The New York Times - USA (2020-11-15)

10 N THE NEW YORK TIMES, SUNDAY, NOVEMBER 15, 2020

Tracking an OutbreakU.S. Fallout

Young, healthy people who con-
tract the coronavirus are often
asymptomatic, very rarely need
hospital care and can transmit the
virus to a roommate unwittingly
even when following strict quar-
antine orders, according to two
new studies from the U.S. Navy.
The findings support the need for
strong measures, like daily test-
ing, that go beyond the tempera-
ture checks and symptom report-
ing now commonly deployed to
prevent transmission in offices,
dormitories and other group set-
tings, the authors said.
“These findings all point to the
need for ongoing testing strat-
egies,” said Dr. Andrew Letizia, a
commander and infectious dis-
ease specialist at the Naval Medi-
cal Research Center, in Silver
Spring, Md., and lead author of
one of the studies. “We need to
augment public health measures
and reinforce them with regular
testing” in such settings, he said.
The new reports, both posted

Wednesday by The New England

Journal of Medicine, clarify much

of what is known or suspected

about Covid-19’s effect on young

adults, while also exposing the

limits of quarantine measures.

One study, led by Dr. Letizia, de-

tailed the rate of new infections

detected among nearly 2,000 re-

cruits under quarantine near Par-

ris Island Marine Corps Recruit

Depot, in South Carolina, over the

summer. It was conducted in col-

laboration with researchers at the

Icahn School of Medicine at

Mount Sinai in New York.

The other described an out-

break on the U.S.S. Theodore

Roosevelt, an aircraft carrier on

which nearly a quarter of the crew

— more than 1,200 seamen and

women — tested positive in the

spring.

Numerous studies in the past

year have documented that

Covid-19 is often asymptomatic in

young people, and that symptoms

that do appear are usually mild.

And reports of outbreaks on

cruise ships, particularly the one

on the Diamond Princess in Janu-

ary and February, had found that

the virus moves readily through

the air between people who are

quarantined together in small

rooms.

The two new studies are dis-

tinct, in that they describe situa-

tions in which officials had the re-

sources and the authority to enact

comprehensive measures and, in

the case of the Marine command

in South Carolina, were thor-

oughly prepared from the outset.

The 1,848 recruits who volun-

teered for that study agreed to re-

main in quarantine for two weeks

at home before reporting for duty;

after arrival, they entered quaran-

tine for two more weeks, at the Cit-

adel, the military college in

Charleston, which the Marine

Corps took over for that purpose.

They were tested for the virus on

arrival, one week later, and again

at two weeks.

The containment measures

were extensive on campus. Re-

cruits were under orders to wear

masks at all times, except when

sleeping; to keep six feet of dis-

tance from others; and to sanitize

toilets after using them. Most had

a single roommate, and all train-

ing was outdoors.

“Still, despite very strict pro-

cedures that were monitored 24

hours a day by Marine instruc-

tors, we identified six transmis-

sion clusters,” said Dr. Stuart Seal-

fon, a professor of neurology at

the Icahn School of Medicine, the

senior author of the study. Those

clusters resulted from one recruit

infecting a roommate, or multiple

others in the same platoon, which

have 50 to 60 members.

The researchers determined

that about 1 percent of the recruits

had arrived infected with the co-

ronavirus, almost all of them with-

out knowing it. An additional 2

percent became infected during

the quarantine period. By the end

of the study, the team had identi-

fied 77 recruits with positive tests,

each of whom was moved to an-

other dorm room, to be quaran-

tined alone.

The outbreak on the Theodore

Roosevelt, which began in late

March and spread through May,

provides a clearer picture of ex-

actly how the virus can spread in-

visibly among young people. Of

4,779 crew members, 1,271 ulti-

mately tested positive, of whom 77

percent were asymptomatic at the

time. Almost half of those who

tested positive, 43 percent, never

experienced Covid-19 symptoms;

a total of 23 individuals were hos-

pitalized, with four admitted to in-

tensive care. One died.

“It really speaks to the stealthy

nature of the virus, and how it can

move around asymptomatically in

such a population,” said Cmdr.

Matthew Kasper, the Navy micro-

biologist who led the study. “And I

think the unique situation here —

we had everyone get tested. This

was not based on any subjective

sense or memory recall. They’re

hard numbers.”

Outside experts said that the

two studies, taken together, dem-

onstrated not only how infectious

the virus is but what measures

must ideally be put in place to con-

tain it, whether in military or civil-

ian populations.

“The approaches learned from

the U.S.S. Theodore Roosevelt and

Parris Island can be applied, with

varying degrees of relevance, to

land-based shared living situa-

tions,” Dr. Nelson Michael, of the

Walter Reed Army Institute of Re-

search, wrote in an accompanying

editorial, “such as college dormi-

tories, prisons, and residential

care facilities, as well as sports

training environments, meat-pro-

cessing facilities, and isolated en-

ergy plants.”

TRANSMISSION

Virus Can Evade Strict Quarantine in Groups of Young People, Navy Study Finds

By BENEDICT CAREY

Experts say regular

testing may help curb

asymptomatic spread.

grown inured to the death toll,
even as its pace is now quickening
once more.
“Do you see this human being?
Do you realize?” said Kathy
James, the mother-in-law of Mr.
Raysby, a 57-year-old factory su-
pervisor in Sioux Falls, S.D., who
liked to hunt pheasants on the
weekends. In the weeks since Mr.
Raysby died of the virus, Ms.
James said she had wanted to
wave a photo of him — a quiet, be-
spectacled man who once wooed
her daughter with purple roses —
at the world.
“Do you see Doug?” she said.
“Because he should be alive and
he should be with us right now.”
More than 244,000 people have
died from the coronavirus in the
United States, more than any
other country, and experts say the
pace of new deaths is likely to ac-
celerate in the coming weeks.
Deaths lag several weeks be-
hind infections, so the toll being
recorded now reflects transmis-
sion that happened several weeks
ago, before the country began log-
ging more than 140,000 new cases
per day and hospitalizations
reached their highest levels of the
pandemic. On Friday, public

health officials reported more
than 181,000 new cases across the
country, more than ever before.
The country remains far below
the death toll of the spring, when
as many as 2,200 people were per-
ishing each day, but some esti-
mates suggest that the United
States may soon be on track to
reach or even exceed those levels.
From the Midwest to the Sun
Belt, officials are bracing for a
mounting death toll.
In Marathon County, Wis., a
sprawling community in the grip
of a Covid-19 surge, a refrigerated
morgue truck is now cooled and
ready in case it is needed. The
medical examiner’s office has
stocked extra body bags. A small-
er, walk-in cooler was also brought
in.
Two hours southeast, in Fond
du Lac County, Wis., Dr. Adam Co-
vach, the chief medical examiner,
said the system had been strained
by the uptick in deaths. Funeral
homes are exceedingly busy. Dr.
Covach has looked at his own stor-
age capacity and wondered: How
soon could his office be over-
whelmed? “If things continue in-
creasing at the rate they’re going,
it’s going to start getting pretty
scary pretty fast,” he said.
In El Paso, there have been so
many coronavirus deaths in re-
cent days that the county medical
examiner parked five mobile
morgue units — the size of trucks
— outside its doors. Legacy Mor-
tuary Service, a company that
transports bodies from hospitals
to funeral homes, is busier than
ever, carrying 40 to 50 bodies most
days now, its owner, Pilar Contr-

eras, said.

German Alvarado said he had

to wait nearly two weeks to hold a

funeral for his father-in-law, Anto-

nio Sierra Macias, a professional

mechanic who died of the virus.

Mr. Alvarado said his wife and

three children under the age of 12

first showed symptoms, then he

got it, too. By mid-October, Mr. Si-

erra Macias also fell sick and was

admitted to a hospital, where he

learned he had diabetes, in addi-

tion to high blood pressure.

Things seemed to be improving,

but Mr. Sierra Macias took a turn

for the worse. He was 49.

Mr. Alvarado said it was diffi-

cult to contend with such loss even

as people around him seemed not

to be taking the virus seriously,

believing it was being overhyped

or thinking, somehow, that it was

not dangerous.

“It seems like people think the

news are overthinking, overtalk-

ing,” said Mr. Alvarado, who said

he was waiting for paperwork to

send his father-in-law’s body for

burial in Ciudad Juárez, Mexico,

where cemeteries are running out

of room. “You don’t realize the sit-

uation until you live through it.”

Improved medical treatments

for the virus have emerged in the

months since it first arrived in the

United States, offering hope that

even if cases soared before a vac-

cine was available, deaths might

be held off.

A steroid, dexamethasone, has

been shown to help the seriously

ill; a new antibody treatment,

similar to a therapy given to Presi-

dent Trump shortly after he con-

tracted the coronavirus, just won

emergency approval from the

Food and Drug Administration;

and doctors now know to turn pa-

tients on their stomachs to im-

prove oxygen flow, one of the

many best practices that have

emerged over months of contend-

ing with Covid-19. The case fatal-

ity rate — a crude measure that

looks at the share of people who

die out of those who are known to

have tested positive — has fallen

throughout the pandemic, accord-

ing to public health experts. That

is in part because the country is

conducting far more tests, and

also because the age demograph-

ics have changed, with more cases

among young people, who are less

likely to get seriously ill.

Still, hospitals are now filling

with patients, threatening the lim-

its of medical systems in some re-

gions. More than 68,000 people

are in the hospital with the virus,

greater than two earlier peaks in

the spring and summer. Even the

best medicines and techniques

lose their usefulness if too many

people get sick at the same time,

taxing staffing and supplies.

“When you’ve overwhelmed

the health care system, nobody is

going to get optimal care,” said Dr.

Jessica Justman, an epidemiolo-

gist at Columbia University.

The rising case numbers — and

the threat of mounting deaths —

have led some experts to call for a

coordinated national shutdown

for four to six weeks. Other ex-

perts have advocated for a combi-

nation of masks, increased test-

ing, paid support for people in

quarantine and targeted shut-

downs focused on high-risk indoor

spaces as a way to slow the toll.

“We can expect the case and

death count to continue to rise ex-

ponentially unless we take serious

measures to mitigate the virus,”

said Dr. Howard Markel, a histori-

an of epidemics at the University

of Michigan. “All of this is terrible

news.”

But with no announcements

from the White House for new

measures to respond to the soar-

ing outbreak, most of the country

is open for business, even as a few

governors began calling for new

restrictions on Friday.

Gov. Michelle Lujan Grisham of

New Mexico issued the most

sweeping statewide mandate this

fall, returning to a “stay at home”

order on Monday that will last two

weeks. In Oregon, Gov. Kate

Brown plans to put the state in a

partial lockdown for two weeks

starting Wednesday, shuttering

gyms, halting restaurant dining

and mandating that social gather-

ings have no more than six people.

A visibly angry Gov. Mark Gor-

don of Wyoming, speaking at a

news conference, said that hospi-

tals have set up tents because

they are overrun, that patients

from crowded facilities in South

Dakota have been sent into Wyo-

ming, and that misinformation

about the virus was running

rampant. He said he was consid-

ering a mask mandate and other

restrictions after months of hesi-

tation. People in Wyoming have

been “knuckleheads” about the vi-

rus, he said.

“We’ve relied on people to be re-

sponsible and they’re being irre-

sponsible,” Mr. Gordon said. “If I

can’t rely on you, we’re going to

have to do something else.”

Particularly painful to those

who are part of a growing group

who have lost relatives is a sense

of indifference about the out-

break, they say, by the public.

The family of Tagan Drone, a 5-

year-old girl with a toothy smile

and big, colorful bows in her hair,

said she had just started kinder-

garten in Amarillo, Texas. She

loved Peppa Pig, nail polish and

everything purple and pink. She

was learning how to spell her

name. For Halloween, she was go-

ing to dress up as a mermaid.

But a few days before, she grew

sluggish and started throwing up.

Her mother took her to get medi-

cal treatment, where her family

says she tested positive for the co-

ronavirus.

Tagan’s parents offered her

soup and ginger ale for dinner, and

gave her a bath before bed. Hours

later, they found her unrespon-

sive.

Children rarely need to be hos-

pitalized with the virus, and very

few die, according to the Ameri-

can Academy of Pediatrics. No au-

topsy was conducted, her parents

say, but Amarillo city officials said

she was one of two young people

in the area whose deaths have

been attributed to Covid-19.

“It’s traumatizing,” her father,

Quincy Drone, 30, said, speaking

from a hotel room where he and

Tagan’s mother, Lastassija White,

have been staying because they

cannot bear to return home,

where Tagan used to swing from

her bed like on monkey bars. They

watched numbly as families they

knew went trick-or-treating on

Halloween, and as other children

filed into school in their neighbor-

hood.

“It scared our community, but it

scared them for maybe 12 to 20

hours and then everybody went

back to normal life,” Mr. Drone

said. “And that’s really how the

world is.”

The family of Doug Raysby, a

57-year-old factory supervisor

in Sioux Falls, S.D., who lost

his fight with Covid-19. Hospi-

talizations are climbing nation-

wide, including in El Paso, far

left, and more people are dy-

ing, including Tagan Drone, 5,

near left, of Amarillo, Texas.

TERRY RATZLAFF FOR THE NEW YORK TIMES

JOEL ANGEL JUAREZ FOR THE NEW YORK TIMES VIA FAMILY OF TAGAN DRONE

Mitch Smith contributed report-
ing.

AN ACCELERATING PACE

A Covid-19 patient in Houston. Improved treatments offer hope that deaths might be held off.

GO NAKAMURA/GETTY IMAGES

From Page 1

Families feel pain and

anger at a nation that

seems to be growing

inured to the deaths.

‘Horrifying’ Toll Seen

For the Months Ahead

As Cases Keep Surging