The New York Times - USA (2020-07-28)

THE NEW YORK TIMES, TUESDAY, JULY 28, 2020 Y A

Tracking an OutbreakPlanning Ahead

LONDON — Britain will crack
down on junk food advertising and
introduce calorie counts on menus
in an effort to tackle obesity and
ease the pressure on the country’s
National Health Service amid the
coronavirus pandemic, the gov-
ernment said on Monday.
For the British prime minister,
Boris Johnson, the intersection of
obesity and the coronavirus is
personal. Mr. Johnson was, by his
own admission, “way overweight”
when he was admitted to the hos-
pital after becoming ill with
Covid-19 this year, and his health
deteriorated to such an extent
that at one point he needed inten-
sive care.
Studies have linked obesity to a
greater risk of serious illness or
death from Covid-19, and Mr.
Johnson, writing in the British
newspaper The Daily Express,
described his time in hospital as a
“wake-up call.”
“We all put things off — I know I
have,” Mr. Johnson wrote. “I’ve
wanted to lose weight for ages,
and like many people I struggle
with my weight.”
“I go up and down, but during
the whole coronavirus epidemic
and when I got it, too, I realized
how important it is not to be over-
weight,” he added.
As part of the government’s
new obesity strategy, advertise-
ments for any food high in fat, sug-
ar or salt will be banned on televi-
sion and online until 9 p.m. to
avoid hours when children are
most likely to see them. There will
also be a consultation on whether
Britain should entirely ban online
ads for junk food.
All large restaurants and cafes
will be required to add a calorie

count to their menus, and the gov-
ernment will look into adding cal-
orie labels to alcoholic drinks.
Promotional offers like “buy
one, get one free” on fatty or sug-
ary foods will also be prohibited.
Obesity in Britain has long been
cited as a growing problem and as
a drain on the N.H.S., and the
country is usually near the top of
lists ranking Europe’s fattest
countries.
Government statistics show al-
most two-thirds of adults in Eng-
land are overweight or obese. The
World Health Organization esti-
mates that about 39 percent of
adults worldwide are overweight
and that around 13 percent are
obese.
More than 45,000 people in Brit-
ain have died from the coro-
navirus. Nearly 8 percent of
Covid-19 patients in intensive care
units have been morbidly obese,
the British government said, even
though morbidly obese people ac-
count for only 2.9 percent of the
general population.
Mr. Johnson said in a video
posted on Twitter on Monday that
he had lost more than 14 pounds
since his time in the hospital.
The Daily Telegraph, a British
newspaper, reported that the
prime minister weighed 245
pounds when he was hospitalized
in April. Even with his recent slim-
ming, Mr. Johnson, who is about 5
feet 10 inches tall, would still rank
as obese, according to an N.H.S.
calculator, though the prime min-
ister said he had only just started
concentrating on building his fit-
ness and losing weight.
The wide-ranging measures an-
nounced on Monday are a change
in tack for Mr. Johnson, who last
year described a levy on sugary
drinks as “sin stealth taxes” and
warned of the “continuing creep of
the nanny state.”
Professor Parveen Kumar, a
spokeswoman for the British
Medical Association, which repre-
sents doctors, said in a statement
on Monday that the strategy
“could go a long way in kick-start-
ing a health revolution for the na-
tion.”
But the measures did not re-
ceive such a warm welcome from
the food and retail industry. Tim
Rycroft, the chief operating officer
at the Food and Drink Federation,
a group representing manufactur-
ers in the sector, called the plans a
“punishing blow” for companies
that had been “heralded by gov-
ernment for feeding the nation
during the Covid crisis.”
The federation said that, while
it supported the government’s
push for Britain to become health-
ier, the proposed policies had been
shown to be ineffective and would
serve only to raise prices.

BRITAIN

Weight Loss

Is Set as Goal

To Ease Load

On Hospitals

By ANNA SCHAVERIEN

Unveiling a strategy,

Boris Johnson cites

his own struggles.

States, more people have been in-

fected by far than in any other

country, and the daily rundown of

national numbers on Friday was a

reminder of a mounting emer-

gency: more than 73,500 new

cases, 1,100 deaths and 939,

tests, as well as 59,670 people cur-

rently hospitalized for the virus.

Americans now have access to

an expanding set of data to help

them interpret the coronavirus

pandemic. They are closely track-

ing the number of sick and dead.

They can read daily case counts in

their cities and states, the per-

centage of positive tests, the num-

ber of people hospitalized and the

weekly change in cases. It is possi-

ble to look on the Illinois Depart-

ment of Public Health website and

learn how many hospital beds ex-

ist statewide, how many ventila-

tors are available in Peoria and

how many intensive-care-unit

beds are free in Champaign.

Sophisticated data-gathering

operations by newspapers, re-

search universities and volun-

teers have sprung up in response

to the pandemic, monitoring and

collecting coronavirus metrics

around the clock. Elected officials

who were not particularly well

versed in public health or infec-

tious disease when 2020 began

now sound a little like epidemiolo-

gists, spending their days steeped

in data and making policy deci-

sions based on the figures before

them.

“Everybody’s tracking this vi-

rus in a way that they’ve never

done with any other infectious dis-

ease,” said Dr. Amesh A. Adalja, a

physician and senior scholar at

the Johns Hopkins Center for

Health Security who has treated

coronavirus patients. “For some

people, it’s helped them under-

stand what is happening. For

other people, it’s been misinter-

preted and not very helpful.”

He offered an example of an

“armchair epi” from his own so-

cial circle: Scanning his Facebook

feed recently, Dr. Adalja read a

high-school classmate authorita-

tively sharing information on the

coronavirus fatality rate — far

lower than the flu, the classmate

asserted.

Dr. Adalja instantly saw that the

calculation was flawed. “For flu,

he used the denominator of total

number of flu infections,” he said.

“For coronavirus, he used the de-

nominator for the population of

the U.S.”

He resisted the urge to type a

hasty correction — Covid-19 is be-

lieved to have a substantially

higher fatality rate than that of the

seasonal flu — and kept scrolling.

Epidemiologists generally ad-

vise against relying on a single

data point to determine the state

of the virus in a particular area.

Instead, to assess coronavirus

trends, they recommend review-

ing the daily case count, the posi-

tivity rate, hospitalization data

and the number of confirmed and

probable deaths from the virus.

But they also cautioned that data

can be misleading and difficult to

interpret, and that it is perhaps

best seen as one piece in a larger,

complicated puzzle.

“I view everything with a lot of

skepticism,” said Dr. Natalie E.

Dean, an infectious-disease ex-

pert at the University of Florida.

“I try and triangulate across a lot

of different things.”

For many Americans, the num-

bers are a way to make sense of

the pandemic — which is spread-

ing in the South, the West and

much of the Midwest, but calming

in the Northeast — and to gauge

whether things are better or

worse in their own cities.

They often begin with the case

count. That is the daily tally of in-

dividuals whose coronavirus in-

fections were confirmed by lab-

oratory tests, a data point that is

frequently quoted, misused and

debated.

“If I’m sitting at home and say-

ing, ‘How is my community do-

ing?’ I’d want to look at daily case

counts,” said Dr. John Swartzberg,

an infectious-disease specialist

and a clinical professor emeritus

at the University of California,

Berkeley’s School of Public

Health.

Those numbers are jaw-drop-

ping. In the United States, the cu-

mulative count of people infected

with the coronavirus has sur-

passed four million. New daily

records tied to the case count have

been alarmingly frequent in re-

cent weeks: At least 16 states

posted single-day case records

last week. On Friday, more than

73,000 new cases were identified

across the country, the second-

highest day of the pandemic.

There are several ways to parse

the case count number.

President Trump and other offi-

cials have frequently questioned

the legitimacy of coronavirus case

counts, falsely suggesting that a

rise in testing availability is solely

responsible for the increase in

confirmed infections. More test-

ing can cause an uptick in new re-

ports of infections, but data shows

that the rise in cases far outpaces

the growth in testing.

Experts suggested that the

daily case count is better viewed

as a rough measure of whether an

outbreak is slowing, expanding or

stabilizing. A decrease in new con-

firmed cases could also indicate

that testing is not available widely

enough, or that there is a backlog

of tests that have not yet been pro-

cessed and delivered to the local

health department.

Time period matters, too. Com-

paring case counts in July to case

counts in April is misleading, be-

cause many people were sick but

few people were tested early in

the epidemic. But comparing case

count to a more recent period,

when testing was relatively con-

stant, is a useful measure.

Another frequently cited num-

ber is the positivity rate, the per-

centage of coronavirus tests that

have returned with a positive re-

sult.

“The positivity number is one of

the first places I go to,” said Gov.

Mike DeWine of Ohio, who wakes

up each morning to a fresh Power-

Point presentation from his staff,

which he reads on his iPad before

8 a.m. “That’s what I zero in on.”

A rising positivity rate can point

to an uncontrolled outbreak; it

can also indicate that not enough

testing is occurring.

Mr. DeWine is an avid reader of

the daily PowerPoint presenta-

tion, which he calls the Situation

Update. It started small in the

early days of the pandemic. It has

grown to at least 31 slides of num-

bers, charts and graphs — every

day.

He said he also focused closely

on the number of Ohioans who

have been hospitalized for the co-

ronavirus, a data point that is diffi-

cult to spin or misinterpret. Last

week, the pandemic approached

an alarming milestone: About as

many people in the United States

are now hospitalized with the co-

ronavirus as at any other time in

the pandemic, including during an

earlier surge in the New York re-

gion in the spring.

“Hospitalization is a hard num-

ber,” Mr. DeWine said. “There’s no

fudge on it.”

Yet even that measure has cav-

eats. Hospitalizations do not re-

flect how many people are sick at

home and experiencing mild

symptoms — particularly young-

er people — but who could still be

infecting others.

Dr. Tara C. Smith, a professor of

epidemiology at Kent State Uni-

versity who studies infectious dis-

eases, said that viewed individu-

ally, much of the available coro-

navirus data can offer only a

glimpse of the state of the pan-

demic.

“I think people tend to cherry-

pick what they want to see, to con-

firm their biases,” she said.

She has been hesitant to place

much stock in statistics on deaths

caused by coronavirus, for in-

stance. “I see a lot of use of the fa-

tality statistics, which are incom-

plete,” Dr. Smith said. “You do

have deaths from coronavirus, but

we know those are undercounted.

For me, at least, that is not a par-

ticularly useful metric. But those

are the type of statistics that some

people grab on to.”

Perhaps the most telling num-

bers are trend data — examining

which direction a community or

state seems to be heading, said

Michael T. Osterholm, director of

the University of Minnesota’s

Center for Infectious Disease Re-

search and Policy.

“There’s no magic number for

any of this,” Dr. Osterholm said.

“This is more like a windshield

where you’re looking at every-

thing in front of you. It’s not one

piece of data. It’s all of it coming

together.”

In 1918, newspapers in cities

across the United States pub-

lished daily tallies of the sick and

the dead from the flu pandemic,

said John M. Barry, the author of

“The Great Influenza,” and public

health officials made policy deci-

sions accordingly, based on the

data.

Today’s elected officials have

far more granular data to con-

sider.

In Chicago, Dr. Arwady, the city

health commissioner, has a call

with Mayor Lori Lightfoot every

morning, discussing the city’s to-

tal cases, deaths, the seven-day

average for testing and detailed

hospitalization numbers, among

other metrics.

“Data to me is one of the best

ways to make it real for people,”

Dr. Arwady said. She often tries to

steer Chicagoans to look at coro-

navirus numbers broken down by

ZIP code, so that they understand

the risk they face in their own

neighborhoods. “Mostly, I want

people to feel like Covid is in their

lives.”

DOING THE MATH

Mountain of Data Offers Dizzying View, but ‘No Magic Number’

From Page A

SSM Health St. Anthony Hospital in Oklahoma City. For many Americans, the numbers are a way to make sense of the pandemic.

NICK OXFORD FOR THE NEW YORK TIMES

A socially distanced Mass at St. Monica’s Catholic Church in Mi-

ami Gardens, Fla. The most telling numbers are the trend data.

SAUL MARTINEZ FOR THE NEW YORK TIMES

The first large study of the

safety and effectiveness of a coro-

navirus vaccine in the United

States began on Monday morning,

according to the National Insti-

tutes of Health and the biotech

company Moderna, which collab-

orated to develop the vaccine.

A volunteer in Savannah, Ga.,

received the first shot at 6:45 a.m.,

Dr. Anthony S. Fauci, the director

of the National Institute of Allergy

and Infectious Diseases, said at a

news briefing.

The study, a Phase 3 clinical

trial, will enroll 30,000 healthy

people at about 89 sites around

the country this summer. Half will

receive two shots of the vaccine,

28 days apart, and half will receive

two shots of a saltwater placebo.

Neither the volunteers nor the

medical staff giving the injections

will know who will get the real

vaccine.

Researchers will then monitor

the subjects, looking for side ef-

fects. Their main goal will be to

see if significantly fewer vacci-

nated people contract Covid-19, to

determine whether the vaccine

can prevent the illness. The study

will also try to find out if the vac-

cine can avert severe cases of

Covid and death; if it can block the

infection entirely, based on lab

tests; and if just one shot can pre-

vent the illness.

A second company, Pfizer, an-

nounced late Monday afternoon

that it had begun a late-stage

study of a coronavirus vaccine.

Pfizer has been working with a

German company, BioNTech.

Their study will also include

30,000 people, from 39 states in

the United States, and from Brazil,

Argentina and Germany.

The first subjects received in-

jections at the University of Roch-

ester on Monday.

The government announced

last week that it had reached a

$1.95 billion deal to buy 100 million

doses of Pfizer’s vaccine by the

year’s end, but only if the trial

proves it safe and effective.

Dr. Fauci estimated that the full

enrollment of 30,000 people in the

Moderna trial would be completed

by the end of the summer, and that

results might be available by No-

vember. Findings might emerge

even earlier, he said, but added

that he doubted it. He said that the

high rates of transmission in some

parts of the country, though unfor-

tunate, would help speed up the

process of determining whether

the vaccine works.

Dr. Mark Mulligan, the director

of the N.Y.U. Langone Vaccine

Center in New York, which will be-

gin giving injections of the Pfizer

vaccine on Tuesday, said he

thought that full enrollment would

take two months and that it would

take four to six months to deter-

mine whether the vaccine

worked.

Over all, a total of 150 to 160 co-

ronavirus infections in the study

will be enough to determine

whether the Moderna vaccine is

acceptably effective — that is, if it

protects 60 percent of those who

receive it, Dr. Fauci said.

Ideally, he would like the figure

to be higher, but he said 60 percent

“would be a major, huge step at

controlling this outbreak; we’ll

take that amount.”

Dr. Francis Collins, the director

of the National Institutes of

Health, said the U.S. government

was reaching out to groups hit

hardest by Covid — older people,

those with chronic diseases and

Black, Latinx and Native Ameri-

can people — to encourage them

to participate in the study. He said

that the pandemic had put health

disparities into “sharp relief” and

that extra efforts were needed to

gain the trust of people in those

groups who might be reluctant to

sign up for a medical experiment.

Earlier tests of Moderna’s vac-

cine showed that it stimulated a

strong immune response, with mi-

nor and transient side effects like

sore arms, fatigue, achiness and

fever. But exactly what type of im-

mune response is needed to pre-

vent the illness is not known, so

Phase 3 studies are essential to

determine whether a vaccine re-

ally works.

In a statement, Dr. Collins said,

“Having a safe and effective vac-

cine distributed by the end of 2020

is a stretch goal, but it’s the right

goal for the American people.” He

said that despite the unprecedent-

ed speed in bringing this experi-

mental vaccine to human testing,

“the most stringent safety meas-

ures” were being maintained.

Moderna said in a statement

that it would be able to deliver

about 500 million doses a year,

and possibly up to a billion doses

per year, starting in 2021. The

Massachusetts-based company,

which has received nearly $1 bil-

lion from the federal government

to develop a coronavirus vaccine,

has said it will not sell the vaccine

at cost, but for profit.

Moderna has not said what it

will charge. “We will price it re-

sponsibly during the pandemic, to

make sure it is broadly accessi-

ble,” a spokesman, Ray Jordan,

said in an email. The company

may change the price later, when

the virus becomes endemic, “but

that is not something we have set-

tled at this time,” Mr. Jordan said.

Moderna shares were up more

than 9 percent on Monday.

Pfizer has also said it will sell its

product at a profit; the contract

with the government works out to

about $20 a shot, and people will

need two.

Both the Moderna and Pfizer/

BioNTech vaccines use a syn-

thetic version of genetic material

from part of the coronavirus, en-

cased in tiny particles made of fat

that help it get into human cells.

The genetic material, called mes-

senger RNA or mRNA, then

prompts the cells to churn out a

tiny piece of the virus, which the

immune system sees as foreign

and learns to recognize. If the per-

son is later exposed to the real vi-

rus, the immune system will at-

tack it.

Messenger RNA has not yet

produced any approved vaccines,

but other companies have also in-

vested in the approach because of

its potential to produce a vaccine

quickly. CureVac and Sanofi are

also working on mRNA vaccines.

At the news briefing, Dr. Collins

said that three more Phase 3 trials

would be starting soon, each need-

ing 30,000 patients. Those trials

will involve vaccines made by No-

vavax, Johnson & Johnson and a

collaboration of the University of

Oxford and AstraZeneca. All three

companies are part of the Trump

administration’s Operation Warp

Speed. Pfizer is not.

Adults interested in participat-

ing in the trials can visit coro-

naviruspreventionnetwork.org.

THE RACE FOR A REMEDY

Late-Stage Trials Start for 2 Vaccines; Each Study Needs 30,000 Volunteers

By DENISE GRADY