NPR: As U.S. Reaches 250,000 Deaths From COVID-19, A Long Winter Is Coming
The United States has surpassed yet another devastating milestone in the ongoing COVID-19 pandemic: 250,000 Americans have now died from the disease. That's more than twice the number of U.S. service members killed in World War I. Coronavirus case numbers are exploding across the country at the beginning of what is shaping up to be a difficult winter of illness in America. (Wamsley, 11/18)

The Washington Post: America’s 250,000 Covid Deaths: People Die, But Little Changes
From the start of the pandemic, public health officials and many political leaders hoped that covid’s frightening lethality — the death toll will hit 250,000 this week — might unite the country in common cause against the virus’s spread. But the nation’s deep divisions — political and cultural — as well as the virus’s concentrated impact on crowded urban areas in the early months, set the country on a different path. (Fisher, Jacobs and Kelley, 11/18)

CNN: Covid-19 Deaths In The US Are 10 Times Higher Than Car Crash Fatalities In A Year 
In less than 10 months, Covid-19 has killed more people than strokes, suicides and car crashes typically do in a full year -- combined. The victims include an elderly father and his grown daughter who died within moments of each other. Two parents who died before their son's 5th birthday. In rare cases, even children with no known prior health conditions. Health experts say if Americans don't get more serious about wearing masks and avoiding careless socializing, the rate of deaths will keep soaring this fall and winter. (Yan and Wolfe, 11/18)

The Washington Post: More Than 3 Million People In U.S. Estimated To Be Contagious With The Coronavirus
More than 3 million people in the United States have active coronavirus infections and are potentially contagious, according to a new estimate from infectious-disease experts tracking the pandemic. That number is significantly larger than the official case count, which is based solely on those who have tested positive for the virus. The vast — and rapidly growing — pool of coronavirus-infected people poses a daunting challenge to the governors and mayors in hard-hit communities who are trying to arrest the surge in cases. (Achenbach, 11/18)

The Wall Street Journal: U.S. Daily Cases Top 170,000 For Second Time 
The U.S. logged more than 170,000 newly reported Covid-19 cases for the second time, as the death toll crossed the quarter-million mark. The nation reported 170,161 new cases for Wednesday, according to data compiled by Johns Hopkins University, more than any day but Friday, when it reported 177,224 new cases. More than 11.5 million people in the country have been confirmed to have been infected with the coronavirus so far, Johns Hopkins data show. (Martin, 11/19)

The Hill: US Military Reports Record 1,300 Coronavirus Cases In One Day 
U.S. officials recorded more than 1,300 new confirmed cases of COVID-19 among members of the armed forces on Tuesday, a new record for the military over a 24-hour period, CNN reported. Officials also told the network that the test positivity rate among the armed forces is now 6.8 percent, lower than the U.S. national average. (Bowden, 11/18)

What can be done to halt the decline? —

The Hill: White House Warns Of 'Aggressive, Unrelenting' COVID Spread Across The Country 
Faced with skyrocketing new COVID-19 cases, multiple states are issuing new lockdown restrictions, closing common spaces like bars, restaurants, schools, and gyms. In response to about 50 U.S. states and territories witnessing record-breaking new COVID-19 cases, the White House Coronavirus Task Force issued candid remarks about the state of the nation, describing the “now aggressive, unrelenting, expanding broad community spread across the country, reaching most counties, without evidence of improvement but rather, further deterioration.” (Kelley, 11/18)

KHN: Take It From An Expert: Fauci’s Hierarchy Of Safety During COVID
Like many Americans, I take my signals from Dr. Fauci, the country’s top infectious disease expert and a member of the White House task force on the coronavirus. ... So I asked him how Americans might expect to live in the next six to nine months. How should we behave? And what should the next administration do? (Rosenthal, 11/19)

KHN’s ‘What The Health?’:  What Would Dr. Fauci Do?
On this special episode of KHN’s “What the Health?” podcast, Dr. Anthony Fauci sits down for an interview with KHN Editor-in-Chief Elisabeth Rosenthal, a fellow physician. They explore the thorny political landscape and discuss how regular Americans should prepare to get through the coming months — as the pandemic surges and we wait for vaccines to become available. (11/19)

CNBC: States Impose Targeted Lockdowns, Curfews, Mask Mandates Ahead Of Thanksgiving
Without a cohesive federal plan, state and local officials are reinstituting some of the stay-at-home orders, curfews and other public safety measures that were rolled back over the summer and fall. (Higgins-Dunn, 11/18)

The Washington Post: Biden Praises Republican Governors For Adopting More Stringent Measures To Fight Coronavirus In Defiance Of Trump.
An emotional President-elect Joe Biden praised Republican governors and others who have bucked President Trump to endorse more-stringent measures to control the spread of the coronavirus, while warning Wednesday that a "tough guy" approach contributes to preventable deaths. Biden contrasted restrictions imposed by Ohio Gov. Mike De­Wine (R) and a growing number of other Republican leaders with what he suggested is Trump’s negligence. (Gearan, 11/18)

On mask mandates —

The Hill: Kansas Governor Issues New Mask Mandate 
Kansas Gov. Laura Kelly (D) issued a new mask mandate on Wednesday set to go into effect the day before Thanksgiving, as Kansas and the rest of the country deals with surging coronavirus cases and hospitalizations. Kelly’s executive order will require face-coverings to be worn inside public spaces, health care facilities, in line for public transportation and outdoors where social distancing is not possible. The mandate goes into effect at 12:01 a.m. on Wednesday, Nov. 25. (Coleman, 11/18)

Wisconsin State Journal: Tony Evers To Extend Statewide Mask Mandate Into Next Year
One day after the state reported a record 92 COVID-19-related deaths, Gov. Tony Evers announced Wednesday he plans to extend the state’s emergency declaration and accompanying mask mandate through mid-January. (Schmidt, 11/19)

Arizona Republic: Gov. Doug Ducey Says He Won't Impose A Statewide Mask Mandate
As Arizona's COVID-19 trends spike, the state is giving hospitals $25 million to bolster staffing, but Gov. Doug Ducey said Wednesday that he won't impose a statewide mask mandate. (Innes, Altavena and Polletta, 11/18)

KHN: States’ Face-Covering Mandates Leave Gaps In Protection 
Brady Bowman, a 19-year-old student at the University of Colorado-Boulder, and two friends strolled down 11th Street, all sporting matching neck gaiters branded with the Thomas’ English Muffins logo. He had received an entire box of the promotional gaiters. He thinks they are just more comfortable to wear than a face mask. “Especially a day like today, where it’s cold out,” he said, with the top of his gaiter pulled down below his chin. (Hawryluk, 11/19)

Other restrictions are ordered —

Reuters: Minnesota Governor Orders Restaurants, Bars To Halt In-Person Dining For Four Weeks 
Minnesota Governor Tim Walz on Wednesday ordered all restaurants and bars to halt in-person dining, fitness and entertainment centers to close and youth sports to be canceled for four weeks. (11/18)

The Hill: Iowa State Limiting Attendance For Athletic Events 
Iowa State will limit attendees at some athletic events to family and guests of athletes and staff, the university announced Wednesday amid a surge in coronavirus cases. The restrictions will apply to Saturday’s football game against Kansas State as well as to women’s and men’s basketball through the rest of the month, The Associated Press reported. (Budryk, 11/18)

AP: Ohio Stadium Off Limits To Family And Friends
Ohio State will prohibit family and friends of players and coaches from attending football games this season because of the dramatic spike in COVID-19 cases in the state. The school has allowed a few hundred people at the first two home games, but that will end with the No. 3 Buckeyes’ game at Ohio Stadium on Saturday against No. 9 Indiana. The stadium holds about 105,000. (11/18)

But Florida vows to stay open —

The Hill: DeSantis Promises To Keep Florida Open Despite Recent Coronavirus Case Surge
Florida's Republican Gov. Ron DeSantis said this week he has no plans of imposing new coronavirus restrictions despite a recent surge in cases there. "The Governor will not lock down and hurt families who can't afford to shelter in place for 6 weeks," DeSantis's office said in a statement to local media. "Especially not for a virus that has a 99.8% survival rate. One area of concern is Assisted Living Facilities." (Mastrangelo, 11/18)

The Hill: Group Of Florida Mayors Calls On DeSantis To Issue Mask Mandate 
A group of mayors in Florida called on Gov. Ron DeSantis (R) to issue a statewide mask mandate during a conference call on Wednesday to discuss the COVID-19 outbreak in the Sunshine State. The South Florida Sun Sentinel reported that the mayors of Miami Beach, Sunrise, St. Petersburg, Hialeah and Miami Shores Village urged DeSantis to take a range of actions to confront the outbreak, including expanding state testing and contact tracing efforts. (Bowden, 11/18)

The Hill: Health Officials Say Every State Will Have COVID Vaccine Doses Within 24 Hours After FDA Green Light 
Federal health officials on Wednesday expressed confidence that every state will have access to at least some doses of a COVID-19 vaccine for distribution within 24 hours after authorization. "Every jurisdiction will have access immediately upon the initial push of the vaccine," Gen. Gustave Perna, chief operating officer of the Trump administration's Operation Warp Speed, said during a call with reporters. (Weixel, 11/18)

In other news related to Pfizer and Moderna's COVID vaccines —

Bloomberg: Moderna Vaccine Production Is Gearing Up, Partner Lonza Says
Lonza Group AG made its first commercial batch of the main ingredient in Moderna Inc.’s Covid-19 vaccine candidate in the U.S. last week and plans to start European production by the end of the month, Chairman Albert Baehny said. The company is ramping up and fine-tuning its production lines, a process that may stretch into next year.“We have access to the raw materials; we have access to the people,” Baehny said in an interview. The main challenge is “to optimize as much as possible.” (Kresge, 11/19)

Bloomberg: Covid Vaccine Freezers In Place For Rollout Once FDA Gives OK
Freezers required to store Covid-19 vaccines are in place at health systems that are preparing to administer the initial doses once the two leading candidates for shots receive a green light from regulators, U.S. health officials said Wednesday. The federal government will have 40 million doses—enough to vaccinate 20 million—ready to distribute by the end of December should vaccines developed by Pfizer Inc. and its partner BioNTech SE, and Moderna Inc. receive emergency-use authorizations, said Moncef Slaoui, chief scientific adviser of the joint-effort led by the Department of Health and Human Services and Defense Department to expedite the development and distribution of coronavirus vaccines, dubbed Operation Warp Speed. (Griffin and Baumann, 11/18)

CIDRAP: GAO Highlights COVID Vaccine Supply Chain, Drug Transparency Issues 
A report released yesterday by the US Government Accountability Office (GAO) says supply chain issues could interfere with a smooth rollout of a COVID-19 vaccine and that the Food and Drug Administration (FDA) should disclose scientific review of vaccine and drug efficacy and safety data when issuing emergency use authorizations (EUAs). The report states that Operation Warp Speed, an effort of the Department of Health and Human Services, the Department of Defense, and private industry to dramatically accelerate development of COVID-19 vaccines and therapeutics, has condensed the timeline by directing more than $10 billion to vaccine manufacturers. But, it adds, the FDA needs to address public concerns that the process has been rushed, casting doubt on vaccine and drug effectiveness and safety. (Van Beusekom, 11/18)

FiercePharma: Despite Impressive Data, FDA's Coronavirus Vaccine Reviews Will Take Weeks, Not Days, Official Says 
As leading COVID-19 vaccines post positive phase 3 data and near FDA submissions, the agency official in charge of reviewing vaccines is emphasizing transparency and patience during the high-stakes process. Americans should expect reviews to take weeks rather than days, Peter Marks, head of the FDA’s Center for Biologics Evaluation and Research, told Business Insider. While the dire COVID-19 pandemic naturally creates urgency, Marks and his team "have to take the amount of time that we need to take," he said. The FDA is said to be discussing potential committee meetings for December 8 to 10, CNBC's Meg Tirrell reports. (Sagonowsky, 11/18)

Boston Globe: What You Need To Know About The Latest News From Pfizer On Its COVID-19 Vaccine
Pfizer said Wednesday that its experimental COVID-19 vaccine appeared to be 95 percent effective in warding off the illness that’s surging around the world, a remarkable showing for the first set of complete results from a late-stage clinical trial. The pharmaceutical giant, which has a large presence in Massachusetts, said it expects to apply to the Food and Drug Administration for the first emergency use authorization of a coronavirus vaccine “within days.” (Saltzman, 11/18)

Also —

The Washington Post: Dolly Parton Helped Fund Moderna’s Vaccine. It Began With A Car Crash And An Unlikely Friendship.
As Dolly Parton tells it, her first-ever car accident in October 2013 was minor, but left her bruised and sore enough to seek medical advice at Vanderbilt University Medical Center. That’s where she met Naji Abumrad, a physician and professor of surgery. Abumrad knew next to nothing about the beloved megastar with big, blond hair, but he soon befriended her because he deeply enjoyed their talks about current events and science. Their bond of nearly seven years received worldwide attention Tuesday after it was revealed that Parton’s $1 million donation to Vanderbilt for coronavirus research, made in honor of Abumrad, partially funded the biotechnology firm Moderna’s experimental vaccine, which a preliminary analysis released this week found is nearly 95 percent effective at preventing the illness. (Bella, 11/18)

FiercePharma: CureVac, Armed With COVID-19 Vaccine Deal, Plots 'Pandemic-Scale' Euro Manufacturing Expansion 
As Pfizer and Moderna dominate headlines with positive interim readouts for their COVID-19 vaccine candidates, other mRNA players are taking note. Germany's CureVac, hot on the heels of an EU supply deal—is boosting its manufacturing network to produce "pandemic-scale volumes" of its mRNA shot across the bloc. CureVac aims to produce 300 million doses of its vaccine, dubbed CVnCoV, in 2021 and up to 600 million doses in 2022, to meet what it expects to be greater demand given the early success of other mRNA vaccines, the company said Tuesday. (Kansteiner, 11/17)

Reuters: AstraZeneca COVID-19 Vaccine Shows Promise In Elderly, Trial Results By Christmas
AstraZeneca and Oxford University’s potential COVID-19 vaccine produced a strong immune response in older adults, data published on Thursday showed, with researchers expecting to release late-stage trial results by Christmas. The data, reported in part last month but published in full in The Lancet medical journal on Thursday, suggest that those aged over 70, who are at higher risk of serious illness and death from COVID-19, could build robust immunity. (Kelland, 11/19)

Bloomberg: Oxford Study Confirms Astra Covid Shot’s Response in Elderly
The University of Oxford confirmed that the Covid-19 vaccine it’s developing with AstraZeneca Plc produced strong immune responses in older adults in an early study, with key findings from the last phase of tests expected in the coming weeks. The results, published Thursday in The Lancet medical journal, shed more light on preliminary data released in recent months showing the experimental shot generated an immune response in the elderly, who are at highest risk of severe illness. (Paton and Ring, 11/19)

The Guardian: Oxford Covid Vaccine Could Build Immunity In Older People – Study 
The study’s lead author, Prof Andrew Pollard, from the University of Oxford, said: “Immune responses from vaccines are often lessened in older adults because the immune system gradually deteriorates with age, which also leaves older adults more susceptible to infections. As a result, it is crucial that Covid-19 vaccines are tested in this group who are also a priority group for immunisation. ”Researchers say their findings are promising as they show that older people are having a similar immune response to younger adults. (11/19)

Also —

The New York Times: Immunity To The Coronavirus May Last Years, New Data Hint 
How long might immunity to the coronavirus last? Years, maybe even decades, according to a new study — the most hopeful answer yet to a question that has shadowed plans for widespread vaccination. Eight months after infection, most people who have recovered still have enough immune cells to fend off the virus and prevent illness, the new data show. A slow rate of decline in the short term suggests, happily, that these cells may persist in the body for a very, very long time to come. (Mandavilli, 11/17)

San Francisco Chronicle: Does COVID-19 Result In Lasting Immunity? Growing Evidence Says Yes
A team of researchers from California and New York have found that people infected with the coronavirus may develop lasting immunity, an encouraging discovery for vaccine developers jolted by previous studies indicating human antibodies die out over time. The study, which has not been peer-reviewed nor published in a scientific journal, found that enough immune cells remain in the body to fight off COVID-19 for up to eight months after the initial infection. Scientists say there are signs these virus-fighting capabilities will last for a long time. (Fimrite, 11/18)

And some begin asking the big question —

Voice Of America: Vaccines Alone Won't End Pandemic, WHO Official Says 
The World Health Organization's emergencies program director said Wednesday that vaccines alone would not end the COVID-19 pandemic and would do nothing to stop the current global surge in coronavirus infections. Mike Ryan made the comments during a virtual question-and-answer session from the agency’s headquarters in Geneva. His comments came the same day that pharmaceutical company Pfizer and its German partner BioNTech announced that final results from the late-stage trial of their COVID-19 vaccine showed it was 95% effective. (11/18)

The Atlantic: With Vaccines, The End Of The COVID-19 Pandemic Is In Sight 
The tasks that lie ahead—manufacturing vaccines at scale, distributing them via a cold or even ultracold chain, and persuading wary Americans to take them—are not trivial, but they are all within the realm of human knowledge. The most tenuous moment is over: The scientific uncertainty at the heart of COVID-19 vaccines is resolved. Vaccines work. And for that, we can breathe a collective sigh of relief. “It makes it now clear that vaccines will be our way out of this pandemic,” says Kanta Subbarao, a virologist at the Doherty Institute, who has studied emerging viruses. (Zhang, 11/18)

The Hill: Biden Says Trump's Transition Delay Will Put New Government Behind With Vaccine 
President-elect Joe Biden criticized the Trump administration's delay of the transition, saying it was preventing his team from getting information about how coronavirus vaccines will be distributed. Biden suggested during a roundtable with health care workers on Wednesday that the delays could put his administration behind by weeks or months in putting together a distribution initiative. (Manchester and Easley, 11/18)

USA Today: In Meeting With Biden, Emergency Workers Plead For Equipment, Testing To Combat 'Skyrocketing' Coronavirus Cases
As President-elect Joe Biden prepares to take office in two months, he heard Wednesday from a firefighter, nurses and a caregiver who described chronic shortages of protective equipment, tests and contact tracing to combat the coronavirus pandemic. The virus, combined with rebuilding the economy, is the biggest challenge facing Biden. The online roundtable came as the number of cases nationwide grows rapidly, with more than 11 million cases nationwide and nearly 250,000 deaths so far.  (Jansen, 11/18)

Modern Healthcare: 'Trifecta Of Shortages' Hampering Response To COVID-19 Surge
A "trifecta of shortages" is hampering the U.S. healthcare system's ability to treat current and future COVID-19 patients, a member of President-elect Joe Biden's COVID-19 Advisory Board said Wednesday. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said during a webinar hosted by the National Institute for Health Care Management that care for hospitalized coronavirus patients could be compromised due to a lack of staffing rather than a lack of beds. Providers will again run out of personal protective equipment in light of the current surge in cases, especially since Europe is experiencing similar increases, he said. Finally, critical drugs used to treat COVID patients are in increasingly short supply, a problem also exacerbated by Europe's surge. (Bannow, 11/18)

USA Today: Biden's COVID-19 Plan To Face Hurdles As Coronavirus Pandemic Rages
President-elect Joe Biden will arrive at the White House Jan. 20 at a critical juncture in America's battle against COVID-19. In the weeks before he takes office, the winter season is expected to further the virus' unrelenting spread as the U.S. holds out hope a vaccine will soon eradicate a pandemic that has taken hundreds of thousands of lives and decimated the economy. (Subramanian, 11/19)

Politico: The Biden Adviser Focused On The Pandemic’s Stark Racial Disparities
When Marcella Nunez-Smith started treating some of the first hospitalized Covid-19 patients in Connecticut this March, she huddled with fellow doctors to try to understand this deadly new disease. But she wasn’t surprised that it was hitting minorities so brutally hard. Health crises often hit minorities hard. ... Eight months later, President-elect Joe Biden tapped Nunez-Smith, an expert on health care inequality, to help lead the transition’s coronavirus advisory board. That puts the fight against the virus in devastated Black, Latino and Native American communities smack in the center of his pandemic response. (Kenen, 11/19)

Stat: Biden Adviser Says Scientists Should Lead Communications On Covid-19
A member of President-elect Joe Biden’s Covid-19 task force is advocating for federal scientists — rather than high-ranking political appointees — to take on the daily work of informing the public about the pandemic beginning in January. Celine Gounder, a task force member and veteran infectious diseases specialist, specifically highlighted two veteran Centers for Disease Control and Prevention scientists who appeared at public briefings early in the pandemic but largely disappeared from public view in the spring. (Facher, 11/19)

In related news about Drs. Fauci and Birx —

USA Today: Anthony Fauci On Why He Thinks He Hasn't Heard From Joe Biden's Team
Dr. Anthony Fauci said Wednesday he wants to begin talks with President-elect Joe Biden to ensure a smooth transition for the new administration but believes the Biden team is wary of putting him in a "compromised position" as President Donald Trump refuses to concede the election. Fauci, the nation's top infectious disease expert, hasn't spoken to Biden as the U.S. battles a significant spike in the coronavirus pandemic and the president-elect looks to start working on his plan to combat the virus. (Garrison, 11/18)

Politico: ‘It’s Complicated’: Biden Team Weighs Whether To Retain Deborah Birx
President-elect Joe Biden’s transition team is weighing whether to give Trump administration coronavirus coordinator Deborah Birx a role in its Covid-19 response, even as it prepares a broader purge of officials closely tied to the president’s handling of the pandemic. The debate over Birx’s future has vexed transition officials, with advocates for the longtime public health official arguing that her experience on the front lines of the pandemic could aid a Biden administration that will be thrust into the middle of a deepening crisis. (Cancryn, 11/18)

NPR: Judge Says Coronavirus Can't Be Used As Reason To Quickly Deport Unaccompanied Minors 
A federal judge on Wednesday ordered the Trump administration to stop deporting minor immigrants on the grounds that they are a coronavirus threat. The government has already expelled nearly 9,000 children who crossed the border alone, seeking protection, citing a public health order issued by the Centers for Disease Control and Prevention. Since March, immigration agents have been ejecting nearly everyone — children and adults — who shows up at the U.S. border asking for asylum. The government had insisted that it had to turn youngsters back to prevent the possible infection of border agents, youth shelter workers and other immigrants in custody. (Burnett, 11/18)

Fox News: Judge Orders Trump Administration To Stop Deporting Unaccompanied Minors Amid Coronavirus Pandemic
The emergency declaration — challenged by the American Civil Liberties Union, Texas Civil Rights Project, Center for Gender & Refugee Studies, and Oxfam — was invoked in March under the Public Health Service Act. The Trump administration used it to deport thousands of minors, arguing in court that it must do so during the pandemic to prevent infecting border agents. (Best, 11/18)

Politico: Trump Officials Clash Over Coronavirus Precautions For Thanksgiving 
Senior Trump administration officials sent starkly different messages on Wednesday as they prepared Americans for their first pandemic Thanksgiving — with the federal government’s top health official urging deference to local coronavirus guidelines and the White House press secretary describing those same directives as “Orwellian.” The fierce criticism of state-level mitigation efforts from Kayleigh McEnany, President Donald Trump’s top spokesperson, came in an interview on Fox News’ "Fox & Friends." She was asked by co-host Steve Doocy specifically about “suggestions and guidelines” from some governors that residents not gather in large groups when celebrating next Thursday. (Forgey, 11/18)

The Hill: Army Must Review Discharges For Troops Kicked Out Over PTSD, Sexual Assault Under New Settlement 
Thousands of Army veterans removed from the service due to mental illness or sexual assault trauma were handed a legal victory on Wednesday that offers a chance for them to change the status of their dismissal. The new legal settlement — the result of a class-action lawsuit brought by two Connecticut veterans against Army leadership more than three years ago — orders service officials to review tens of thousands of denied discharge upgrade requests from the past nine years, applying more lenient guidelines. (Mitchell, 11/18)

And 340B drug program rules are under review —

Modern Healthcare: White House Reviews Rule For 340B Dispute Resolution
The White House budget office is reviewing a final rule that could establish a long-awaited dispute resolution process for the 340B drug discount program. The move comes amid heated conflict in recent months between providers and drugmakers over providers' use of contract pharmacies. Community health centers sued last month to force HHS to expedite creation of such a process, as providers have limited ability to directly sue drugmakers in court. (Cohrs, 11/18)

KHN: Surprise Federal Drug Rule Directs Insurers To Reveal What They Pay For Prescription Drugs 
Health insurance companies will have to give their customers estimated out-of-pocket costs for prescription drugs and disclose to the public the negotiated prices they pay for drugs, under an unexpected new Trump administration rule. The administration said those requirements, part of a broader rule issued Oct. 29 forcing health plans to disclose costs and payments for most health care services, will promote competition and empower consumers to make better medical decisions. (Meyer, 11/19)

Stat: House Passes Bill To Close Loophole Giving Drug Makers 'Unfair' Monopolies
Seeking to boost competition in the pharmaceutical industry, the House passed a bill that would close a loophole in a law that was meant to encourage development of rare disease drugs, but that had inadvertently precluded availability of lower-cost versions of medicines. The legislation was proposed last year after a company complained that it was unable to win approval from the Food and Drug Administration to sell an opioid addiction treatment because of a stipulation in the Orphan Drug Act. (Silverman, 11/18)

In other news from Capitol Hill —

The Hill: Senate Democrats Introduce Bill To Shore Up PPE Supply 
Senate Democrats on Wednesday introduced a bill that would shore up the supply of protective equipment for health care workers as the U.S. faces another surge of COVID-19 cases. The bill would appropriate $10 billion for the government to purchase large quantities of masks, gloves, gowns and face shields, Senate Minority Leader Charles Schumer (D-N.Y.) told reporters Wednesday. (Hellmann, 11/18)

The Hill: Bipartisan Lawmakers Call For Expedited Diabetes Research 
Lawmakers on both sides of the aisle Wednesday called for bipartisan policies to expedite diabetes research. Speaking at The Hill's Diabetes and The Future of Healthcare Reform event, Rep. Diana DeGette (D-Colo.) discussed what she saw as some of the obstacles to better care. (Baker, 11/18)

The Hill: AOC, Progressive Dems Attack Corporate Greed During Health Care Discussion 
Several progressive members of the House Democratic Caucus joined a livestreamed conversation on health care reform on Wednesday and attacked what they said was widespread greed and fraud in the pharmaceutical and health care industries. Reps. Alexandria Ocasio-Cortez (D-N.Y.), Pramila Jayapal (D-Wash.) and Katie Porter (D-Calif.) spoke at the event hosted by the left-leaning Center for Health and Democracy, where they and former Cigna executive Wendell Potter, now a "Medicare for All" advocate, discussed the state of the U.S. health care system. (Bowden, 11/18)

Also —

CNN: Two More House Members Announce They Have Covid-19
Two more House members announced Wednesday they have tested positive for Covid-19 and are isolating, the latest in a string of diagnoses that have hit Capitol Hill. The cases brings CNN's tally to 26 House members and eight senators that have so far tested positive or been presumed positive. (Diaz and Wilson, 11/18)

The Hill: Capitol's COVID-19 Spike Could Be Bad Thanksgiving Preview 
Congress is experiencing a spike in COVID-19 cases among lawmakers while doing exactly what Americans are being warned not to do for Thanksgiving this year: gathering together after traveling from all over the country. In the last week alone, seven members of Congress have tested positive for COVID-19, with three others quarantining after exposure. (Marcos, 11/18)

The Washington Post: Walmart And McDonald’s Have The Most Workers On Food Stamps And Medicaid, New Study Shows
A sizable number of the recipients of federal aid programs such as Medicaid and food stamps are employed by some of the biggest and more profitable companies in the United States, chief among them Walmart and McDonald’s, according to a new report from Congress’s nonpartisan watchdog. The Government Accountability Office undertook the study at the behest of Sen. Bernie Sanders (I-Vt.) to answer questions about the relationship between employers and the federal assistance programs. The report draws on February data from agencies in 11 states that administer Medicaid and the federal Supplemental Nutrition Assistance Program, better known as SNAP, or food stamps. (Rosenberg, 11/18)

The Washington Post: 12 Million Americans Will Lose Their Unemployment Benefits If Congress Fails To Act, According To Report
Deadlines set by Congress early in the pandemic will result in about 12 million Americans losing unemployment insurance by the year’s end, according to a report released Wednesday — a warning about the sharp toll that inaction in Washington could exact on the economic health of both individual households and the economy at large. According to the report from unemployment researchers Andrew Stettner and Elizabeth Pancotti, those Americans will lose their unemployment benefits the day after Christmas — more than half of the 21.1 million people currently on the benefits — due to deadlines Congress chose when it passed the Cares Act in March amid optimism the pandemic would be short-lived. (Rosenberg, 11/18)

The Hill: 2 In 3 Say Coronavirus Relief Should Be Top Priority For Biden In First 100 Days: Poll 
Two-thirds of registered voters say a coronavirus relief package should be the top priority for President-elect Joe Biden in his first 100 days in office in a new Politico-Morning Consult poll released Wednesday. The push for a relief bill comes from voters of both parties, with 78 percent of Democrats and 53 percent of Republicans saying it should be a top priority at the start of a Biden administration. (Axelrod, 11/18)

Also —

NPR: These City Maps Show The Current Health Impacts Of Redlining From Decades Ago
The lingering harms of racist lending policies known as redlining are apparent today. Researchers created a set of interactive maps allowing you to explore the current impacts in your city. Torey Edmonds has lived in the same house in an African-American neighborhood of the East End of Richmond, Va., for all of her 61 years. When she was a little girl, she says her neighborhood was a place of tidy homes with rose bushes and fruit trees, and residents had ready access to shops like beauty salons, movie theaters and several grocery stores. (Godoy, 11/19)

AP: 'Tired To The Bone': Hospitals Overwhelmed With Virus Cases
Overwhelmed hospitals are converting chapels, cafeterias, waiting rooms, hallways, even a parking garage into patient treatment areas. Staff members are desperately calling around to other medical centers in search of open beds. Fatigue and frustration are setting in among front-line workers. Conditions inside the nation’s hospitals are deteriorating by the day as the coronavirus rages across the U.S. at an unrelenting pace and the confirmed death toll surpasses 250,000. (Weber and Rankin, 11/19)

Stat: Hospitals In Half The States Are Facing A Massive Staffing Shortage
Hospitals in at least 25 states are critically short of nurses, doctors, and other staff as coronavirus cases surge across the United States, according to the industry’s trade association and a tally conducted by STAT. The situation has gotten so bad that in some places, severely ill patients have been transferred hundreds of miles for an available bed — from Texas to Arizona, and from central Missouri to Iowa. (Goldhill, 11/19)

The Washington Post: Health-Care Workers Are Desperate For Americans To Listen: ‘We Didn’t Go To Nursing School To Be Martyrs’
Lauren Sharp graduated from nursing school last year. She started working on an adult respiratory floor at a public hospital in East Lansing, Mich. Then in March, the coronavirus struck. “Mentally, it takes such a toll on you. It makes me question so many things and it almost feels like I’m not doing anything — not helping anybody when people just keep coming in and getting sick,” she said. “Nurses are supposed to help people. And I feel like I’m not doing that.” (Youn, 11/18)

NPR: Nurses Implore Public To Stay Safe As COVID Hospitalizations Surge
The number of hospitalizations from the coronavirus reached nearly 77,000 on Tuesday — a new record. For the country's nurses, the surge is taking a heavy toll, as they grow exhausted, worried and frustrated by disinformation and disregard for safety. Some eight months into the crisis, nurses have been taking to social media, describing grim scenes at work and imploring Americans to stay safe as hospitals reach capacity limits. Nationwide, hospitalizations have been steadily climbing, with the Midwest and the South hit especially hard. In the last week alone, each has seen a roughly 35% spike in hospitalizations, according to the Covid Tracking Project. (Glenn and Inskeep, 11/18)

And states are swamped with COVID hospitalizations —

Indianapolis Star: Indiana COVID: Hospitals Plead For Hoosiers To Help Curb Spread
Struggling to maintain sufficient staff and resources to care for a surge of COVID-19 patients, three hospital executives Wednesday implored Hoosiers to curb the spread of the virus by doing the simple things officials have asked them to do for months. Week after week at his Wednesday coronavirus briefings, Gov. Eric Holcomb has repeated over and over that individuals have the power to tamp down coronavirus by wearing masks, socially distancing and washing their hands. (Rudavsky, 11/18)

Detroit Free Press: Michigan Is 6th For Highest COVID-19 Cases In Nation, 5th For Deaths
Michigan now ranks sixth nationally in coronavirus cases and fifth for the number of COVID-19-related deaths, said Sarah Lyon-Callo, director of the Bureau of Epidemiology and Population Health at the Michigan Department of Health and Human Services, citing data from the last seven days. (Jordan Shamus, 11/18)

Philadelphia Inquirer: Pa. Hospitalizations Pass April Peak As State Reports More Than 6,000 New Cases In One Day
As the coronavirus continued its unrelenting spread, more patients were hospitalized in Pennsylvania on Wednesday than ever before, surpassing the state’s late April peak as officials also reported more than 6,000 new cases — the first time the state has seen that many people test positive in one day. In just the last seven days, more than 38,000 people in Pennsylvania have tested positive. That’s about enough people to fill the Wells Fargo Center — twice. (McDaniel, Steele and McCarthy, 11/18)

Las Vegas Review-Journal: More Nevadans Now Hospitalized For COVID-19 Than Any Stage Of Pandemic
Nevada on Wednesday reported 1,665 additional coronavirus cases, as the Nevada Hospital Association said the state has reached the highest number of hospitalized patients since the start of the pandemic. There also were three additional deaths reported, according to the Department of Health and Human Services. The updated figures posted to the state’s coronavirus website brought totals in Nevada to 125,459 cases and 1,947 deaths since the pandemic began. Newberg, 11/18)

Cincinnati Enquirer: Cincinnati Doctor: Curfew 'Reflects The Desperate Situation That We're In'
On yet another pandemic barnstorming of the Buckeye State Wednesday, Gov. Mike DeWine asked Ohioans to abide by an overnight curfew he has ordered for three weeks in hopes of stemming the current surge of the new coronavirus." By 10 o'clock, people need to be home," DeWine said outside Lunken Airport Terminal, his final stop of the day after touching down with the same message earlier in Toledo, Cleveland, Youngstown and Columbus. (Saker, 11/18)

Anchorage Daily News: Virus Surge Continues With 551 New Cases And Record Hospitalizations Reported Wednesday
The pandemic in Alaska is continuing to grow, with the state reporting 551 new COVID-19 cases and record hospitalizations, according to data from the Alaska Department of Health and Social Services.“ We’re in an acceleration phase (in Alaska),” said Louisa Castrodale, an epidemiologist with the state, during a call Wednesday. “I don’t think we have a hint yet that things are leveling off.” (Berman and Krakow, 11/18)

CNN: More Than 900 Mayo Clinic Staff Members Diagnosed With Covid-19 In Midwest Over Two Weeks 
More than 900 staff members across the Midwest Mayo Clinic system have been diagnosed with Covid-19 over the last 14 days, a spokesperson told CNN. That's about 30% of the total number who have tested positive since March. "Our staff are being infected mostly due to community spread (93% of staff infections), and this impacts our ability to care for patients," Kelley Luckstein wrote to CNN in a Wednesday email. (Lemos and Maxouris, 11/19)

In other COVID-related developments in the health industry —

AP: Coalition Seizes On Pandemic To Boost 'Obamacare' Sign-Ups
As COVID-19 spreads uncontrolled in many places, a coalition of states, health care groups and activists is striving to drum up “Obamacare” sign-ups among a growing number of Americans uninsured in perilous times. The campaign kicking off Thursday is called Get Covered 2021 and contrasts with a lack of outreach to the uninsured by the Trump administration, which is still trying to overturn the Affordable Care Act, even in the coronavirus pandemic. (Alonso-Zaldivar, 11/9)

AP: Sanford Health To Open New COVID-19 Unit In Bismarck
Sanford Health is opening a new COVID-19 unit in Bismarck, a move the hospital’s president called a “wake-up call” as beds become increasingly scarce because of the explosion of coronavirus cases in the state. The 20-bed unit at the former Bismarck Surgical Associates building is expected to open next week, according to the health care system. (11/18)

Modern Healthcare: Small Doc Groups Struggle With Telehealth, State Panel Finds
Many Massachusetts physician groups are struggling to leverage telehealth as they continue to deal with lagging patient volumes, according to new data. Small physician groups across the country had not seen volumes return to pre-pandemic levels as of early October, in part because they have not been able to incorporate telehealth into their practice, which was mirrored in Massachusetts. (Kacik, 11/18)

Houston Chronicle: Health Experts Call For A Texas Reserve Force To Battle The Next Pandemic
The coronavirus pandemic is far from over, but a group of Texas health experts is already looking forward, recommending that the state prepare for future health crises by improving data collection, expanding access to health care and building a reserve force of Texans who can help with surge efforts including testing, contact tracing and logistical support. In a report released Wednesday, the group, which includes doctors, academics and health care executives, also said federal and state lawmakers should increase funding for public health and develop incentives for more students to enter the field, including more degree programs at public universities and government-sponsored internships. (Blackman, 11/18)

Modern Healthcare: 4 Policy Priorities For The American Medical Association
The American Medical Association's House of Delegates passed several resolutions during their meeting this week. Most of the measures focused on addressing the two most notable public health concerns of 2020 — combating racial discrimination and addressing COVID-19's on the country's clinical workforce. But other proposals passed during the meeting offer into the key lobbying priorities of the nation's largest physicians' organization. Here are four new AMA policies adopted this week that could affect healthcare policy over the next year. (Ross Johnson and Cohrs, 11/18)

Also —

Modern Healthcare: Federal Judge Strikes Down Anti-Union Payment Rule For Home Health Workers
A federal judge in California on Tuesday overturned a federal rule that prohibited home health workers from using Medicaid payments to pay for their union dues. The final HHS rule has been in effect since 2019 and overturned a 2014 rule specifically allowing Medicaid payments to be diverted from providers to third parties for expenses like union dues. (Christ, 11/18)

Modern Healthcare: Baylor Scott & White To Create Med School Campus With Baylor College Of Medicine
Baylor Scott & White Health announced this week it's financing the formation of a new medical school campus in Temple, Texas, through a partnership with Baylor College of Medicine. The new campus, which is slated to open in fall 2023 to its first class of students, is part of an effort by Baylor Scott & White to expand the physician workforce in Texas and build a pipeline of physicians practicing at its system. Texas had a shortage of 2,002 primary care physicians in 2017 and that shortage is expected to increase by 67% in 2030, according to a 2018 report by the state's department of health services. (Castellucci, 11/18)

CNBC: Biden Advisor Could Face Ethics Pressure As Brother Lobbies For Pharma
One of President-elect Joe Biden’s closest advisors could face pressure to recuse himself from working on some of the incoming administration’s key initiatives as his brother lobbies for at least two pharmaceutical companies. Steve Ricchetti, who on Tuesday was named counselor to the president in Biden’s eventual administration, has a brother, Jeff, who was hired to lobby for pharmaceutical firms while Biden was running for president, according to disclosure reports. Ricchetti was Biden’s campaign chairman and previously his chief of staff. (Schwartz, 11/18)

Fox News: Biden Appoints Two Former Lobbyists To Senior Staff
President-elect Joe Biden is already ignoring progressive demands by adding former lobbyists to his roster of senior staff. Last week, more than 50 liberal advocacy organizations and more than a dozens liberal House members signed a letter urging Biden to bar anyone with ties to the corporate world from serving in his administration. “We urge you to decline to nominate or hire corporate executives, lobbyists, and prominent corporate consultants to serve in high office,” the letter demanded. It said that such people are incapable of “working in the service of the general welfare.” (Phillips, 11/18)

In other pharmaceutical industry news —

Asbury Park Press: Johnson & Johnson Vows To Add 50% More Black Managers In Five Years
Johnson & Johnson plans to increase the number of Black managers in the company by 50% within five years as part of a $100 million initiative to tackle racial inequality, executives said Tuesday. The world's biggest health company said it also would create college scholarships for Black students interested in science, business and health care. (Diamond, 11/18)

KHN: Surprise Federal Drug Rule Directs Insurers To Reveal What They Pay For Prescription Drugs 
Health insurance companies will have to give their customers estimated out-of-pocket costs for prescription drugs and disclose to the public the negotiated prices they pay for drugs, under an unexpected new Trump administration rule. The administration said those requirements, part of a broader rule issued Oct. 29 forcing health plans to disclose costs and payments for most health care services, will promote competition and empower consumers to make better medical decisions. (Meyer, 11/19)

FiercePharma: Cambrex Looks To Fill 'Onshore' API Manufacturing Demand With $50M Expansion In Iowa
With the COVID-19 pandemic nearing its second year in the U.S., lawmakers have banged the drum on boosting "onshore" production of key pharmaceuticals and ingredients to ensure supply-side security. Now, a New Jersey-based contract manufacturer is dropping more money into its Iowa site to support the effort. Cambrex will invest $50 million to add four active pharmaceutical ingredients (API) facilities at its Charles City, Iowa, small-molecule drug site and expand capacity by 30%, the company said Tuesday.  (Blankenship, 11/17)

FiercePharma: Sanofi Sponsors Parkinson's Foundation's Genetic Study With $1M For Free Testing
It's estimated that 10% to 15% of people with Parkinson's have a genetic form of the disease and Sanofi Genzyme is backing a new study to help find those people. Working with the Parkinson's Foundation, the effort, called PD GENEration, will provide free genetic testing, either by in-person blood testing at selected sites or by a telemedicine appointment combined with at-home cheek swabs. Sanofi will contribute $1 million to the study over the next two years. (Klahr Coey, 11/18)

Stat: How Amazon Pharmacy Is Poised To Shake Up The Drug Delivery Market
The launch of Amazon Pharmacy on Tuesday sent shockwaves through the pharmacy pipeline, with industry observers speculating that the shipping giant’s latest move would spur major competition across the sector. Above all else, Amazon’s new service — which lets customers buy prescription drugs online and have them delivered — further centralizes the home as a site of care, likely motivating others in the business to roll out similar offerings designed to meet patients where they are, according to health care analysts. (Brodwin, 11/18)

Politico: Northeast Governors Call On Colleges To Provide Students With Covid Testing
Citing rising coronavirus cases nationwide, seven northeast governors are calling on colleges and universities in their states to provide Covid-19 tests for all students traveling home for Thanksgiving. New Jersey Gov. Phil Murphy and New York Gov. Andrew Cuomo, along with the governors of Connecticut, Delaware, Pennsylvania, Rhode Island and Massachusetts on Wednesday announced they are encouraging residential colleges and universities in their respective states to make tests widely available to traveling students before they leave campus and to double down on isolation and quarantine efforts for those students who test positive. (Sitrin, 11/18)

Des Moines Register: COVID Test Before Thanksgiving? Colleges Fear Travel Will Spread Virus
After a semester battling the coronavirus, often unsuccessfully, college leaders have one final plea for students heading home for Thanksgiving: Get tested, please. What's unclear: whether the plea will work. (Quintana, 11/19)

Boston Globe: Mass. Set To Launch First Phase Of Rapid Coronavirus Testing In Schools In December
Amid a surge in COVID-19 cases, the Baker administration on Wednesday announced new testing guidelines and initiatives affecting a broad swath of Massachusetts students — from kindergarten through college — aimed at squelching infections before they spread. Under the plans, the state will roll out quick-turnaround tests to 134 public school districts, charters, and special education collaboratives in early December to screen students and staff who show any COVID-19 symptoms, however mild. (Lazar, Fernandes and Gans, 11/18)

The Washington Post: Long Lines And Delayed Results Again Plague Coronavirus Tests As Thanksgiving Approaches 
Americans seeking coronavirus tests amid an unprecedented surge in cases are experiencing lengthier lines and waiting days to get test results — delays that complicate efforts to slow the pandemic and that are expected to intensify as people try to get tested ahead of family gatherings. Testing sites from New York to Wisconsin to Oregon are reporting lines stretching three to four hours, with results taking as long as five days. (Wan, 11/18)

In other testing and tracing news —

CIDRAP: Smartwatch Data May Help Identify Pre-Symptomatic COVID-19
A study in Nature Biomedical Engineering today shows that smartwatches and other wearable devices may detect pre-symptomatic COVID-19 infection and allow for early-stage interventions that reduce transmission. Among infected smartwatch users, 81% showed alterations in their heart rate, number of daily steps, or time asleep. Changes before symptom onset identified 63% of the COVID-19–positive individuals, showing that consumer wearable device data can recognize pre-symptomatic infection. (11/18)

KHN: People Proving To Be Weakest Link For Apps Tracking COVID Exposure 
The app builders had planned for pranksters, ensuring that only people with verified COVID-19 cases could trigger an alert. They’d planned for heavy criticism about privacy, in many cases making the features as bare-bones as possible. But, as more states roll out smartphone contact-tracing technology, other challenges are emerging. Namely, human nature. The problem starts with downloads. Stefano Tessaro calls it the “chicken-and-egg” issue: The system works only if a lot of people buy into it, but people will buy into it only if they know it works. (Bichell, 11/19)

The Washington Post: Mardi Gras 2021: New Orleans Bans Parades Due To Covid-19 
Mardi Gras celebrations in 2021 will not include New Orleans’ traditional parades, which take place every year to mark the carnival season, Mayor LaToya Cantrell’s office confirmed in a news conference Tuesday. Mardi Gras guidance on the city’s website states: “Parades of any kind will not be permitted.” The guidelines stress that not all celebrations around Mardi Gras are canceled, but parades will not be possible “because large gatherings have proven to be super spreader events.” (McMahon, 11/17)

The Washington Post: Delta Air Lines Will Block Middle Seats Through March 2021 
Delta, the only airline of the big three still blocking middle seats for social distancing, will continue to do so until March 30, 2021, the airline announced Wednesday. The decision comes days after JetBlue announced it will stop limiting capacity in January 2021 and weeks after Southwest said it will stop blocking middle seats on Dec. 1. Alaska Air has committed to blocking seats until Jan. 6. (McMahon, 11/18)

AP: All NFL Teams To Enter Intensive COVID-19 Protocol Saturday
The NFL is placing all teams in intensive protocol starting Saturday to mitigate the risk of COVID-19 as the number of cases rises around the country. Use of masks will be mandatory at all times at team facilities, including during practice and in weight rooms. Meetings must be held either virtually or in the largest indoor space with approval by the league. Meals have to be made available for grab-and-go to avoid players and staff congregating in cafeterias. Time spent in the locker room also has to be limited. (Maaddi, 11/19)

KQED: Most Coronavirus Transmission Happens At Indoor Restaurants, Cafes, Gyms: Study
"There is a very small number of places, about, let's say, 10%, where 85% of all infections happen," said Jure Leskovec, a Stanford computer scientist and one of the study's authors. The research, conducted by a group from Northwestern University and the Chan Zuckerberg Biohub as well as Stanford, looked at infections between March 1 and May 2 of this year. Indoor sit-down restaurants, cafes and gyms were the top three points of transmission, and crowding in any indoor business increased the risk of contracting the virus. (Venton, 11/18)

CNN: Coronavirus Quarantine: Are American Adults Capable Of Isolating For Two Weeks? 
If you think quarantine needs a better publicist in the United States, you might be right. New Zealanders went into a strict lockdown and so did Italians. So did the residents of China, Spain, Bolivia, Morocco and South Korea. The idea of isolating for a stretch of two weeks either because you've been exposed to Covid-19 or are traveling from a Covid-19 hotspot, however, can feel like a punishment to Americans, not a long-standing infectious disease prevention policy. (Hochwald, 11/19)

In other public health news —

CIDRAP: Childhood Vaccine Uptake Down 26% This Year, Report Estimates
Nine million childhood vaccines are projected to be missed by the end of this year in the United States—a 26% decrease compared with 2019—according to a Blue Cross Blue Shield Association (BCBSA) report. This decline would cause a gap between vaccination rate and that required for herd immunity of 4.8 percentage points for measles and 12.7 percentage points for pertussis (whooping cough). Polio would still maintain a 2.9-percentage-point buffer. According to BCBS medical claims, both measles, mumps, and rubella (MMR) and diphtheria, tetanus, and pertussis (DtaP) childhood vaccination rates dropped 26% January through September year-over-year, with a predicted 2020-end rate of 88.2% and 79.3%, respectively. That compares with herd immunity requirements of 93.0% and 92.0%, respectively, according to the Centers for Disease Control and Prevention. (11/18)

KHN: Family Mourns Man With Mental Illness Killed By Police, Calls For Change
Rulennis Muñoz remembers the phone ringing on Sept. 13. Her mother was calling from the car, frustrated. Rulennis could also hear her brother Ricardo shouting in the background. Her mom told her that Ricardo, who had been diagnosed with paranoid schizophrenia five years earlier, wouldn’t take his medication. Within an hour, Ricardo Muñoz, 27, was dead. Muñoz, who had a knife, was killed by a police officer in Lancaster, Pennsylvania. The incident has striking similarities to the killing of Walter Wallace Jr. in Philadelphia six weeks later but has received far less national attention. (Sholtis, 11/19)

Politico: In A Major Setback, New York City Schools To Shut Down Over Parents' Objections
In a bruising setback to the city’s recovery, the nations’s largest public school system will temporarily shut down in-person learning this week after coronavirus infections in New York City climbed to a level not seen since the spring, when the city was the national epicenter of the pandemic. Mayor Bill de Blasio exacted a hard won victory in bringing some 300,000 kids back to school in September — one of the more successful endeavors by the administration since the onset of the pandemic. But amid reluctance from the teachers union, the city agreed to close schools if it reached a 3 percent infection rate on a 7-day average, which Mayor Bill de Blasio said it just reached Wednesday. (Toure, 11/18)

Lexington Herald Leader: Beshear Stops All In-Person K-12 Classes In Kentucky Starting Monday As COVID-19 Surges
Starting Monday, all K-12 schools in Kentucky, including private schools, will stop in-person classes and move to remote learning, Gov. Andy Beshear said at a news conference Wednesday. “This virus at its level right now is and will overwhelm each and everyone of our schools if we do not take action,” he said. (Honeycutt Spears, 11/18)

NBC News: Covid School Closings Raise Privacy Concerns For Students And Teachers
Maintaining certain pre-coronavirus policies makes sense — schools have an obligation to ensure students treat their peers respectfully and are graded fairly, for example. But other rules are trickier, with schools weighing the competing equities raised by rules governing attendance policies, monitoring students’ virtual workspaces and dress codes (including guidelines for how onscreen family members may dress). (Reddy, 11/18)

In other news —

AP: Not Just COVID: Nursing Home Neglect Deaths Surge In Shadows
When COVID-19 tore through Donald Wallace’s nursing home, he was one of the lucky few to avoid infection. He died a horrible death anyway. Hale and happy before the pandemic, the 75-year-old retired Alabama truck driver became so malnourished and dehydrated that he dropped to 98 pounds and looked to his son like he’d been in a concentration camp. Septic shock suggested an untreated urinary infection, E. coli in his body from his own feces hinted at poor hygiene, and aspiration pneumonia indicated Wallace, who needed help with meals, had likely choked on his food. (Sedensky and Condon, 11/19)

Politico: Newsom's French Laundry Dinner Sparks Questions About 'Outdoor Dining' Definition
Does a fancy open garage count as an outdoor dining venue? That's the question prompted by pictures that emerged this week of Gov. Gavin Newsom's dinner with friends and lobbyists at the posh French Laundry in Yountville. The photos, taken by another dinner patron and obtained by Fox LA, show Newsom sitting at a round table for 12 in a dining room that is enclosed on three sides and covered. In his Monday apology for attending the dinner, Newsom stressed repeatedly that the event was outdoors, a qualifier that in the pandemic era implies safer conditions due to natural air circulation that reduces transmission. (Colliver, 11/18)

The Washington Post: Coronavirus Second Wave May Have Eased In Europe, But Deaths Are Increasing. 
Europe’s painful second coronavirus wave may be starting to ease, a top World Health Organization official said Thursday, as cases drop slightly even though over the last week someone on the continent died every 17 seconds from the virus. The cautious prognosis came after new diagnoses of the novel coronavirus slowed last week across Europe to 1.8 million cases, compared to 2 million the week before last. Hospitals across the continent remain packed, a situation that sharply increases the chance that patients will die of the disease. “There is good news and not so good news,” said Hans Kluge, the WHO’s regional director for Europe, at a news conference, describing the drop in new diagnoses as “a small signal, but it’s a signal nevertheless.” (Birnbaum, 11/19)

Reuters: China Sinopharm's Coronavirus Vaccine Taken By About A Million People In Emergency Use
Nearly one million people have taken an experimental coronavirus vaccine developed by China National Pharmaceutical Group (Sinopharm) through the country’s emergency use programme, the firm said late on Wednesday. China launched the emergency use programme in July, which so far includes three vaccine candidates for essential workers and other limited groups of people even as clinical studies have yet to be completed to prove their safety and efficacy. (11/19)

The Hill: Closures Of US Borders With Canada, Mexico Expected To Be Extended
The U.S. borders with Mexico and Canada will remain closed through mid-December as cases of the coronavirus spike in the United States, officials said Wednesday. Mexico's foreign ministry confirmed in a pair of tweets that nonessential land traffic would be shut down at the U.S.-Mexico border through Dec. 21. U.S. officials confirmed to Reuters that the same policy was being followed at the U.S.-Canada border. (Bowden, 11/18)

AP: African Continent Hits 2 Million Confirmed Coronavirus Cases
The African continent has surpassed 2 million confirmed cases as the top public health official warned Thursday that “we are inevitably edging toward a second wave” of infections. The Africa Centers for Disease Control and Prevention said the 54-nation continent had crossed the milestone. Africa has seen more than 48,000 deaths from COVID-19. Its infections and deaths make up less than 4% of the global total. (Anna, 11/19)

AP: Berlin Police Forcefully Disperse Protest Over Virus Rules
German police used water cannons and pepper spray Wednesday to disperse people protesting coronavirus restrictions in Berlin’s government district, after crowds ignored calls to wear masks and keep their distance from one another in line with pandemic regulations. As water sprayed from the cannons rained down on protesters outside the landmark Brandenburg Gate, police in riot gear moved through the crowd carrying away some participants. Some demonstrators threw fireworks, flares and other objects in response as police helicopters hovered overhead. (Rising, 11/18)

Reuters: COVID Toll Turns Spotlight On Europe's Taboo Of Data By Race
Many European countries avoid breaking down data along racial or ethnic lines out of concern over privacy or discrimination, but COVID-19’s outsized impact on Black and Asian people has exposed flaws in the approach, some scientists and activists said. They want more comprehensive data collection across the continent to improve understanding about how and why COVID-19 affects different communities, and thereby help countries tailor testing and care to better protect them. (Waldersee, 11/19)

The Wall Street Journal: Covid-19 Vaccine Progress Gives Tokyo Olympics A Tailwind 
Breakthroughs in Covid-19 vaccine trials are giving a boost to the organizers of next summer’s Tokyo Olympics, who are looking into vaccine suppliers and planning to encourage athletes to get their shots. Still, local organizers remain publicly cautious about whether enough vaccines will be available in time, and they are leaving room for the Games to proceed regardless. If vaccines are in short supply, it would be hard to justify prioritizing young athletes with low risk of serious illness. (Gale, 11/19)

The Washington Post: Japan Still Subsidizing People To Eat Out And Travel Even As Covid Cases Hit New Records
[The Japanese] government said it was sticking with an increasingly controversial domestic travel and tourism subsidy program, in which people can be refunded for up to half of costs of hotels, flights, restaurants, tourist attractions and even shopping on trips within the country. It is meant to boost domestic tourism and support local economies but has been blamed for spreading the virus from urban hotspots to every corner of Japan.

In updates on Ebola —

CIDRAP: WHO Declares End To DRC's 11th Ebola Outbreak 
Today marks the end of the 11th Ebola virus outbreak in the Democratic Republic of Congo (DRC) after causing 119 confirmed cases, 11 probable ones (130 cases total), and 55 deaths (42.3% of all cases), according to the World Health Organization (WHO). Since beginning in the country's western province of Equateur on Jun 1, the outbreak affected 13 of the province's 18 health zones in both urban and remote communities. (McLernon, 11/18)

CIDRAP: US Vets With COVID-Related Kidney Injury At 6.7 Times Risk Of Death
Acute kidney injury (AKI) and its attendant almost-seven-times-higher risk of death is common in US veterans hospitalized with COVID-19—especially black patients, an observational study published yesterday in the Clinical Journal of the American Society of Nephrology suggests. (Van Beusekom, 11/17)

CIDRAP: Diaphragm Dysfunction Found In Patients Who Died Of COVID-19
A research letter published yesterday in JAMA Internal Medicine shows that patients who died of COVID-19 in the Netherlands were more than twice as likely to have scarring of their diaphragms than patients who died of other causes. A research team led by Amsterdam University Medical Center compared diaphragm specimens from 26 patients who died of coronavirus with those of 8 patients who died of other causes at three academic medical centers in April and May. Weakness of the diaphragm, the main muscle responsible for breathing, can result in acute respiratory failure, prolong mechanical ventilation, and raise the risk of death. (11/17)

CIDRAP: Study Shows Cross-Neutralizing Antibodies In Recovering COVID Patients
Patients recovering from severe COVID-19 infections show a strong neutralizing antibody response, with some people producing cross-neutralizing antibodies that are capable of neutralizing other types of coronaviruses, a study yesterday in Nature Microbiology reported. Patients with severe disease had a higher frequency of circulating immune cells called T follicular helper (TFH) cells specific to SARS-CoV-2 spike proteins—surface molecules that allow the virus to bind to and penetrate host cells. (11/17)

Nature Medicine: Wearable Sensor Data And Self-Reported Symptoms For COVID-19 Detection 
Owing to the current lack of fast and reliable testing, one of the greatest challenges for preventing transmission of SARS-CoV-2 is the ability to quickly identify, trace and isolate cases before they can further spread the infection to susceptible individuals. As regions across the United States start implementing measures to reopen businesses, schools and other activities, many rely on current screening practices for COVID-19, which typically include a combination of symptom and travel-related survey questions and temperature measurements. However, this method is likely to miss pre-symptomatic or asymptomatic cases, which make up ~40–45% of those infected with SARS-CoV-2, and who can still be infectious1,2. An elevated temperature (>100 °F (>37.8 °C)) is not as common as frequently believed, being present in only 12% of individuals who tested positive for COVID-193 and just 31% of patients hospitalized with COVID-19 (at the time of admission)4. (Quer et al, 10/29)

Also —

CIDRAP: CARB-X To Fund Development Of Monoclonal Antibody For Biofilm Infections
CARB-X announced today that it is awarding up to $2.42 million to Clarametyx Biosciences of Columbus, Ohio, to develop a monoclonal antibody treatment for serious infections caused by bacterial biofilms. The money from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) will help fund preclinical development of CMTX-101, a monoclonal antibody designed to rapidly collapse bacterial biofilms by targeting a region of DNABII-binding proteins that help stabilize and maintain biofilm integrity. (11/18)

American Academy Of Pediatrics: Timing Of Puberty Suppression And Surgical Options For Transgender Youth 
Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. (van de Grift et al, 11/1)

JAMA Network: Evaluation Of Time To Benefit Of Statins For The Primary Prevention Of Cardiovascular Events In Adults Aged 50 To 75 Years: A Meta-Analysis
What is the time to benefit of statin therapy for primary prevention of cardiovascular events in adults aged 50 to 75 years? In this survival meta-analysis of 8 trials randomizing 65 383 adults, 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 cardiovascular event for 100 patients treated with a statin. (Yourman, 11/16)

The Washington Post: Seven Governors: Americans Need To Stay Home This Thanksgiving
For eight months, the covid-19 pandemic has devastated American families everywhere. To fight this virus, governors across the country have listened to medical experts and worked around the clock to protect our families, the brave men and women on the front lines, and our small-business owners. No matter the action we take, we understand that our fight against covid-19 will be more effective when we work together. That is why we, a group of bipartisan governors, are joining forces today to urge families across our region, and Americans everywhere, to do their part to protect themselves and their loved ones from the spread of covid-19. When it comes to fighting this virus, we are all on the same team. (Gretchen Whitmer, D-Mich.; Mike DeWine, R-Ohio; Tony Evers, D-Wis.; Tim Walz, D-Minn.; J.B. Pritzker, D-Ill.; Eric Holcomb, R-Ind.; and Andy Beshear, D-Ky., 11/18).

The Wall Street Journal: Gretchen Whitmer Strikes Again
Rule by executive fiat in the states has become a hallmark of the pandemic, and Michigan Gov. Gretchen Whitmer seems determined to push its limits. After a rebuke by the state Supreme Court, the Democrat has found a new statutory justification to continue her arbitrary emergency rule of one. Michigan’s Emergency Management Act gives the Governor some emergency authority but requires legislative approval beyond 28 days. In October the state Supreme Court found Ms. Whitmer exceeded her authority by declaring a new emergency “for the identical reasons” after time ran out on the first one. (11/18)

Bloomberg: What Winning The Covid-19 War Would Look Like 
In early spring, as Covid-19 began marching across the U.S., President Donald Trump described it as an existential challenge. “We’re at war. In a true sense, we’re at war,” he said. “Look, the greatest thing we can do is win the war. The war is against the virus. That’s the war.” He was right. And recently there’s been heartening and exciting news from the battlefront. Three companies, Pfizer Inc., BioNTech SE and Moderna Inc., have announced promising results from late-stage trials of possible Covid-19 vaccines. If all goes well, they might be generally available early next year. So far, though, we’ve been losing this war. The coronavirus is setting new caseload and hospitalization records nationally. (Timothy L. O'Brien, 11/19)

The Washington Post: A National Covid Lockdown Won’t Happen, And The U.S. Doesn’t Need One
Can we please stop talking about lockdowns? A national lockdown is not going to happen in the United States. Every time it’s brought up, it distracts attention from practical public health measures that can work to control covid-19. I understand that a “shutdown” or “lockdown” is a convenient shorthand to describe restrictions that states have recently put into place. This week, Washington state closed bars and restaurants for indoor dining and prohibited indoor social gatherings for people in different households. Michigan closed casinos and movie theaters and ended in-person classes for colleges and high schools. And as of Thursday, New York City’s public schools are returning to all-remote instruction. (Leana S. Wen, 11/18)

The New York Times: The Problem With Coronavirus School Closures 
Some things are true even though President Trump says them. Trump has been demanding for months that schools reopen, and on that he seems to have been largely right. Schools, especially elementary schools, do not appear to have been major sources of coronavirus transmission, and remote learning is proving to be a catastrophe for many low-income children. Yet America is shutting schools — New York City announced Wednesday that it was closing schools in the nation’s largest school district — even as it allows businesses like restaurants and bars to operate. What are our priorities? (Nicholas Kristof, 11/18)

Stat: The Year Of The Pandemic: A View From South Korea
The central explanation for South Korea’s success in taming the pandemic so far is its strategy of targeted testing and aggressive contact tracing. That and the willingness of the public — including most religious believers and political protestors — to follow basic precautions. So far, as schools have been closed or partially closed and many people have spent parts of this year working from home, we’ve managed to avoid a national lockdown. (Michael Breen, 11/19)

Stat: Self-Interest Nudged Me To Join Moderna's Covid-19 Vaccine Trial 
I volunteered to take part in a Covid-19 vaccine trial. I wish I could say I did it to help hasten the defeat the coronavirus or to further science. But I really just wanted a chance to get a vaccine as soon as possible. (John Yang, 11/19)

Bloomberg: The Covid Economy: Congress Must Pass Coronavirus Stimulus 
In the months leading up to the election, U.S. lawmakers failed to agree on a new coronavirus relief plan. Now, with a lame-duck Congress and President Donald Trump moving reluctantly toward the exit, the temptation will be to do nothing until President-elect Joe Biden is in office and the new legislature is installed. That’s too long to wait. (11/18)

The Wall Street Journal: Amazon Shakes Up Health Care
Amazon has driven innovation and competition across the retail industry from supermarkets to books. Now it’s gunning for pharmacies, which could force healthy changes across America’s sclerotic health-care system. On Tuesday the retail and cloud-computing giant announced it is launching an online pharmacy that will deliver common medications, including insulin and asthma inhalers, with free two-day shipping for its Prime members. The move was facilitated by its purchase two years ago of PillPack, the online pharmacy startup that sorts, packages and delivers medication. (11/18)

Stat: The Shameful Abundance Of Birth- And Pregnancy-Related Deaths In The U.S. 
The U.S. spends more on health care than any other wealthy nation. Yet, more people here die from complications of pregnancy and childbirth than in any of those countries. The numbers are stark: Birthing people die in 17 of every 100,000 births in the U.S., compared to just three or fewer in the Netherlands, Norway, and New Zealand. Those who die in this country are, more often than not, Black people, the delivery room being one more place where systemic racism takes its toll on Black families. (Laurie Zephyrin and Roosa Tikkanen, 11/18)