After Criticism, C.D.C. Reverses Covid-19 Guidelines on Testing People Who Were Exposed

The Centers for Disease Control and Prevention on Friday reversed a recommendation that people who have had close contact with someone infected with the coronavirus did not need to get tested unless they had symptoms.

The change came after widespread criticism of the earlier guideline, as well as reporting from The New York Times that the recommendation had come from political appointees in the Trump administration and skipped the agency’s usual, rigorous scientific review.

The Times reported Thursday that the guideline was posted on the C.D.C. website despite strenuous objections from the agency’s scientists.

The previous phrasing, which said asymptomatic people who have had close contact with an infected individual “do not necessarily need a test,” now clearly instructs them: “You need a test.”

Public health experts welcomed the change as consistent with research showing that people without symptoms can spread the virus. Some research has suggested that they are actually most likely to transmit to others starting around a day before the onset of symptoms, when the viral load can be the highest.

“It’s good to see science and evidence taking a front seat for a change,” said Scott Becker, chief executive of the Association of Public Health Laboratories.

The original guidance, posted on Aug. 24, drew sharp criticism even from the C.D.C.’s partners, including the Infectious Diseases Society of America, which urged its members to continue testing people without symptoms.

Emails obtained by The Times illustrate how a top Trump health official and his science adviser tried to browbeat career officials at C.D.C. at the height of the pandemic, challenging the science behind their public statements and trying to silence agency staff members.

The Times reported last week on pressures on the C.D.C. to change its weekly disease reports exerted by Michael R. Caputo, a former Trump campaign official installed by the White House in April as the top spokesman for the Health and Human Services Department, and his science adviser, Dr. Paul Alexander, a part-time assistant professor of health research methods. Mr. Caputo went on medical leave this week.

The emails, obtained by Noah Weiland of The Times, conform with what current and former C.D.C. officials called a five-month campaign of bullying.

One of the emails was written after Dr. Anne Schuchat, a 32-year veteran of the C.D.C., appealed to Americans to wear masks and warned, “We have way too much virus across the country.”

“She is duplicitous,” Dr. Alexander wrote to Mr. Caputo. He asked Mr. Caputo to “remind” Dr. Schuchat that during the H1N1 swine flu outbreak in 2009, thousands of Americans had died “under her work.”

Of Dr. Schuchat’s assessment of Covid-19’s dangers, Dr. Alexander fumed, wrongly, “The risk of death in children 0-19 years of age is basically 0 (zero) … PERIOD … she has lied.”

Mr. Caputo forwarded that assessment to Dr. Robert R. Redfield, the C.D.C. director. When a member of the health department’s White House liaison office called the agency to ask questions about Dr. Schuchat’s biography, C.D.C. officials were left with the impression that some in Washington could have been searching for ways to fire her.

Far from hiding what they knew about the virus’s danger, as Bob Woodward’s new book contends President Trump was doing, the emails seem to indicate that aides in Washington were convinced of their own rosy prognostications, even as coronavirus cases were shooting skyward.

Mr. Trump sought on Friday to recalibrate his assurances on vaccine availability, acknowledging that authorized doses might not be widely available in the United States until next spring even if distribution starts earlier.

Speaking at the White House, Mr. Trump said that once a vaccine is authorized, “distribution will begin within 24 hours after notice.” He added: “We will have manufactured at least 100 million vaccine doses before the end of the year. And likely much more than that. Hundreds of millions of doses will be available every month, and we expect to have enough vaccines for every American by April.”

The president had said earlier that a vaccine would be available to “the general public immediately” once it is authorized, and although he held firm on that pledge, he acknowledged that it would take perhaps months from that point to distribute vaccines to hundreds of millions of Americans.

Because of fears that Mr. Trump would interfere in the process to improve his election chances and pressure the Food and Drug Administration to approve a vaccine before it was proved safe, the chief executives of all the leading pharmaceutical companies signed a pledge two weeks ago saying they would not release any vaccines until they were sure they were safe.

Opinion polls have shown that many Americans are already hesitant about taking a vaccine that is seen to have been rushed to market by the federal government for political reasons.

Mr. Trump’s estimates of how many vaccine doses would be available this year conflicted with projections by the chief science adviser for his administration’s Operation Warp Speed effort, Moncef M. Slaoui, a former chairman of global vaccines for GlaxoSmithKline and a widely respected figure in the vaccine field. He and other leaders of Warp Speed were present at Friday’s news conference but not asked to comment.

In interviews with CNN and National Public Radio, Dr. Slaoui has said he expected only enough vaccine to immunize 20 million to 25 million people by year’s end. Enough to vaccinate all Americans would be ready by about the middle of next year, he said.

Dr. Slaoui has publicly said he would resign if there was political interference in the process of delivering a safe, effective vaccine.

Iranian health officials warned for weeks that the country would see another wave of the virus if schools reopened and religious ceremonies proceeded. But the government ignored their advice, instead allowing crowds to gather for the Shiite ceremony of Ashura, universities to resume classes and a million students to sit for an indoor college entrance exam.

“We consider the entire country in the state of alarm and a red zone,” said Iran’s deputy health minister, Iraj Harirchi, in an interview on state television Friday. (Iran has defined a red zone as a place with an alarming increase in the number of deaths, new cases and hospitalizations.)

In February, during the earliest weeks of the pandemic, Iran emerged as a global hot spot, but the country’s health ministers initially denied the severity of the outbreak. Officials have repeatedly resisted the harsh shutdowns and quarantines enacted by other countries to curb the spread of the virus.

President Hassan Rouhani has said that Iranians must find a way to coexist with the virus and that shutting down businesses, schools and religious ceremonies was not feasible. And from the start, power struggles between the president and the military have hampered the country’s response.

On Friday, the health ministry said 144 people had died and 3,049 had tested positive for the virus in the past 24 hours.

An infectious-disease doctor at the main coronavirus hospital in Tehran posted a video on Instagram saying his hospital’s Covid-19 emergency triage team had seen over 200 patients a day in the past week, many of them students and teachers. He warned that at this pace, the country would soon face a crisis as hospital and medical staff members become overstretched and beds unavailable for new patients.

Roughly 10 million people in England face new virus restrictions amid a spike in new cases. The country’s once-vaunted testing system is on the verge of collapse. And Prime Minister Boris Johnson of Britain is contemplating closing restaurants and pubs to corral a second surge in Europe’s worst-affected country.

Mr. Johnson is also facing rising anger over his contradictory edicts. Over the summer, he offered people a government-subsidized discount at restaurants and pubs but spoke bluntly on Friday about the virus advancing across Britain.

“There’s no question, as I’ve said for several weeks now, that we could expect and we are now seeing a second wave coming in,” Mr. Johnson said in a television interview. “I don’t think anybody wants to go into a second lockdown, but clearly when you look at what is happening, you’ve got to wonder whether we need to go further than” the new law forbidding gatherings of more than six.

“It does seem ironic,” said Jonathan Ball, a professor of molecular virology at the University of Nottingham, “after encouraging mass attendance at pubs, cafes and restaurants,” that restrictions on those activities were being considered.

The R number, a measure of how many people on average a single patient will infect, rose to between 1.1 and 1.4, the government said on Friday. Any number over 1 is a worrisome indication that the epidemic is growing.

In the week ending Sept. 10, there were roughly 6,000 new daily cases outside hospitals and nursing homes in England, the government’s official statistics authority estimated, nearly a doubling from the week before.

In other news from around the world:

  • More than 30 million cases have been reported worldwide as of Friday morning, according to a New York Times database. India, in particular, has recently contributed significantly to the count, having added more than 93,000 new cases a day on average over the last week.

  • President Alejandro Giammattei of Guatemala said Friday that he had tested positive for the virus, becoming at least the fourth Latin American leader to be infected during the pandemic. In a video address, the president said he was in stable condition and continuing to work. More than 3,000 people have died from the virus in Guatemala. The country’s pandemic response has been hindered by widespread poverty, proximity to hard-hit Mexico and the Trump administration’s decision to continue deporting Guatemalan migrants, despite the high positivity rates among the returnees.

  • Thousands of Hasidic pilgrims who set out to celebrate the Jewish New Year at the grave in Ukraine of a revered rabbi started heading home on Friday, after being prevented from entering from Belarus due to virus travel restrictions.

  • New Zealand recorded no new cases of the virus on Friday for the first time in more than a month, after an outbreak in Auckland in August threatened the progress against the virus. The country now has just 70 active cases. Of those, 37 are from community transmission and the rest are from overseas arrivals.

  • Sciences Po, one of France’s most prestigious universities, is closing its Paris campus for 14 days after a significant number of students tested positive for the virus. Classes will be held online. And Nice, the country’s fifth-largest city, banned social gatherings of more than 10 people in parks, gardens and beaches to try to slow the spread of the virus. Cases have surpassed 50 per 100,000 people in Nice, where a third of the residents are considered elderly. The sale and consumption of alcohol is also forbidden after 8 p.m. and bars will have to close at 12:30 a.m. Bordeaux and Marseille are facing similar rules.

  • President Rodrigo Duterte of the Philippines has extended a national state of emergency until September 2021. Last month, the Philippine Congress extended Mr. Duterte’s emergency powers to address the pandemic, and it passed legislation allocating support for low-income households and people who lost their jobs because of the crisis.

  • A repeatedly extended ban on nonessential travel between the United States and Canada and the United States and Mexico that was set to expire Sept. 21 has been extended again, to Oct. 21, according to the Department of Homeland Security. However, Mr. Trump, speaking to reporters in Washington on Friday, said he was working to open the border with Canada “pretty soon.”

  • China’s CanSino Biologics and a military-backed research institute are preparing to start clinical trials of a two-dose vaccine regimen after scientists raised concerns that their current one-dose treatment failed to produce a strong enough immune response. The vaccine was promoted by Chinese state media as a front-runner in the vaccine race but struggled to get Phase 3 trials started in Canada.

Early voting began in earnest Friday in four states: Virginia, South Dakota, Wyoming and Minnesota, a key Midwestern battleground that both candidates visited.

With the pandemic limiting indoor gatherings, elections administrators have urged voters to cast ballots either by mail or in person before Election Day. States have already seen record numbers of absentee ballot requests, and officials expect exceptional levels of voter participation before Nov. 3.

At a municipal voting center in northeast Minneapolis, voters waited 30 to 40 minutes in a line that snaked through an office park near Interstate 35W. The familiar “I Voted” stickers were replaced with a more precise “I Voted Early” model.

Darcy Berglund of Minneapolis said she had voted the first day that polls were open because she often travels back and forth to Iowa to care for her ailing mother.

“If she really takes a turn Nov. 2, I won’t be coming up here,” said Ms. Berglund, 60. “Even if I were in town, I’m so worried about this election. I just wanted to make sure I got my vote in.”

In most places in states that allow in-person early voting, it means going to a City Hall or a local board of elections, though some larger jurisdictions will arrange for regional early vote centers. The pandemic has brought even larger early-vote locations, with some major league sports franchises opening their vacant arenas and stadiums.

As millions of American students have returned to school across the country in recent weeks, cases have forced quarantines and shutdowns, and a few states, including Texas and Ohio, have rolled out online dashboards to track cases in schools.

Determining the impact of school openings on the broader trajectory of the pandemic has been difficult as reporting from states and districts has been spotty and inconsistent, with officials in some places refusing to reveal case numbers.

The number of cases reported by schools will almost certainly be an undercount, experts say, because children in particular are likely to be asymptomatic when carrying the virus, and are unlikely to be tested in the absence of symptoms.

In other education news:

  • A high school student in Attleboro, Mass., went to the first day of in-person classes on Monday despite testing positive days earlier. Roughly 30 people at Attleboro High School who came into contact with the student are now in quarantine. Attleboro’s mayor said that the student’s parents knew he had tested positive when they sent him to school.

  • Police in Mitchell, S.D., removed a man from a school board meeting for refusing to put on a mask in violation of district policy. Several speakers later criticized the mask mandate and asked why parents had not been surveyed about whether they supported it. “A survey wouldn’t change my mind,” one member of the school board said.

  • Because of virus-related precautions, Baylor University has postponed its football season opener scheduled for Saturday against the University of Houston. The matchup was hastily arranged last week to fill a void after each team’s original season-opening opponent had to cancel because of unmet standards for playing during the pandemic. More than a dozen football games at the elite F.B.S. level have been canceled or postponed in the first three weeks of the season.

  • Northeastern University in Boston has agreed to refund most of the fall semester tuition of 11 first-year students who were dismissed earlier this month for violating the school’s virus rules by gathering in a room without masks or social distancing.

  • More than 1,000 students and employees at Liberty University in Lynchburg, Va., have been instructed to quarantine, according to the school’s virus dashboard.

New York City will soon let restaurants add a temporary charge of up to 10 percent as help in the pandemic, (though not for takeout or delivery), as long as it is clearly noted on menus.

The charge, which comes before tax, will be allowed until 90 days after the date, yet to be determined, when indoor dining is fully restored. (Indoor dining resumes on Sept. 30 at only 25 percent capacity.)

But in interviews, many restaurant owners said they weren’t ready to add the new surcharge, especially at the full 10 percent.

A growing group of restaurateurs and activists urging the City Council to add some restrictions to the surcharge that will improve conditions for workers, such as limiting it to restaurants that pay their entire staff, including servers, at least the full city minimum wage or above, as he does.

Elsewhere in the area:

  • New York City’s indoor pools will be allowed to reopen on Sept. 30, the mayor said Friday, so long as they do not exceed 33 percent capacity and follow all other city and state guidelines. Saunas, steam rooms and indoor spa pools in gym facilities remain closed.

  • Mask compliance has been generally high in most indoor settings in New York City, but confrontations have been playing out on buses, and dozens of drivers have been attacked after trying to enforce the rules.

  • The state’s Department of Motor Vehicles is expanding online services, the governor said Friday. A pilot program will offer digital written tests for learners’ permits for passenger cars and motorcycles. Another pilot program will allow residents of counties with state-run D.M.V. offices to register their vehicles.

As Israelis prepare to celebrate the holiest days on the Jewish calendar under a new lockdown, organizing prayer services is proving to be more of a mathematical brainteaser than a spiritual exercise.

Rabbis must arrange worshipers into clusters of 20 to 50, separated by dividers, determining the size of the groups based on complex calculations involving local infection rates, and how many entrances and square feet their synagogues have. Masks will be required, and many seats will have to remain empty.

With the virus rampaging again, Israel became one of the few places in the world to go into a second lockdown. The rules took effect on Friday, on the eve of Rosh Hashana, the Jewish New Year.

The government has issued a list of restrictions — along with a plethora of exemptions that many criticize as a formula for confusion and noncompliance.

The atmosphere in the run-up to the holidays was more despairing than joyous.

“These are not the holidays we were hoping for,” said Rabbi Kenneth Brander, the president of Ohr Torah Stone, an Israel-based Jewish education group with emissaries around the world. “The fragility of life is upon us, but I see people rising to the occasion.”

The three-week national lockdown was timed to coincide with the Rosh Hashana and Yom Kippur holy days and the festival of Sukkot, in the hope of causing less economic damage because business slows down in any case around the holidays. It was also aimed at preventing large family meals that could become petri dishes for the virus.

Israel successfully limited the spread of the virus in the spring, but the number of cases, when adjusted for population, has risen to among the highest in the world. The country has had more than 300 confirmed new cases per 100,000 people over the last week — more than double the rate in Spain, the hardest-hit European country, and quadruple that of the United States.

Reporting was contributed by Livia Albeck-Ripka, Peter Baker, Alexander Burns, Sarah Cahalan, Julia Carmel, Shaila Dewan, Sydney Ember, Nicholas Fandos, Farnaz Fassihi, Antonella Francini, David Gelles, Denise Grady, Ruth Graham, Katie Glueck, Christina Goldbaum, Jason Gutierrez, Rebecca Halleck, Anatoly Kurmanaev, Mike Ives, Andrea Kannapell, Isabel Kershner, Apoorva Mandavilli, Donald G. McNeil Jr., Constant Méheut, Zachary Montague, Benjamin Mueller, Kevin Roose, Anna Schaverien, David Segal, Michael D. Shear, Mitch Smith, Megan Specia, Liam Stack, Matt Stevens, Katie Thomas, Glenn Thrush, Maria Varenikova, Amber Wang, Sui-Lee Wee, Noah Weiland and Rachel Wharton.

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