The New York Times - USA (2020-10-17)

(Antfer) #1

A6 Y THE NEW YORK TIMES, SATURDAY, OCTOBER 17, 2020


Tracking an OutbreakU. S. Response


Seventeen states, including
many in the Mountain West, have
added more cases in the past week
than any other week of the pan-
demic. And the spread through
sparsely populated areas of rural
America has created problems in
small towns that lack critical re-
sources — including doctors —
even in ordinary times.
Wyoming, which did not have
1,000 total cases until June, re-
cently added more than 1,000 in a
single week. Reports of new infec-
tions have recently reached
record levels in Alaska, Colorado
and Idaho. And Montana, where
more than half of the state’s cases
have been announced since Au-
gust, is averaging more than 500
cases per day.
In Cascade County, more than
300 inmates and staff members
have been infected in a facility
meant to hold 365 people, the
county’s first major outbreak in a
region where the virus is sud-
denly surging.
The county seat, Great Falls, is
seeing its worst case numbers yet.
The local hospital and its 27-bed
Covid-19 unit are at capacity. The
county health department is rac-
ing to hire new contact tracers.
And Mr. Krogue, who also teaches
nursing at Montana State Univer-
sity’s Great Falls campus, has
seen attendance in his classes
dwindle as students fall ill or quar-
antine.
One place where the infections
have spread has been local jails,
which are confined, often crowded
spaces. Jails are staples of local
communities and tend to have
people coming and going more
quickly than prisons. Jails can
hold everyone from people await-
ing criminal trials for months to
those picked up for a suspended
driver’s license for a few hours.
With so many people filtering in
and out, jails pose extra risks for
the virus’s spread — not only in-
side facilities but in potentially
feeding outbreaks in the rest of
the community.
Nationally, jails and prisons
have seen disproportionate rates
of infection and death, with a mor-
tality rate twice as high as in the
general population and an infec-
tion rate more than four times as
high, according to recent data.
A New York Times database
has tracked clusters of at least 50
coronavirus cases in a dozen rural
jails in Montana, Idaho, Utah and
New Mexico during the pan-
demic. Among them: the Purga-
tory Correctional Center in Hurri-
cane, Utah, with 166 infections;
the jail in Twin Falls, Idaho, with
279; and, in New Mexico, the Cibo-
la County Correctional Center,
which has reported 357 cases.
In Cascade County, infections at
the jail make up about a quarter of
all known virus cases in the
county. Health authorities say
that the jail’s outbreak, which be-
gan in mid-August, was not be-
lieved to be the main cause of the
community’s recent surge, but
that it had led to some cases. In
the past two months, Mr. Krogue
said, the jail released 29 people
who were considered actively in-
fected.
Great Falls, home to about
58,000 residents, is in the less
mountainous part of Montana,
with the Missouri River flowing
through and a large oil refinery on
its banks. The Cascade County
Detention Center sits along a
highway at the edge of town.
Drive five miles in any direction
and you are surrounded by wide-
open plains.
Montana requires that masks
be worn inside businesses and in-
door public spaces, and many peo-
ple in Great Falls wear them when
walking around downtown’s Cen-


tral Avenue, where shops and ca-
fes are still recovering from shut-
ting down in the spring. Others go
without masks, citing the open
space and lack of crowds.
Bob Kelly, the mayor, said peo-
ple had not been overly worried
about how the jail outbreak might
affect the rest of town when it
started.
“I think that by the very defini-
tion of a jail, hopefully, the disease
will be incarcerated, as well as the
patients,” he said. “Is there con-
cern? Sure, there’s concern. But is
there overreaction? No.”
Some residents’ nonchalance
about the risks of the virus, said
Mr. Krogue, the jail’s medical di-
rector, can be traced to a spring
and early summer when almost
no one in Cascade County knew
anyone who had been sickened.
“We benefited from that early
on,” he said. “But in some ways, I
think it did us a disservice, too, be-
cause it also created a certain lev-
el of complacency.”
That has quickly shifted now, he
said, as cases have spiked.
The number of active cases
known to county officials on any
given day has risen sharply to
about 600, according to Trisha

Gardner, Cascade County’s health
officer. The county has seen 1,
cases and six deaths during the
pandemic, a Times database
shows. Some of the cases have
been tied to the jail, she said, and
others have been connected to
bars and restaurants. Even figur-
ing out what has led to some cases
has been complex, she said, as
residents have been reluctant to

cooperate with contact tracers.
“Our hospitals are at capacity,
our public health system is at ca-
pacity,” she said. “It’s not sustain-
able at this rate.”
When the outbreak at the jail
began, social distancing was im-
possible, the authorities said.
Three inmates shared cells de-
signed for two. At night, men slept
on thin blue pads in every avail-
able space: on the floor in the day

room, in shower stalls, in stair-
wells, in hallways outside of cells.
Inmates did not receive masks
until August, and jail officials said
many have refused to wear them.
In interviews with more than a
dozen inmates and their family
members, inmates described the
jail during the outbreak as chaotic
and unsanitary. They said their
pleas for help often went unan-
swered by nurses and guards.
Newly arriving inmates were
not always quarantined from one
another before their test results
were known because of a lack of
space, inmates and jail officials
said.
Owen Hawley, 30, said every in-
mate in his living area of 38 men
had tested positive for the virus.
He said he had been unable to eat
for three days, had intensive body
aches and suffered from a head-
ache so powerful it felt as if it was
“behind my eyes.”
“After the fourth day of like, not
eating and stuff, I just shut off, you
know?” he said.
At one point, Mr. Hawley said,
he and other prisoners protested
the way the virus was being han-
dled by refusing to leave their liv-
ing areas and by blocking new in-

mates from entering. Everyone
was ultimately tested, Mr. Hawley
said, and each prisoner was given
a disposable mask.
Sierra Jasmine Wells, 25, an-
other inmate, said women in her
dormitory had grown ill, one after
the next.
“Everyone around me was get-
ting sick and it was tough on me,”
she said. “By then, I had already
accepted the fact that I was going
to get sick.”
When she became infected, she
said, she was given cough syrup
and Tylenol.
“I kind of was just left alone to
deal with it,” she said.
Jesse Slaughter, the county
sheriff who oversees the jail, said
that the jail’s medical staff was do-
ing everything it could, and that
he had been seeking health care
assistance from other counties.
Officials defended their handling
of the outbreak, noting that all in-
mates received standard medica-
tions including Tylenol twice a day
and were taken to area hospitals
when they needed added care.
Seven inmates, as well as some
staff members, were hospitalized.
No one from the jail has died from
the virus, officials said.

Mr. Krogue said that since the
start of the outbreak he had been
working up to 16 hours each day
and sleeping in his basement,
away from his wife and children.
He remains healthy but says he
fears bringing the virus home.
The virus has slowed some in the
jail, and officials have moved
some inmates to other facilities,
but other prisons and jails in the
state are now seeing outbreaks.
“You can start to see what some
of these other places experienced
much earlier on, and we just didn’t
have that experience, but it’s cer-
tainly happening now,” Mr.
Krogue said. “It’s just real in a way
that it wasn’t.”

CLUSTERS


PHOTOGRAPHS BY TAILYR IRVINE FOR THE NEW YORK TIMES

Lucy Tompkins reported from
Great Falls, Maura Turcotte from
Chicago and Libby Seline from Lin-
coln, Neb. Reporting was contrib-
uted by Izzy Colón from Columbia,
Mo., Brendon Derr from Phoenix,
Rebecca Griesbach from
Tuscaloosa, Ala., Danya Issawi
and Timothy Williams from New
York, Ann Hinga Klein from Des
Moines, K.B. Mensah from Silver
Spring, Md., and Mitch Smith from
Chicago.

More than 300 people were infected at the Cascade County Detention Center in Great Falls, Mont., and the surrounding community is seeing its worst case numbers.

As people filter in and


out, the risks for


getting sick grow.


Left, Paul Krogue, the medical director of the Cascade County jail, said he feared bringing the virus home after a major outbreak among inmates and staff. The virus
began spreading at the facility after a few infected people were arrested. Social distancing was not possible at the jail, where three inmates share cells meant for two.

From Page A

In Rural West, Cramped Local Jails Are Becoming Hubs for Infections


The chief executive of Pfizer
said on Friday that the company
would not apply for emergency
authorization of its coronavirus
vaccine before the third week of
November, ruling out President
Trump’s assertion that a vaccine
would be ready before Election
Day on Nov. 3.
In a statement posted to the
company website, the chief execu-
tive, Dr. Albert Bourla, said that
although Pfizer could have pre-
liminary numbers by the end of
October about whether the vac-
cine works, it would still need to
collect safety and manufacturing
data that will stretch the timeline
to at least the third week of No-
vember.
Close watchers of the vaccine
race had already known that Pfi-
zer wouldn’t be able to meet the
requirements of the Food and


Drug Administration by the end of
this month. But Friday’s an-
nouncement represents a shift in
tone for the company and its
leader, who has repeatedly em-
phasized the month of October in
interviews and public appear-
ances.
In doing so, the company had
aligned its messaging with that of
the president, who has made no
secret of his desire for an ap-
proved vaccine before the elec-
tion. He has even singled out the
company by name and said he had
talked to Dr. Bourla, whom he
called a “great guy.”
Some scientists applauded Pfi-
zer’s announcement.
“This is good, really good,” said
Dr. Eric Topol, a clinical trial ex-
pert at Scripps Research in San
Diego who was one of 60 public
health officials and others in the
medical community who signed a
letter to Pfizer urging it not to rush
its vaccine.
He said company officials had
assured him that a vaccine would

most likely not be authorized be-
fore the election, but the letter Fri-
day is “even more solid about
their not being part of any political
machinations.”
Dr. Bourla has pushed back
against any suggestion that Pfi-
zer’s vaccine timeline was politi-
cally motivated. In September,
Pfizer was the driving force be-
hind a pledge by nine vaccine
companies to “stand with science”
and not put forward anything that
had not been properly vetted. Ear-
lier this month, he published an
open letter to employees that said
he “would never succumb to polit-
ical pressure” and expressing dis-
appointment that “we find our-
selves in the crucible of the U.S.
presidential election.”
Pfizer is one of four companies
testing a coronavirus vaccine in
late-stage clinical trials in the
United States, and it has been the
most aggressive in its timeline es-
timates. Moderna, AstraZeneca
and Johnson & Johnson have said
that later in the year is more likely,

matching the predictions of fed-
eral health officials. (AstraZeneca
and Johnson & Johnson's trials
have been paused for potential
safety concerns, which could fur-
ther delay their outcomes.)
In interviews, Mr. Bourla has
said that he expects a “conclusive

readout” by late October, with an
application for emergency author-
ization that could be filed “imme-
diately.”
Pfizer’s trial of 44,000 volun-
teers tests the vaccine by giving
one group the vaccine, another
group the placebo, and waiting un-
til a certain number of people be-

come infected with the virus. If
significantly more people who re-
ceived the placebo got infected,
then the vaccine is considered to
be effective.
A company spokeswoman said
last month that Pfizer would not
be anywhere near completion of
its trial by the end of October and
that when Dr. Bourla had referred
to a “conclusive readout,” he
meant it was possible the outside
board of experts monitoring the
trial would have by that date
found promising signs that the
vaccine works.
In his statement on Friday, Dr.
Bourla acknowledged those time-
lines were uncertain. “Since we
must wait for a certain number of
cases to occur, this data may come
earlier or later based on changes
in the infection rates.”
He also said the company would
release the results of any decision
by the outside panel — good or
bad — within a few days of its deci-
sion.
Dr. Bourla’s statement arrived

soon after the F.D.A. published
new guidelines detailing how the
agency would evaluate a vaccine
for emergency authorization, a
document published after weeks
of stalling by the White House.
The guidelines, which do not carry
the force of law, call for gathering
comprehensive safety data in the
final stage of clinical trials before
an emergency authorization can
be granted.
In a tweet on Oct. 6, Mr. Trump
accused the F.D.A. of having a po-
litical agenda with the recommen-
dations, which he said “make it
more difficult for them to speed up
vaccines for approval before Elec-
tion Day.” Mr. Trump called it a
“political hit job.”
In a video he posted from the
White House a day later, Mr.
Trump said that a vaccine should
be available before the election,
“but frankly, the politics gets in-
volved.”
“They want to play their
games,” he said. “It’s going to be
right after the election.”

LATE-STAGE TRIALS


Pfizer Says It Won’t Apply for Vaccine Authorization Before Mid-November


By KATIE THOMAS
and NOAH WEILAND

Jonathan Martin contributed re-
porting.


Extending a timeline


well beyond Election


Day despite the


president’s assertions.

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