The New York Times - USA (2020-10-10)

A4 SATURDAY, OCTOBER 10, 2020

Tracking an Outbreak

Y

This was a week defined by two images. One showed President
Trump back at the White House after four days in the hospital with
the coronavirus, breathing a bit hard after climbing a flight of stairs
and defiantly ripping a mask off his face.
The other showed the virus that had landed in Walter Reed
National Military Medical Center — not from his own bloodstream,
of course, but an atom-by-atom model based on samples taken in
China in February. Since then, scientists have discovered how the
coronavirus commandeers patients’ biochemistry, how tree-shaped
spike proteins in the virus membrane maneuver like Chubby
Checker, how RNA strands build up inside chambers that are creat-
ed by the virus and which look like the landscape of the moon.
Such tiny components. Such big damage. Just over 56,000 Amer-
icans were found to be infected on Thursday, pushing the total to
more than 7.64 million. California and Texas did an uncomfortable
two-step at the top of a list no one wants to be on: California led the
nation in total cases, followed by Texas. But in new cases over the
last seven days, Texas led, followed by California.
The president is said to be planning his first in-person event
since announcing that he tested positive — a gathering on the South
Lawn of the White House that he would address from one of the
balconies. Some of his advisers worry that it could serve to amplify
criticism of the administration’s handling of the virus and the ques-
tions that remain about the president’s own case.

Mayors Under Quarantine

This week brought fresh evidence that the virus does not recog-
nize temporal constructs like the geographic boundaries that define
government. The mayors from several towns across New York State
rushed to quarantine after appearing at a news conference with
Mayor Richard C. David of Binghamton, who said on Thursday that
he had tested positive. He had appeared on Wednesday with mayors
from Syracuse, Albany and Ithaca, all of whom began self-quaran-
tining on Thursday.
Of 139,300 people tested in New York State on Wednesday, 1,
were found to be positive, or 1.14 percent. Some of the highest pos-
itive rates are in upstate communities with large Orthodox Jewish
populations where secular authority and scientific messaging are
taken skeptically and where the ravages of an overwhelming spring
— harrowing infections and deaths — have given way to a sense of
powerlessness about the virus.
The rest of the Northeast continues to do well, but some health
officials are concerned that smaller caseloads could breed overconfi-
dence now that restrictions are less burdensome. “The point is, once
you let up on the brake, then eventually, slowly, it comes back,” said
Michael Osterholm, an infectious-disease expert at the University of
Minnesota.
And there are places that were not trouble spots in the early
months of the pandemic because they emptied out. But they are
now. On college campuses, at least 70 people have died and at least
178,000 have been infected over all since the pandemic began —
more than 3,800 at the University of Georgia in Athens, more than
at 3,700 at Clemson University in South Carolina and just over 3.000.
In Pennsylvania, Centre County, home to Penn State University,
leads the state in cases per capita.
Dr. Deborah L. Birx, the White House’s coronavirus response
coordinator, visited the University of Connecticut’s Hartford cam-
pus, where on Thursday she met a researcher who samples waste-
water, looking for the genetic material of the coronavirus, an indica-
tor of potential outbreaks in dormitories. Dr. Birx also praised the
university for managing to conduct many of its classes in person.
But Trinity College, also in Hartford, switched to online classes this
week after 21 students tested positive and 55 others were placed in
quarantine.
Connecticut’s seven-day average for new cases has climbed to
287, the highest since June 2, but with 56 cases per 100,000 resi-
dents, Connecticut is well behind hot spots in the Midwest and the
Great Plains. Wisconsin, the Dakotas and Montana lead the nation
in new cases per 100,000 residents over the last seven days, and the
13 of top 14 states or territories are in those areas (the exception is
Guam, which trails Montana). Hospitals in the Midwest are scram-
bling to make reparations that echo those made in New York City in
March and April, when a convention center in Manhattan was
turned into a makeshift hospital. Wisconsin plans to open a field
hospital at the state fairgrounds next week.

An Empty Courtroom

It has been seven or eight months since the pandemic began
reshaping time-honored routines. Now it is forcing extensions of the
workarounds that it brought on. The Supreme Court, which has
heard arguments by conference call since May, announced on Fri-
day that it would continue to do so through the end of the year. The
court said it would decide later how it would hear cases in 2021,
based on health guidance.
And Broadway will remain dark at least through May 30, more
than 14 months after the curtain last came down. That will mean
more trouble in River City — another delay in the revival of “The
Music Man” starring Hugh Jackman and Sutton Foster. It was ini-
tially scheduled to open next week. “Some think we will open in the
summer,” said Charlotte St. Martin, the president of the Broadway
League, which represents producers and theater owners, “and I
hope they are right. But I think people’s bets are the fall of next
year.”

By JAMES BARRON

Coronavirus Update

Coronavirus Update wraps up the day’s developments with infor-

mation from across the virus report.

Scientists Study Detailed Images of Virus

Trump Plans Public Rally on South Lawn

Broadway Will Stay Closed Through May

New Coronavirus Cases Announced Daily in U.S.

THE NEW YORK TIMES

March 1 Oct. 9
Note: Friday’s total is incomplete because some states report cases after
press time. Data is as of Oct. 9, 2020, at 5 p.m. Eastern.
Sources: State and local health agencies; hospitals; C.D.C.

As of Friday evening, more than 7,680,900 people across every state,
plus Washington, D.C., and four U.S. territories, have tested positive
for the virus, according to a New York Times database.

New cases

7-day average

60,

30,

Many cases from

unspecified days

Hot Spots in the United States

Sources: State and local health agencies. The map showsthe shareof population with a new reportedcase over the last week.Partsof a county with a

population density lower than 10 people per square mile are not shaded. Data for Rhode Island is shown at the state level because county level data is

infrequently reported. Data is as of Oct. 9, 2020, at 5 p.m. Eastern. THE NEW YORK TIMES

As of Friday evening, more than 7 ,680, 900 people across every state, plus Washington,D.C.,and four U.S. territories,have tested positive for the

coronavirus, according to a New York Times database. More than 2 13,20 0 people with the virus have died in the United States.

Average daily cases per 100,000 people

in the past week

16 Few or

no cases

32 48

Nev.

Ga.

Miss.

Conn.

N.C.

Iowa

N.D.

Kan.

Texas

R.I.

Mass.

Ark.

Utah

Mont.

S.C.

Mich.

Calif.

Wis.

N.M.

Ill.

Fla.

Wyo.

N.Y.

Ind.

Minn.

Ore.

Maine

Alaska

Tenn.

Pa.

Md.

Ariz.

Wash.

N.H.

Hawaii

Mo.

Del.

W.Va.

N.J.

Idaho

D.C.

Ohio

Ky.

Okla.

La.

Ala.

Vt.

Neb.

S.D.

Minn.

Colo.

Va.

Puerto Rico

When President Trump pro-

moted an experimental drug as a

“cure” for Covid-19 in a video on

Wednesday, it might have seemed

that he was at it again: touting a

questionable fix for a deadly pan-

demic, not unlike his earlier en-

thusiasm for the malaria drug hy-

droxychloroquine or even, at one

point, disinfectant.

But the treatment that Mr.

Trump extolled, which was ad-

ministered last week after doctors

diagnosed Covid-19, is not a fringe

product. It’s a promising drug in

the final stages of testing devel-

oped by a respected biotech com-

pany, Regeneron. Infectious dis-

ease experts have been closely

following the treatment, as well as

a similar product from Eli Lilly, in

the hopes that the therapies could

be a real advance in the fight

against Covid-19.

Pharmaceutical companies of-

ten pay handsomely for celebrity

endorsements, but this patient

testimonial was like no other. It

came from a polarizing president

who, just weeks away from an

election, and having found himself

and his White House at the center

of an outbreak, is eager to show

that his administration is doing

something about a pandemic that

has killed more than 212,

Americans.

Although he couldn’t possibly

have known whether Regeneron’s

treatment had helped him — or

even if he was out of the woods yet

— Mr. Trump sang its praises in

the video, calling it “unbelievable”

and suggesting it was only mo-

ments away from being autho-

rized it for widespread use. In do-

ing so, Mr. Trump reminded his

critics of the many times — from

reopening schools to authorizing

hydroxychloroquine and blood

plasma — over the past nine

months that he has inserted poli-

tics into the decisions of independ-

ent health agencies.

Regeneron, which filed an ap-

plication with regulators within

hours of the president’s video,

must now shepherd its antibody

treatment through a politically

fraught approval process, where

the president’s over-the-top en-

dorsement has likely raised the

profile of its product, but could

also sow suspicion about whether

it works.

“I don’t see how it is going to

end up being good for a pharma

company,” said Ronny Gal, a phar-

maceutical analyst for the Wall

Street firm Bernstein. “Once you

become a political opinion, that’s

not great.”

Already, Regeneron is fielding

messy questions about how its

treatment was tested using cells

originally derived from an

aborted fetus — a line of research

that Mr. Trump has opposed —

and the president’s relationship

with Regeneron’s chief executive.

Mr. Trump has further compli-

cated the potential rollout of these

treatments by pledging — first on

Wednesday and again in another

video Thursday — that the drugs

would be free of charge and would

be soon be available in hundreds

of thousands of doses.

But Regeneron said it would

only initially have enough doses

for 50,000 patients, with the plan

to have enough for about 300,

people by the end of the year. Re-

generon has received more than

$500 million in federal funding to

develop and manufacture the

treatment, and through that deal,

the company has said it will make

the products available at no cost to

Americans.

Still, that’s a small number, giv-

en the scale of the outbreak in the

United States and the fact that the

treatment is believed to work best

soon after infection. On Wednes-

day alone, more than 50,

Americans tested positive for the

virus.

“This is like a massive direct-to-

consumer advertising campaign

for a product where we have

scarce supply and limited capaci-

ty to treat, which is a nightmare

for companies in the industry,”

said Geoffrey Porges, an analyst

for SVB Leerink, an investment

bank in Boston.

There is no way to know if Re-

generon’s antibodies have helped

Mr. Trump. The president was giv-

en several drugs at Walter Reed

National Military Medical Center,

including the antiviral remdesivir

and the steroid dexamethasone,

which have been proven to help

patients with Covid-19.

Mr. Trump has said he is feeling

better, but his doctors have pro-

vided sparse and conflicting de-

tails about his health, and he has

only just entered the second week

of the disease, when some pa-

tients take a turn for the worse.

Dr. Mark Mulligan, director of

the N.Y.U. Langone Vaccine Cen-

ter, who is involved in studies of

both Regeneron’s and Eli Lilly’s

antibody products, said the presi-

dent’s claim that he was cured

seemed premature — though not

impossible.

“We know sometimes people

will get better and then worse,” Dr.

Mulligan said. “I would want to re-

serve judgment and hope he’s on a

good trajectory.”

The only way to know whether

a treatment works is to test it in

large groups of patients, compar-

ing those who got the drug to

those who got a placebo.

Monoclonal antibodies, the

treatments developed by Regen-

eron and Eli Lilly, are believed to

work by giving patients powerful

antibodies that help fight the vi-

rus. Like Regeneron, Eli Lilly has

also recently asked the Food and

Drug Administration for emer-

gency authorization of its treat-

ment.

Although the companies’ trials

are not complete and they have

not published their findings in

medical journals, early data has

shown promise. Eli Lilly is testing

two treatments: one that uses a

single antibody and another that

uses two. Both have shown evi-

dence that they reduced the rate

of hospitalization in patients who

got the treatments soon after they

tested positive.

Regeneron recently released

data showing that its drug, a cock-

tail of two antibodies, appeared to

help the body clear the virus when

it was given early in the disease.

“We feel like the early indica-

tions of antiviral activity and po-

tential impact on the clinical

course of disease is very promis-

ing,” Dr. Janet Woodcock, who is

overseeing the federal effort to

speed coronavirus treatments to

market, said on Friday in a call

with reporters. She said the emer-

gency use application was now in

the hands of the F.D.A.

While they wait for the govern-

ment’s decision, Eli Lilly and Re-

generon now face the challenge of

preserving their credibility even

as the president continues to

make unfounded and exaggerated

claims.

“When he comes out and says,

‘Great news, I’m cured,’ it can only

be seen through the political lens

of his re-election,” said Arthur L.

Caplan, a professor of medical

ethics at the N.Y.U. Grossman

School of Medicine.

Now Regeneron will need to

prepare for a potential surge in de-

mand. “They are in a thicket of

ethical difficulties, awaiting what

I think will be a pretty big on-

slaught of further requests,” Dr.

Caplan said.

All of the attention has raised

the profile of Regeneron, a lesser-

known pharmaceutical company

based in Westchester County that

sells the eye drug Eylea and the

asthma drug Dupixent.

Since the president received the

experimental treatment last Fri-

day, a company spokeswoman has

said they have seen an uptick in

requests for the drug outside of

clinical trials — through what’s

known as “compassionate use” —

although she did not provide de-

tails. Enrollment in the trials has

also increased, she said: Over the

past two weeks, the company has

enrolled 500 participants into its

trials, for a total of 2,500 people.

But the scrutiny has not all been

positive. Some have raised ques-

tions of fairness, such as why the

president should have been given

access to a not-yet-available drug

when tens of thousands of Ameri-

cans are sickened with the virus

every day.

“I can’t offer it to my patients,”

said Dr. Matthew G. Heinz, a hos-

pitalist at a large medical center in

Tucson, Ariz., who acknowledged

that the treatment’s benefits are

still not proven. “That’s the most

frustrating thing to me as a physi-

cian.”

Others have questioned the

president’s relationship to Dr.

Leonard S. Schleifer, the billion-

aire co-founder and chief execu-

tive of Regeneron, who has been a

member of Mr. Trump’s golf club

in Westchester County. The two

have known each other casually

for years, and Dr. Schleifer has

told associates that Mr. Trump

calls him to ask about the status of

the coronavirus treatment.

But Dr. Schleifer is also a fre-

quent donor to Democratic candi-

dates, and his son, Adam Schleifer,

ran unsuccessfully in New York’s

Democratic primary this spring

for the seat vacated by Rep. Nita

Lowey.

The company also had to field

questions this week about its use

of cells derived from fetal tissue to

test the antibody cocktail. The cell

line, developed decades ago, has

been used to test many other

drugs, including remdesivir and

some of the coronavirus vaccines

in trials.

The juxtaposition of Mr.

Trump’s boosterism with his op-

position to the use of fetal tissue in

scientific research struck his crit-

ics as rich with hypocrisy. But the

president’s enthusiastic peddling

of Regeneron’s antibodies may at

least have brought public atten-

tion to treatments that could even-

tually pan out.

“The fact that he was given one

of these therapies has increased

the awareness of them,” Dr. Mulli-

gan said. “I think in a way it’s a

good thing. We need some suc-

cesses.”

EXPERIMENTAL TREATMENT

Trump’s Testimonial May Be Burden for Regeneron

By KATIE THOMAS

and DENISE GRADY

Gina Kolata and Noah Weiland

contributed reporting.

Mari Johnson, a researcher at Regeneron, in a lab in Chandler,

Ariz. The company’s drug was taken by President Trump.

ADRIANA ZEHBRAUSKAS FOR THE NEW YORK TIMES

The president called a

drug a ‘cure,’ but also

raised doubts over

whether it works.