Scientists Link Covid-19 Risk to Genetic Variations

Why do some people infected with the coronavirus suffer only mild symptoms while others become deathly ill?

Geneticists have been scouring our DNA for clues. Now, a study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus.

Variations at two spots in the human genome are associated with an increased risk of respiratory failure in patients with Covid-19, the researchers found. One of these spots includes the gene that determines blood types.

Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The findings suggest that relatively unexplored factors may be playing a large role in who develops life-threatening Covid-19. The new study is currently going through peer review.

It’s not the first time Type A blood has turned up as a possible risk. Chinese scientists who examined patient blood types also found that those with Type A were more likely to develop a serious case of Covid-19. No one knows why.

“That is haunting me, quite honestly,” said Andre Franke, a molecular geneticist at the University of Kiel in Germany and a co-author of the new study.

U.S. emergency room visits plunged, raising concerns about the care for people with serious conditions.

As the virus spread, visits to emergency rooms in the United States decreased 42 percent over four weeks in April, compared to the same period in 2019, according to a new analysis released Wednesday by the C.D.C. The declines were greatest among children 14 and younger, women and in geographic areas like the Northeast.

While there were high numbers of emergency room visits because of the virus, including an increase in visits related testing for infectious diseases and for pneumonia, these were outweighed by the steep declines in visits that typically make up trips to the emergency room.

The C.D.C. also noted that there had been a recent rebound in visits, but the volume of visits remained significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with a year earlier.

The agency’s report highlights the monthslong decline in general hospital care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in Covid-19 patients. While hospitals have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid them.

While E.R. treatment for complaints of minor ailments were far fewer this year, agency officials pointed to a more disconcerting drop in the number of people seeking emergency care for chest pain, including those undergoing a heart attack. There were also declines in children requiring emergency help for conditions like asthma.

C.D.C. officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources.

The analysis of visits from the National Syndromic Surveillance Program, which collects real-time electronic health data, representing nearly three quarters of all U.S. emergency room visits, was published in an early release of the Morbidity and Mortality Weekly Report by the C.D.C.

Hydroxychloroquine did not prevent Covid-19 in the first controlled clinical trial.

The malaria drug hydroxychloroquine did not prevent Covid-19 in a rigorous study of 821 people who had been exposed to patients infected with the virus, researchers from the University of Minnesota and Canada are reporting Wednesday.

The study was the first controlled clinical trial of hydroxychloroquine, a drug that President Trump has repeatedly promoted and said he had taken himself to try to ward off the virus.

Conducted in the United States and Canada, the trial was the first to test whether the drug could prevent illness in people who have been exposed to the virus. This type of study, in which patients are picked at random to receive either an experimental treatment or a placebo, is considered the most reliable way to measure the safety and effectiveness of a drug.

“The take-home message for the general public is that if you’re exposed to someone with Covid-19, hydroxychloroquine is not an effective post-exposure, preventive therapy,” the lead author of the study, Dr. David R. Boulware of the University of Minnesota, said in an interview.

The results are being published in The New England Journal of Medicine.

The president’s promotion of the drug, and the backlash against it, have politicized medical questions that would normally have been left to researchers to answer objectively. The drug is approved to treat rheumatoid arthritis and lupus, as well as malaria, and is considered safe for those patients as long as they do not have underlying abnormalities in their heart rhythm.

Studies in very ill coronavirus patients have linked the drug — especially when combined with the antibiotic azithromycin — to dangerous heart-rhythm disorders, and both the Food and Drug Administration and the National Institute of Allergy and Infectious Diseases have warned that it should not be used outside of clinical trials or in hospitals.

The Trump administration has selected five companies as the most likely candidates to produce a vaccine for the coronavirus, senior officials said, a critical step in the White House’s effort to deliver on its promise of being able to start widespread inoculation of Americans by the end of the year.

By winnowing the field in weeks from a pool of about a dozen companies, the government is betting that it can identify the most promising vaccine projects at an early stage, speed along the process of determining which will work and ensure that the winner or winners can be quickly manufactured in huge quantities and distributed across the country.

Noah Weiland and David E. Sanger of The New York Times report that the five companies are Moderna, a Massachusetts-based biotechnology firm, which Dr. Anthony S. Fauci said he expected would enter the final phase of clinical trials next month; the combination of Oxford University and AstraZeneca, on a similar schedule; and three large pharmaceutical companies: Johnson & Johnson, Merck and Pfizer. Each is taking a somewhat different approach.

The announcement of the decision will be made at the White House in the next few weeks, government officials said. Dr. Fauci, the federal government’s top epidemiologist and the director of the National Institute of Allergy and Infectious Diseases, hinted at the action when he told a medical seminar on Tuesday that “by the beginning of 2021, we hope to have a couple of hundred million doses.”

Despite promising early results and the administration’s strong interest in nurturing a government-industry partnership, substantial hurdles remain. Many scientists consider Mr. Trump’s goal of having a vaccine widely available by early next year to be optimistic, if not unrealistic. Vaccine development is notoriously difficult and time-consuming; the record is four years, and a decade is not unusual.

The Senate gave final approval to a measure that would relax the terms of a federal loan program for small businesses struggling amid the pandemic, sending the bill to President Trump.

The measure, approved overwhelmingly by the House last week, would extend to 24 weeks from eight weeks the time that small businesses would have to spend the loan money.

Senator Ron Johnson, Republican of Wisconsin, had previously objected to an attempt by Democrats to pass the legislation without a formal roll call vote.

Republicans said that they generally favored revamping the Paycheck Protection Program, which was created by the $2.2 trillion stimulus bill enacted in March, and that an agreement to do so could come as soon as later Wednesday.

But Mr. Johnson said he first wanted a letter clarifying that the time frame to spend the loan money would be extended until the end of the year, not the application period. Senator Mitch McConnell of Kentucky, the majority leader, submitted such a letter just after 7 p.m.

The program aims to help small businesses continue paying their workers by giving them access to government-backed loans that will be forgiven entirely if most of the money is spent on payroll costs. The House-passed bill would give companies greater flexibility to use the loan money on other business expenses, like utilities and rent, by lowering the amount required to be spent on payroll to 60 percent, from 75 percent.

U.s. Roundup

The number of confirmed cases is rising in 16 states, partly a consequence of expanded testing.

Police brutality, protests and unrest may have knocked the pandemic from the lead of many U.S. newscasts, but the outbreak is continuing to spread. Even as some Northeast states are seeing improvements, daily case numbers are reaching new highs in others.

That is partly a consequence of the country’s vastly expanded testing capacity. Earlier in the pandemic, when test kits were scarce, many people who contracted the virus were not tested and not included in official counts. Here is a look around the country.

• In California, daily case reports exceeded 3,000 twice in the past week, a threshold the state had not crossed before. In Northern California, six chief health officers said in a statement that they were “encouraged by what we are seeing in some areas and concerned about what we are seeing in others.” As more businesses were allowed to reopen, they said, “each decision we make involves difficult trade-offs.”

• Arizona, Tennessee, Wisconsin, at least 12 other states and Puerto Rico are also seeing an upward trend of newly reported cases, and some are reaching new highs.

• In Mississippi, the 439 cases announced Saturday were the most yet on a single day. In Alaska, which has so far avoided the worst of the virus, cases have soared to their highest levels in recent days.

• The Trump administration said that it planned to block Chinese airlines from flying into or out of the United States starting on June 16, after the Chinese government effectively prevented U.S. airlines from resuming service between the countries.

• In Dallas County, Texas, case numbers have continued to rise, and the 16 deaths announced on Tuesday were the most of any day so far. Clay Jenkins, Dallas County’s chief elected official, said there was also no improvement in data on hospitalizations and intensive care unit admissions. He called for residents to use caution even though restrictions had eased.

• Chicago moved to its third phase of reopening, which eases restrictions on businesses combined with new precautions. Child care centers are reopening, but children are screened for signs of illness, and parents and teachers must wear face coverings. Restaurants will reopen with outdoor dining only. Riders will be encouraged to wear face masks while using public transportation.

• In most of New York State outside of New York City and its suburbs, restaurants can offer outdoor dining starting Thursday. In New Jersey, outdoor dining can start on June 15. An additional 112 virus-related deaths were reported in New Jersey and 49 deaths in New York.

• In Florida, the governor said most of the state could start a second reopening phase on Friday, allowing movie theaters, bars and concert halls at 50 percent capacity, and gyms at full capacity. Miami-Dade, Broward and Palm Beach counties, where the brunt of the state’s cases have been, will remain in Phase 1.

• As moviegoing has essentially ceased around the country, AMC Theaters, the largest theater operator in the world, said in a financial filing on Wednesday that “substantial doubt exists about our ability to continue as a going concern for a reasonable period of time” because of the disruption caused by the pandemic.

GLOBAL ROUNDUP

As Italy removes travel restrictions, some in Venice hope for a future with fewer tourists.

The country’s addiction to tourism has priced many residents out of historic centers and crowded out creativity, entrepreneurialism and authentic Italian life.

Of all Italy’s cities, Venice — a tourism cash cow worth €3 billion, or about $3.3 billion — changed most drastically during the months of lockdown.

Without visits by giant cruise ships and hordes of day-trippers, the city’s alleys, porticoes and campos reverberated with conversations in Italian, and even with the Venetian dialect. The lack of big boats reduced the waves on the canals, allowing residents to take their small boats and kayaks out on cleaner water. Some even ventured to St. Mark’s Square, which they usually avoid.

“This is a tragedy that has touched us all, but Covid could be an opportunity,” said Marco Baravalle, a leader of the anticruise ship movement in Venice who called the absence of big boats “magnificent.”

Here’s what else is happening around the world:

• Germany will lift its travel ban on 29 European countries, including Britain and Iceland, on June 15 and replace it with travel advisories, Foreign Minister Heiko Maas said. According to the new rules, if regional infections should mount, bans to specific countries could be reinstated.

• A powerful cyclone slammed into India’s coast, pushing thousands of people into shelters in the commercial hub of Mumbai, which is struggling to contain a rising number of infections. More than 100 Covid-19 patients were evacuated from a makeshift hospital to higher ground.

• Sweden’s restrictions should have been tighter, the architect of its no-lockdown policy, Anders Tegnell, said on Wednesday. Mr. Tegnell, the state epidemiologist, told Radio Sweden: “If we encountered the same disease knowing what we know today, I think we would end up doing something in the middle between what Sweden did and what the rest of the world did.”

Long considered the world’s premier public health agency, the Centers for Disease Control and Prevention made missteps that undermined America’s response to the most urgent public health emergency in the agency’s 74-year history — a virus that has killed more than 100,000 people in the United States.

A New York Times review of thousands of emails, and interviews with more than 100 state and federal officials, public health experts, C.D.C. employees and medical workers, revealed how the pandemic shook longstanding confidence in the agency and its leader, Dr. Robert R. Redfield. These are some of the key findings.

• Aging data systems left the agency with blind spots. As the virus began to spread in the United States in January, the C.D.C.’s response was hampered by an antiquated data system and a fractured public health reporting system. The C.D.C. could not produce accurate counts of how many people were being tested, compile complete demographic information on confirmed cases or even keep timely tallies of deaths.

• The C.D.C. clashed with White House aides who viewed them as the “deep state.” As the crisis deepened, tensions between the agency and the White House increased, with aides to Mr. Trump referring to the scientists at the C.D.C. as members of the “deep state” who were eager to wound him politically by leaking to the press. At the same time, some C.D.C. employees watched with growing alarm as Mr. Trump, facing criticism for his administration’s response, repeatedly undermined the agency. And they paled at what they saw as meddling by politically motivated Trump aides.

• The C.D.C.’s culture slowed its response. The culture at the C.D.C. — risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis — shaped its scientists’ ambitions and contributed to some of its failures as it tried to respond to the pandemic.

• Redfield felt he was ‘on an island’ between his agency and the White House. The pandemic underscored the need for Dr. Redfield to manage the mercurial demands of the president who appointed him and the expectations of the career scientists at the agency he leads. Although he is on the White House coronavirus task force, Dr. Redfield soon found himself eclipsed by Dr. Anthony S. Fauci, the nation’s chief — and most famous — infectious disease specialist, and Dr. Deborah L. Birx, an AIDS expert and former C.D.C. physician.

• Confusing guidance left doctors, public officials and others to look elsewhere. The C.D.C. struggled at times to provide clear and timely guidance, leading many to say they looked to universities, mailing lists or online research articles for detailed recommendations about how to safely care for infected patients.

While the National Basketball Association’s team owners are preparing to vote Thursday on a formal plan to resume play, Major League Baseball’s efforts to return to the field have stalled as the team owners and the players’ union battle over the length of a reconstituted season.

The N.B.A. plan calls for bringing back 22 of the league’s 30 teams and stationing them all at Walt Disney World in Florida, where they would each play eight games to decide a 16-team playoff field. Fans would not be present. The proposal, which needs approval from 23 of the owners, is expected to pass and then be presented to the union, whose president, Chris Paul of the Oklahoma City Thunder, has been working on the proposal with the N.B.A. commissioner, Adam Silver.

For M.L.B., team owners have proposed an 82-game schedule, just over half of the usual 162 regular-season games. The union, long considered the most tenacious in American professional sports, countered with a 114-game proposal, which the owners reportedly rejected on Wednesday. Now the owners are threatening to schedule only 50 games.

The union wants more games because the players agreed in March to take their 2020 salaries on a prorated basis. The owners and the M.L.B. commissioner, Rob Manfred, have essentially said the players would get prorated salaries — if they play a drastically compressed schedule.

Like most major U.S. sports organizations, the N.B.A. and M.L.B. shut down because of the coronavirus pandemic in mid-March. At the time, they were in very different positions, the N.B.A. deep into its 82-game regular season and just weeks away starting the playoffs, while M.L.B. was in spring training, two weeks from its first official game of the year.

On Wednesday, Major League Soccer players ratified a new labor agreement and agreed to turn this season into a tournament at the site the N.B.A. has also chosen, the Disney World sports complex. The National Hockey League and the National Women’s Soccer League had previously announced plans for abbreviated seasons. All of the plans to play hinge on approval from public health officials.

As the pandemic upends work and home life, women have carried an outsized share of the burden: They are more likely to lose a job and more likely to shoulder the responsibilities of closed schools and day care. The gradual reopening threatens to compound their problems — forcing them out of the labor force or into part-time jobs while increasing their duties at home.

In February, right before the outbreak began to spread in the United States, working women passed a milestone: making up more than half of the nation’s civilian nonfarm labor force. But the effects of the pandemic could last a lifetime, reducing their earning potential and work opportunities.

“We could have an entire generation of women who are hurt,” Betsey Stevenson, a professor of economics and public policy at the University of Michigan, said of pregnant women and working mothers whose children are too young to manage on their own. “They may spend a significant amount of time out of the work force, or their careers could just peter out in terms of promotions.”

Women who drop out of the work force to take care of children often have trouble returning, and the longer they stay out, the harder it is.

The economic crisis magnifies the downsides. Wage losses are much more severe and enduring when they occur in recessions, and workers who lose jobs now are likely to have less secure employment in the future.

“Even the limited gains made in the past decades are at risk of being rolled back,” warned a recent report from the United Nations on the effects of the virus on women.

New York City is still working toward lifting some virus-related restrictions on Monday, despite a curfew amid mostly peaceful protests against racism and police brutality. But one larger question looms: How can the city’s mass transit system safely accommodate all the people who are expected to return?

The Metropolitan Transportation Authority, which runs the buses and subways, and Mayor Bill de Blasio have outlined their visions, but many details remain to be worked out.

On Wednesday, for instance, Mr. de Blasio reiterated his request that social distancing be enforced by limiting seating. “It is crucial that every other seat be blocked off so that it’s clear that you never end up sitting next to someone,” he said.

The agency dismissed the proposal.

“Like many of the mayor’s ideas, this is nice in theory but utterly unworkable,” an M.T.A. spokeswoman said in a statement. “The mayor’s plan would allow us to serve only a tiny percentage of our riders — likely around 8 percent.”

On Tuesday, in an open letter to the mayor, the agency released some elements of its plan: Full service will resume across the system on Monday, though subways will still close for nightly disinfecting from 1 a.m. to 5 a.m. Social-distancing floor markings will be set at stations. Workers known as “platform controllers” will try to reduce crowding.

Under the first phase of the city’s reopening, curbside retail pickup and nonessential construction and manufacturing can restart. The mayor has said he expected that at least 200,000 people would begin returning to work.

But the M.T.A.’s plan said that during that phase, subway and bus service would remain for “essential trips only.”

Mr. de Blasio had also asked that trains and buses skip stops if they are over capacity and that the agency “temporarily close stations when needed during peak hours,” which could make slow commuting. The agency’s letter to the mayor did not address either request.

‘Farewell, hero.’ After another Wuhan doctor dies, public grief mixes with upset at China’s authorities.

The death of a doctor who worked on the front lines of China’s coronavirus battle has prompted an outpouring of grief and anger, and also revived concerns about Beijing’s handling of the outbreak.

The doctor, Hu Weifeng, 42, died on Tuesday in Wuhan, where the pandemic originated and where officials have nearly completed a vast testing campaign to keep the virus contained. He endured more than four months of treatment, according to reports in the state-run news media, and had become widely known when photos circulated showing him in his hospital bed with darkened skin.

Health officials said a drug used during the treatment had caused changes in his complexion.

Dr. Hu, a urologist, is the sixth worker at Wuhan Central Hospital to die of the virus. The reaction to his death echoes the mourning after the loss of another worker there: Li Wenliang, a 34-year-old ophthalmologist who tried to sound the alarm about the outbreak, only to be silenced by the police. He died on Feb. 6.

“Farewell, hero,” one user said of Mr. Hu on Weibo, a popular microblogging site. “How did Wuhan Central Hospital become a major disaster zone?”

“Who can protect the medical workers?” another user wrote on Weibo, reacting to Mr. Hu’s death. “Who will protect the people of Wuhan?”

Tear gas used against protesters across the U.S. could make them more susceptible to the virus.

The billowing clouds of tear gas that the authorities are sending through protest crowds across the United States may increase the risk that the virus could spread through the gatherings.

Along with the immediate pain that can cause watering eyes and burning throats, tear gas may cause damage to people’s lungs and make them more susceptible to getting a respiratory illness, according to studies on the risks of exposure. The gas can also incite coughing, which can further spread the virus from an infected person.

Sven-Eric Jordt, a researcher at Duke University who has studied the effects of tear gas agents, said he had been shocked to watch how much the authorities had turned to the control method in recent days.

“I’m really concerned that this might catalyze a new wave of Covid-19,” Mr. Jordt said.

The protests against police brutality and racism after the killing of George Floyd in Minneapolis have already raised alarm among health experts who have watched as protesters gathered by the thousands in cities around the country. While some demonstrators have worn masks and gloves, the crowds have often involved shouting and chanting in close quarters — a risky activity for a virus spread by respiratory droplets. Epidemiologists have said the protests would almost certainly lead to more cases.

Because of delays between exposure and the start of symptoms, the impact of protests on the virus likely won’t be known for several weeks.

On Wednesday, Gov. Andrew M. Cuomo of New York said that the virus “is still in people and in society.”

“We’re still battling that,” he said.

Reporting was contributed by Fahim Abed, Reed Abelson, Liz Alderman, Yousur Al-Hlou, Mike Baker, Emily Cochrane, Michael Cooper, Andrew Curry, Melissa Eddy, Thomas Erdbrink, Sheri Fink, Thomas Gibbons-Neff, Abby Goodnough, Denise Grady, Javier C. Hernández, Jason Horowitz, Tyler Kepner, Patrick Kingsley, Eric Lipton, Patricia Mazzei, Apoorva Mandavilli, Sarah Mervosh, Benjamin Mueller, Andy Newman, Najim Rahim, Luis Ferré Sadurní, Dagny Salas, David E. Sanger, Christopher F. Schuetze, Michael D. Shear, Kaly Soto, Marc Stein, Tracey Tully, Megan Twohey, Mark Walker, Noah Weiland, Carl Zimmer and Karen Zraick. Albee Zhang contributed research.