Administration approved remdesivir for the treatment of coronavirus infection. The drug became the first coronavirus treatment to receive FDA approval. 

Remdesivir may have received FDA approval but not WHO's recommendation because of emerging research — which initially showed some benefit against Covid-19, but as more data accumulate, that appears to be changing, said Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, who was not involved in the WHO guidance. 

"The fact that it was an antiviral that showed some benefit in certain trials — but not in all trials — was enough to push people to want to use it because we had no tools, but I do think it probably will be supplanted shortly," Adalja said, adding that the indication for drugs can change over time.

Some context: WHO convened an international panel of 24 experts and four survivors of Covid-19 to review data and make recommendations. The recommendation against remdesivir was based on data from four randomized trials including 7,333 people hospitalized with Covid-19.

"The panel concluded that most patients would not prefer intravenous treatment with remdesivir given the low certainty evidence," researchers from various institutions around the world wrote in the updated WHO guideline.

An early cold snap in the middle of the country at the end of September has helped drive the most recent surge of coronavirus infections, White House coronavirus adviser Dr. Deborah Birx said Thursday.

People began moving indoors, she said. That’s when transmission really begin to take off, especially with close to half of all infections asymptomatic, so people do not even realize they are infecting others.

“So we have been going across the country to really tell them, (the) mid-Atlantic states and the Northeast, to really increase testing, looking for these asymptomatic cases and I really want to thank the governors across this great land who have really heeded that call,” Birx told a White House briefing – the first public briefing by the task force since July.

Birx said when states increase the use of masking and encourage people to avoid gatherings, it helps control the rise in cases. 

Health officials say smaller gatherings are helping drive the spread of the virus. The US Centers for Disease Control and Prevention earlier on Thursday advised against traveling for the Thanksgiving holiday and urged Americans to celebrate the holiday only with household members.