Early in the pandemic, public health workers all over the United States launched efforts to trace outbreaks back to their origins, whether at busy restaurants or crowded meatpacking plants. But with the virus now spreading rapidly in much of the country, overwhelmed state and local health officials are scaling back those contact tracing efforts, or even abandoning them altogether.
Revealing the trail of transmission from one person to another is a key tool for containing the spread of an infectious disease. Within 48 hours of testing positive, patients receive a phone call from a trained contact tracer, who conducts a detailed interview, and then hunts down each new person who may have been exposed, warning them to quarantine and get tested.
That, at least, is how it’s supposed to work.
Now, with the United States recording a staggering two million new cases in less two weeks and 42 states recording sustained caseload increases, public health agencies are making hard choices about how much they can still realistically learn, and acknowledging that contact tracing efforts can no longer be expected to contain the virus’s spread.
On Monday, the Centers for Disease Control and Prevention released new guidance that called on health departments to focus contact tracing efforts on people who had tested positive within the past six days and especially those who were at the greatest risk of infecting others. Patients infected more than 14 days ago should not be traced, the new guidance says.
States like Pennsylvania, which had already been revising its tracing protocols, have announced that they will follow the C.D.C.’s new guidance.
Dr. Nirav Shah, who heads Maine’s coronavirus response, explained how his state would scale back its ambitions: Contact tracers would touch base with each new patient only once, and not throughout the course of their illness, to make sure they were well and quarantining.
“Unfortunately, going forward, we have had to make a difficult decision, and I wanted you to hear about that difficult decision from me,” he said when announcing the change.
“Sadly, in Maine and throughout the country, the virus is moving faster and spreading faster than the ability of states to train and deploy new public health investigators.”
Similar decisions were being made all over the country.
New Hampshire last week said that it would only trace cases of people connected to outbreaks or in specific at-risk age or racial groups.
Minnesota’s Itasca County this month said that it was abandoning contact tracing, advising the public that, “if you are in a group setting, just assume that someone has Covid.”
In North Dakota, state officials said last month that they could no longer have one-on-one conversations with everyone who may have been exposed. Aside from situations involving schools and health care facilities, people who test positive were advised to notify their own contacts, leaving residents largely on their own to follow the trail of the outbreak.
Public health experts remain hopeful that contact tracing remains useful in identifying clusters and determining the broad contours of how and where infections are spreading.
“There are diminishing returns when the outbreak is out of control, like it is currently, but the returns aren’t zero,” said Dr. Thomas Tsai, a health policy researcher at Harvard T.H. Chan School of Public Health. “The discourse around our treatments tends to be all or nothing.”
Crystal Watson, an assistant professor at Johns Hopkins Bloomberg School of Public Health, said contract tracers should give first priority to the patients most at risk of spreading the virus.
“It still saves lives, it still breaks chains of transmission,” she said. “Every person we can get to quarantine at home, who is not out in the community — that contributes to reduction in incidence.”
Rich DiPentima, New Hampshire’s former chief of communicable disease and epidemiology, said contact tracing capacity much of in the United States has been weak since the pandemic began, so it is no surprise that it can’t keep up now.
“We have a situation where we missed the boat in the beginning,” he said of the situation in his state. “Then you throw up your hands, saying you can’t do this any more.”
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Americans have agonized over Thanksgiving this year, weighing skyrocketing coronavirus numbers and blunt warnings from the Centers for Disease Control and Prevention against gathering with family for a traditional, carbohydrate-laden ritual.
The United States reported more than 2,200 virus-related deaths on Tuesday alone, the highest daily total since May 6. The country’s seven-day average for new cases has also exceeded 175,000 for the first time.
Around 27 percent of Americans plan to dine with people outside their household, according to interviews conducted by the global data-and-survey firm Dynata at the request of The New York Times.
Views on whether to risk Thanksgiving gatherings appear to track closely with political views, with respondents identifying as Democrats far less likely to be planning a multihousehold holiday.
Megan Baldwin, 42, had planned to drive from New York to Montana to be with her parents, but last week, she canceled her plans.
“I thought I would get tested and take all the precautions to be safe, but how could I risk giving it to my parents, who are in their 70s?” she said, adding that they were not happy with the decision.
“All they want is to see their grandkids,” she said, “but I couldn’t forgive myself if we got them sick. It’s not worth it.”
Others decided to take the plunge, concluding that the emotional boost of being together outweighed the risk of becoming infected, after a grim and worrying year.
“We all agreed that we need this — we need to be together during this crazy, lonely time, and we are just going to be careful and hope that we will all be OK,” said Martha Dillon, who will converge with relatives from four different states on her childhood home in Kentucky.
The AAA has forecast a 10 percent overall decline in Thanksgiving travel compared with last year, the largest year-on-year drop since the recession of 2008. But the change is far smaller, around 4.3 percent, for those traveling by car, who make up a huge majority of those who plan to travel — roughly 47.8 million people.
About 912,000 people were screened by the Transportation Security Administration on Tuesday, which was 1.5 million fewer people than were seen on the same day in 2019, according to federal data published on Wednesday.
Airlines are struggling from a dramatic decline in demand that has forced them to drop flights and make big capacity cuts, said Katherine Estep, a spokeswoman for Airlines for America, an industry trade group. “Currently, cancellations are spiking, and carriers are burning $180 million in cash every day just to stay operating,” she said. “The economic impact on U.S. airlines, their employees, travelers and the shipping public is staggering.”
Demand for travel by train is down more sharply, at about 20 percent of what it was last year, said Jason Abrams, a spokesman for Amtrak.
Susan Katz, 73, said she canceled plans to spend Thanksgiving with her daughter last Friday, after watching a monologue by Rachel Maddow, the MSNBC host, describing her partner’s bout of coronavirus and her fear that it would prove fatal.
“Her emotion, Rachel Maddow’s emotion, made it so real, it just moved us,” Ms. Katz said. “I probably called her within a few hours of seeing that.”
Ms. Katz, who lives in Raleigh, N.C., said she would spend the holiday alone with her husband. She is trying to decide whether to bother thawing a turkey breast.
Warnings from experts swayed Laura Bult, 33, to cancel her Sunday flight to St. Louis two days before she was scheduled to leave.
“Doing the small part of being one less person circulating through an airport felt important enough to me,” she said.
Boris Epshteyn, a member of the Trump campaign legal team, tested positive for the coronavirus on Tuesday, he said in a tweet.
“I have tested positive for COVID-19. I am experiencing mild symptoms, and am following all appropriate protocols, including quarantining and contact tracing,” he wrote.
Mr. Epshteyn was present at a news conference at the Republican National Committee headquarters last week, along with Andrew Giuliani, a White House aide who announced the next day that he had tested positive for the virus.
Mr. Epshteyn has spent lots of time with Rudolph W. Giuliani, Andrew’s father and President Trump’s lead lawyer on efforts to overturn the results of the 2020 elections.
Mr. Giuliani is scheduled to attend a gathering of Republican lawmakers in Gettysburg, Pa., on Wednesday afternoon to talk about allegations of voting irregularities. He had convinced President Trump to join him, despite concerns from a number of other advisers who believed it was beneath a sitting president to attend and had tried to get the trip canceled.
The press pool that covers Mr. Trump was told the trip was canceled just as they were getting ready to depart by car, after Mr. Epshteyn tweeted that he had tested positive.
News of his diagnosis had raised questions of whether Mr. Giuliani would risk other people’s health by traveling to Gettysburg.
At least 45 people closely connected to the White House — including the president and first lady, aides, advisers and others — have tested positive for the virus since the start of the pandemic.
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Frontline health care workers have been the one constant, the medical soldiers forming row after row in the ground war against the raging spread of the coronavirus. But as cases and deaths shatter daily records, foreshadowing one of the deadliest years in American history, the very people whose life mission is caring for others are on the verge of collective collapse.
In interviews, more than two dozen frontline medical workers described the unrelenting stress that has become an endemic part of the health care crisis nationwide. Many related spikes in anxiety and depressive thoughts, as well as a chronic sense of hopelessness and deepening fatigue, spurred in part by the cavalier attitudes of many Americans who seem to have lost patience with the pandemic.
Surveys from around the globe have recorded rising rates of depression, trauma and burnout among a group of professionals already known for high rates of suicide. And while some have sought therapy or medications to cope, others fear that engaging in these support systems could blemish their records and dissuade future employers from hiring them.
In Texas, a critical care physician battles the lingering memories of the summer weeks when his entire family was sickened with Covid-19, after he came home from the hospital infected.
In New York, an emergency room nurse grapples with the trauma of the spring, as cases once again rise ahead of the winter months.
In Arizona, an emergency medicine physician deals with the déjà vu of a local outbreak — an eerie echo of the swell in New York he experienced in March, April and May.
In Colorado, a geriatrician fights to find hope amid a slew of nursing home deaths and the stigma of seeking mental health treatment during the nation’s time of crisis.
America’s health workers, they said, will not benefit from empty words of praise. The recent rises in cases could have been prevented. “It’s so disheartening. We’re coming here to work every day to keep the public safe,” said Jina Saltzman, a physician assistant in Chicago. “But the public isn’t trying to keep the public safe.”
And on the front lines, health workers are no stronger or safer than anyone else. “I’m not trying to be a hero. I don’t want to be a hero,” said Dr. Cleavon Gilman, the Arizona emergency physician. “I want to be alive.”
The top refugee official at the United Nations said Wednesday that the rise in coronavirus infections in much of the world has worsened an already extant toxic side effect of the pandemic: the abuse of refugee women and girls.
“We are receiving alarming reports of sharp increases in the risks of gender-based violence, including intimate partner violence, trafficking, sexual exploitation and child marriages,” said the official, Filippo Grandi, the high commissioner for refugees.
In a statement, the U.N. Refugee Agency, the leading provider of assistance to many of the world’s nearly 80 million refugees, attributed the spike in violence in at least 27 countries to “a lethal mix of confinement, deepening poverty and economic duress” caused partly by the pandemic.
The refugee agency reported double-digit increases in gender-based violence in the African nations of Cameroon and the Central African Republic. In Colombia, home to Venezuelans who have fled the dysfunction and mayhem in their own country, gender-based violence increased 40 percent in the first nine months of 2020 compared with a year earlier, the agency said.
In Cox’s Bazar, Bangladesh, which has an enormous population of Rohingya refugees from neighboring Myanmar, the agency said 42 percent of respondents to a survey reported that conditions were now more unsafe for women and girls “inside the home” because of the coronavirus. In particular, the agency said, women and girls risk “intimate partner violence, resulting from tensions over containment measures, movement restrictions and financial difficulties.”
U.N. officials have been warning since the pandemic began that a pre-existing “shadow pandemic” of gender-based violence against women and girls was intensifying because of the health crisis. U.N. Women, an agency that promotes gender equality, said in a statement on Wednesday that for every three months the coronavirus lockdowns continue, an additional 15 million women are expected to be affected by violence.
A Malaysian company that makes disposable gloves used around the world for protection against the coronavirus has been hit by a major outbreak among its workers, many of them foreign laborers who live in crowded dormitories.
The outbreak at 28 factories operated by the company, Top Glove Corporation, has infected more than 2,400 workers this month and driven one of Malaysia’s biggest spikes in coronavirus cases since the pandemic began.
Until now, Malaysia has been relatively successful in containing the virus, reporting 59,817 total cases and 345 deaths as of Wednesday. But the country of 32.5 million people reported a new daily high of 2,188 cases on Tuesday, topping the previous record of 1,884 set a day earlier.
Top Glove said Wednesday that it had stopped work at 20 factories in the hope of stemming the outbreak.
The company makes disposable gloves and face masks, and has ramped up production because of the pandemic. The United States and Europe are among its biggest customers.
Most of Top Glove’s workers come from developing countries in Asia — including Bangladesh, Myanmar and Nepal — and live and work in crowded conditions where the virus can easily spread. Malaysia’s minister of human resources, M. Saravanan, toured workers’ quarters days ago and said that the living conditions were “terrible,” according to The Star, a Malaysian newspaper.
“We have started investigations and will spare no one if they were found to have flouted labor laws,” he told The Star.
Andy Hall, a labor activist who has long criticized Top Glove, said its workers live in unsanitary and overcrowded dormitories, sometimes packed more than 30 to a room.
“It was obvious it would happen,” Mr. Hall said. “This company has never focused on the welfare of its staff.”
Company officials defended the company’s treatment of workers and rejected assertions that the quarters were crowded and unsanitary.
They said they were surprised by Mr. Saravanan’s comments and said that conditions in the dormitories have improved since his visit.
Top Glove officials said the company had been upgrading the dormitories since the United States sanctioned the company in July, citing evidence that it had engaged in forced labor practices, and banned the import of some of its products. In response, Top Glove also has begun paying restitution to affected workers.
Top Glove hopes that the outbreak will be under control in two to four weeks. The company sought to assure its customers that the gloves it produced were not contaminated with the coronavirus.
In other news from around the world:
Japan and China, its largest trading partner, have agreed to restart business travel between the countries later this month, the Japanese foreign minister said on Wednesday. Business travelers will be exempt from quarantine if they test negative for the coronavirus and submit an itinerary of their activities. The arrangement does not apply to tourists and follows similar ones that Japan has begun with Singapore, South Korea and Vietnam.
President Emmanuel Macron of France said on Tuesday that the country was past the peak of its second wave and that shops could reopen on Saturday. Bars and restaurants are unlikely to reopen until mid-January, he said.
Applications for unemployment benefits in the United States rose for the second week in a row last week, the latest sign that the nationwide surge in coronavirus cases is threatening to undermine the economic recovery.
More than 827,000 people filed first-time applications for state unemployment benefits last week, the Labor Department said Wednesday. That was up 78,000 from a week earlier, before adjusting for seasonal patterns, and more than 100,000 from the first week of November, when weekly filings hit their lowest level since pandemic-induced layoffs began last spring.
Another 312,000 people filed for benefits under the federal Pandemic Unemployment Assistance program, which covers freelancers, self-employed workers and others who don’t qualify for state benefits.
Unemployment filings have fallen dramatically since last spring, when more than six million people a week were applying for benefits. But progress has stalled in recent months, and the data reported Wednesday suggests it could be going in reverse.
Other evidence tells a similar story. Consumer confidence fell in November, the Conference Board reported Tuesday, and private-sector data on job postings, hours worked and consumer spending show either a loss of momentum or outright declines in November.
“We have definitely seen a slowdown since Labor Day, and in the last few weeks it’s actually gone into a decline,” said Dave Gilbertson, a vice president at UKG, which provides time-tracking software to about 30,000 U.S. businesses.
Economists worry that the slowdown could deepen in coming weeks, as consumers pull back on spending and cities and states reimpose business restrictions, something that has already begun to happen in California, Michigan and other states.
Those We’ve Lost
This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.
Honestie Hodges, who was handcuffed by the police outside her home in Grand Rapids, Mich., when she was 11, a frightening incident that drew outrage and national headlines in 2017, died on Sunday. She was 14.
Her death, at the Helen DeVos Children’s Hospital in Grand Rapids, was caused by Covid-19, her grandmother Alisa Niemeyer wrote in a post on the website GoFundMe.
On Dec. 6, 2017, Honestie and her family were confronted outside their home by police officers with their guns drawn.
The police, who said they had been searching for a 40-year-old woman in connection with a stabbing, briefly handcuffed the 11-year-old, an incident that caused a widespread uproar and led to a soul-searching within the Grand Rapids Police Department.
This year, Honestie developed severe stomach pains on Nov. 9, her 14th birthday. Taken to the hospital, she tested positive for the coronavirus, and she was placed on a ventilator a few days later.
Then, on Sunday, Ms. Niemeyer wrote: “It is with an extremely heavy heart that I have to tell you that my beautiful, sassy, smart, loving granddaughter has gone home to be with Jesus.”
Ms. Niemeyer told WOOD-TV that Honestie had been “healthy and happy” with no underlying health issues.
A Chinese state-owned vaccine maker has filed an application with the country’s Food and Drug Administration to market coronavirus vaccines in China before the completion of late-stage trials that will determine their safety and efficacy.
Vaccines made by CNBG, a subsidiary of the state-owned pharmaceutical company Sinopharm, are in late-stage trials with more than 50,000 volunteers in 10 countries, including Argentina, Bahrain, Egypt, Jordan, Morocco, Peru and the United Arab Emirates.
The announcement was made by Sinopharm’s deputy general manager, Shi Shengyi, the state-run Xinhua news agency reported on Wednesday. The article, by the agency’s finance arm, gave no further details and did not specify whether the application was for one or both of the coronavirus vaccines that CNBG manufactures. The company did not respond to requests for comment.
The Chinese government has approved three coronavirus vaccines for emergency use, including two made by CNBG.
Even before the completion of the late-stage trials, Chinese officials had considered those vaccines and one by a rival firm so effective that they allowed tens of thousands of people to be injected. That prompted criticism from scientists that the government was ignoring the risks posed to public health.
Last week, Sinopharm’s chairman, Liu Jingzhen, said the company had injected nearly a million people and that none had reported adverse reactions, with “only a few having some mild symptoms.”
Mr. Liu said those people included construction workers, diplomats and students who took the vaccines before traveling to more than 150 countries. None were infected during their trips, he added.
Many scientists have said that such data is anecdotal and should not be used as evidence that the Sinopharm vaccines are effective.
For the first time since the coronavirus outbreak hit the United States, the country has added more than one million cases in each of the past two weeks. Covid deaths, which lag reported cases by weeks, are also at a level not seen since the spring.
In the past week, the United States added an average of 173,000 new daily cases. If this growth pattern holds, the total number of cases reported for the full month of November is likely to hit 4.5 million. That would be more than double the number of any previous month.
With several days still left in the month, about 3.3 million people in the United States had already tested positive for the coronavirus as of Monday.
North Dakota continues to have the country’s worst outbreak when adjusted for population, a position it has maintained since early September. Almost one in 10 North Dakotans have tested positive for the virus since the outbreak began, a vast majority in the last two months.
But cases there as well as in other parts of the Upper Midwest and Mountain West that drove the initial fall surge have leveled off slightly, while cases are growing on both coasts and in the South and Southwest.
Amid numerous game cancellations and players and coaches alike testing positive for the coronavirus, the men’s college basketball season will start Wednesday with more than 100 games being played nationwide. This burst of games and the travel — some of which will happen on commercial flights — come at a time when universities are urging their non-basketball-playing students to exercise great caution as they head home for Thanksgiving.
Some coaches are wondering how long a season can go on like this.
Rick Pitino, head coach at Iona College, believes that with vaccines being readied and flu season just arriving, the best way to rescue college basketball’s moneymaker — the N.C.A.A. tournament — may be to move the season back. He suggests starting the season in March and ending it with May Madness.
Dedrique Taylor, the coach at Cal State Fullerton, said one of his players tested positive last Thursday, prompting his team to quarantine for two weeks. The next day, the University of Washington tournament they had entered was canceled. Mr. Taylor said that in the normal rhythms of a season, coaches want their teams to build toward playing at their best in March, just as the Titans did when they reached the N.C.A.A. tournament in 2018.
Now, though, instability will be baked in — along with many questions. Mr. Taylor wonders about injury risks when players return from quarantine, about whether the country will loosen up or lock down and how he can support his players and assistants.
“I don’t understand why we’re playing or why we’re opening up when we’re trying to do away with the virus,” he said. “We’re almost encouraging the virus by bringing people together.”
Though her mother lives in Arizona, Cecily Smith typically spends Thanksgiving in New York City with friends who feel like family.
Some years, they shared holiday meals at restaurants. Other times, they held potlucks in cramped apartments.
But with the country in the grip of a surging pandemic, Ms. Smith will spend Thanksgiving this year alone in her Harlem apartment, making herself cocktails and binge-watching Netflix. Her friends, she said, plan to do the same.
“I know I’m going to be lonely,” said Ms. Smith, 46, who has lived in the city for about 20 years. “It is lonely. This is a whole lonely experience.”
The pandemic has altered holiday plans all over the United States this year. But in a bustling city where traditions often extend beyond family to bring friends and acquaintances around the table, the loneliness can especially gnaw.
With a second wave bearing down, officials have urged Americans not to travel, Gov. Andrew M. Cuomo limited private gatherings to 10 people for the foreseeable future and Mayor Bill de Blasio implored people to skip the crowded feasts that generally mark the holiday.
The city’s holiday staples will also be missing. The Macy’s Thanksgiving Day Parade has cut its route to one block, and movie theaters, long an antidote for holiday loneliness, remain closed. Restaurants have limited capacity, a rainy forecast does not favor outdoor dining and many people remain uncomfortable eating indoors.
Last week, Gov. Phil Scott of Vermont announced newly tightened quarantine rules for anyone visiting the state, which could mean fewer out-of-state visitors to area ski slopes and fewer dollars coming into a hospitality industry badly hurt by the pandemic.
With international destinations out of reach and domestic air travel feeling risky, the state had the biggest ski market in the nation — New York and the Northeast corridor — at its doorstep, and the state’s 20 alpine and 30 cross-country ski destinations were feeling optimistic.
But the governor’s announcement last Tuesday of virus-containment measures, combined with a huge spike in cases across the Northeast, triggered a wave of cancellations at hotels and inns and fear among tourism-dependent businesses that travelers would shun Vermont this winter because of the pandemic.
Visitors who do travel to Vermont must now commit to a 14-day quarantine (at home or in state), or a quarantine of seven days followed by a negative Covid-19 test. The new rules hit hard at a big market for Vermont — people who drive up for the weekend and who are unlikely to quarantine for a week for two or three days of skiing.
The Vermont economy depends on winter ski-season visitors who spend more than $1.6 billion a year in the tiny state, according to the Vermont Ski Areas Association. Vermont is something of a crown jewel of Eastern skiing, annually recording the most skier-day numbers in the East, around 4 million per season, a figure that rivals Utah. New Hampshire, by comparison, sees a little over 2 million per winter.
Ski resort operators, particularly in southern Vermont, which draws more weekenders from Connecticut, New Jersey, and the Albany and Long Island areas of New York than their northern counterparts, said the quarantine will hurt.
“We’re going to feel that,” said Bill Cairns, the president of Bromley Mountain Resort.