Florida breaks record with more than 21,000 new COVID cases

ORLANDO, Fla. (AP) — Florida reported 21,683 new cases of COVID-19, the state’s highest one-day total since the start of the pandemic, according to federal health data released Saturday, as its theme park resorts again started asking visitors to wear masks indoors.

The state has become the new national epicenter for the virus, accounting for around a fifth of all new cases in the U.S.

Republican Florida Gov. Ron DeSantis has resisted mandatory mask mandates and vaccine requirements, and along with the state Legislature, has limited local officials’ ability to impose restrictions meant to stop the spread of COVID-19. DeSantis on Friday barred school districts from requiring students to wear masks when classes resume next month.

The latest numbers were recorded on Friday and released on Saturday on the U.S. Centers for Disease Control and Prevention’s website. The figures show how quickly the number of cases is rising in the Sunshine State: only a day earlier, Florida reported 17,093 new daily cases. The previous peak in Florida had been 19,334 cases reported on Jan. 7, before the availability of vaccinations became widespread.

The Florida Hospital Association said Friday that statewide COVID-19 hospitalizations are nearing last year’s peak, and one of the state’s largest health care systems, AdventHealth’s Central Florida Division, this week advised it would no longer be conducting nonemergency surgeries in order to free up resources for COVID-19 patients.

Universal Orlando Resort and SeaWorld on Saturday became the latest theme park resorts in Florida to again ask visitors to wear masks indoors, with Universal also ordering its employees to wear face coverings to protect against COVID-19, which has been surging across the state.

All workers at Universal’s Florida park on Saturday started being required to wear masks while indoors as the employees returned to practicing social distancing. The home to Harry Potter and Despicable Me rides also asked visitors to follow federal and local health guidelines by voluntarily wearing face coverings indoors.

“The health and safety of our guests and team members is always our top priority,” Universal said in a statement.

Health officials on Friday announced that coronavirus cases in Florida had jumped 50% over the past week with COVID-19 hospitalizations in the state nearing last year’s peak.

SeaWorld on Saturday posted on its website that it was recommending that visitors follow recently updated federal recommendations and wear face coverings while indoors.

The change in policy this week at the theme park resorts came after the U.S. Centers for Disease Control and Prevention recommended that everyone wear masks indoors, regardless of vaccination status.

Crosstown rival Walt Disney World started requiring employees and guests older than 2 to wear masks on Friday, but it also went a step further. The Walt Disney Company said in a statement that it will be requiring all salaried and non-union hourly employees in the U.S. who work on site to be fully vaccinated.

Disney employees who aren’t already vaccinated will have 60 days to do so and those still working from home will need to show proof of vaccination before returning. Disney said it was discussing the vaccine requirements with the union, and added that all new hires will be required to be fully vaccinated before starting work at the company.

-Associated Press

SPECIAL REPORT-Former Labradoodle breeder tapped to lead US pandemic task force

WASHINGTON - On January 21, the day the first US case of coronavirus was reported, the secretary of the Department of Health and Human Services appeared on Fox News to report the latest on the disease as it ravaged China. Alex Azar, a 52-year-old lawyer and former drug industry executive, assured Americans the US government was prepared.

“We developed a diagnostic test at the CDC, so we can confirm if somebody has this,” Azar said. “We will be spreading that diagnostic around the country so that we are able to do rapid testing on site.”

While coronavirus in Wuhan, China, was “potentially serious,” Azar assured viewers in America, it “was one for which we have a playbook.”

Azar’s initial comments misfired on two fronts. Like many US officials, from President Donald Trump on down, he underestimated the pandemic’s severity. He also overestimated his agency’s preparedness.

As is now widely known, two agencies Azar oversaw as HHS secretary, the Centers for Disease Control and Prevention and the Food and Drug Administration, wouldn’t come up with viable tests for five and half weeks, even as other countries and the World Health Organization had already prepared their own.

Shortly after his televised comments, Azar tapped a trusted aide with minimal public health experience to lead the agency’s day-to-day response to COVID-19. The aide, Brian Harrison, had joined the department after running a dog-breeding business for six years. Five sources say some officials in the White House derisively called him “the dog breeder.”

Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis. His HHS is a behemoth department, overseeing almost every federal public health agency in the country, with a $1.3 trillion budget that exceeds the gross national product of most countries.

Azar and his top deputies oversaw health agencies that were slow to alert the public to the magnitude of the crisis, to produce a test to tell patients if they were sick, and to provide protective masks to hospitals even as physicians pleaded for them.

The first test created by the CDC, meant to be used by other labs, was plagued by a glitch that rendered it useless and wasn’t fixed for weeks. It wasn’t until March that tests by other labs went into production. The lack of tests “limited hospitals’ ability to monitor the health of patients and staff,” the HHS Inspector General said in a report this month. The equipment shortage “put staff and patients at risk.”

A promised virus surveillance program failed to take root, despite assurances Azar gave to Congress. Rather than share information, three current and three former government officials told Reuters, Azar and top staff sidelined key agencies that could have played a higher-profile role in addressing the pandemic. “It was a mess,” said a White House official who worked with HHS.

Officials across the government, from President Trump on down, have been blasted for America’s halting response to the pandemic. Critics inside and outside the administration say a meaningful share of the responsibility lies with HHS and Trump appointee Azar.

“You have to blame the problem on the virus, but it’s Azar's operation,” said Lynn Goldman, the dean of the public health school at George Washington University, who has served on advisory boards of the FDA and CDC. “And the buck stops there.”

HHS declined to make Azar available for an interview. Michael Caputo, the new chief HHS spokesman, declined to answer Reuters questions about Azar’s stewardship, saying in a statement: "We are communicating to the American public during a deadly pandemic.”

DALLAS LABRADOODLES

Azar is a Republican lawyer who once clerked for the late conservative Supreme Court Justice Antonin Scalia and counts current Supreme Court Justice Brett Kavanaugh as a friend. Under George W. Bush, Azar worked for HHS as general counsel and deputy secretary. During the Obama years, he cycled through the private sector as a pharmaceutical company lobbyist and executive for Eli Lilly. After Trump’s first HHS secretary was forced out in a travel corruption scandal, Azar stepped in, in January 2018.

Two years later, at the dawn of the coronavirus crisis, Azar appointed his most trusted aide and chief of staff, Harrison, as HHS’s main coordinator for the government’s response to the virus.

Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a “Confidential Assistant” to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.

Before joining the Trump Administration in January 2018, Harrison’s official HHS biography says, he “ran a small business in Texas.” The biography does not disclose the name or nature of that business, but his personal financial disclosure forms show that from 2012 until 2018 he ran a company called Dallas Labradoodles.

The company sells Australian Labradoodles, a breed that is a cross between a Labrador Retriever and a Poodle. He sold it in April 2018, his financial disclosure form said. HHS emailed Reuters that the sales price was $225,000.

At HHS, Harrison was initially deputy chief of staff before being promoted, in the summer of 2019, to replace Azar’s first chief of staff, Peter Urbanowicz, an experienced hospital executive with decades of experience in public health.

This January, Harrison became a key manager of the HHS virus response. “Everyone had to report up through him,” said one HHS official.

One questionable decision, three sources say, came that month, after the White House announced it was convening a coronavirus task force. The HHS role was to muster resources from key public health agencies: the CDC, FDA, National Institutes of Health, Office of Global Affairs and the Assistant Secretary for Preparedness and Response.

Harrison decided, the sources say, to exclude FDA Commissioner Stephen Hahn from the task force. “He said he didn’t need to be included,” said one official with knowledge of the matter.

When task force members were announced January 29, neither Hahn nor the FDA were included. Hahn wasn’t put on the task force until Vice President Mike Pence took over in February. Two of Hahn’s high-profile counterparts were on it from the start: CDC director Robert Redfield and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The HHS denied it was Harrison’s decision to leave out Hahn and the FDA, but declined to say who made the call. The agency lauded Harrison’s work on the task force.

In a statement, Hahn said the FDA was focused on the coronavirus epidemic, “not on when we were added to the task force,” and that the agency was not “excluded.”

Fauci, who has become a public face of the Trump Administration’s COVID-19 effort, said he wasn’t sure including the FDA was necessary at the start. Initially, the Chinese government was saying the virus spread through animals, not human to human, he said. “You would include the FDA when you want to expedite drugs or devices,” Fauci said.

Others said the lack of a strong FDA role early on had direct consequences. Two sources familiar with events say the White House wasn’t getting information from the FDA about the state of the testing effort, a crucial element of the coronavirus response.

Reached by phone, Harrison declined to answer Reuters’ questions. In a later statement, he did not address questions about the task force but said he was proud of his work history. “Americans would be well served by having more government officials who have started and worked in small family businesses and fewer trying to use that experience to attack them and distort the record,” he wrote.

In a statement to Reuters, Azar said Harrison has been an asset. “From day one, Brian has demonstrated remarkable leadership and managerial talents,” Azar wrote.

LOW RISK?

In the pandemic’s early days, Azar offered words of both concern and assurance in public. On January 31, a day after the WHO declared COVID-19 a global health emergency, Azar declared it a public health emergency.

That same day, during the first Coronavirus Task Force briefing, Azar told the public: “I want to stress: The risk of infection for Americans remains low.”

The United States, he said, had taken adequate precautions. Travel restrictions and 14-day quarantines on Americans who had been to Wuhan, where the virus originated, were imposed. Americans returning from other parts of China had to self-quarantine.

The next week, on February 7, in another press conference, Azar repeated the message. “The immediate risk to the American public is low at this time,” he announced.

Behind the scenes, his aides say, Azar had alerted the White House in early January, and then later that month spoke directly to the president. It is unclear exactly what Azar told the president, because transcripts are not available.

“There’s a lot of CYA going on,” said one senior administration official, who said Azar never spelled out that stockpiles of protective equipment might be inadequate or the tests were not working. “We were told the test was ready. That turned out to be flat-out wrong.”

Trump denied Azar sent out alarms. “@SecAzar told me nothing until later,” he tweeted earlier this month.

Meanwhile, Azar continued to say “the immediate risk” to Americans was low and that travel restrictions had worked. “So I think so far, our measures have been quite effective,” he told NPR on February 14.

Others were raising alarms. “It’s not so much of a question of if this will happen any more, but rather more of a question of exactly when this will happen,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said at a February 25 news briefing.

MORE GLITCHES

Responding to Congressional concerns, Azar said HHS had launched a coronavirus surveillance system in five cities. The plan was to test patients who showed up with flu symptoms, to see if they actually were infected with the novel coronavirus.

But the system was either delayed or not implemented in the cities and now is seen by epidemiologists as irrelevant given the massive community spread and continued inadequate testing.

By the end of February, Azar sought more money to attack the crisis as he testified before Congress. “This is an unprecedented potentially severe health challenge globally, and will require additional measures,” he said.

Still, he assured senators his agency was in control. “We have enacted the most aggressive containment measures in the history of our country,” he said.

He again provided words of calm, appearing on Fox News. “But thanks to President Trump's historically aggressive containment efforts, we've actually contained the spread of this virus here in the United States at this point,” he said February 25. “I think part of the message to the American people is we all need to take a bit of deep breath here.”

“The government is working on this. You've got the right people on this.”

By the end of February, Azar and Harrison were no longer running the White House task force. That month, Vice President Pence took control. The FDA and Hahn are now actively involved. A Pence spokesperson said the issue of precluding the FDA from the task force “pre-dates the VP’s leadership” and declined further comment.

Azar seemed caught off guard by the change. “I’m still chairman of the task force,” he told the press after Pence took over.

Given Azar’s early struggles, the White House should have taken a stronger role over the task force from the outset, said Ashish Jha, director of Harvard University’s Global Health Institute. “It was very clear that Azar wasn’t able to marshal the forces across the government like he needed to,” he said.

Jeffrey Flier, a former Harvard Medical School dean, said the HHS role remains as vital as ever. 

“Clearly there was a need for better coordination of the FDA and CDC and other agencies,” he said. “HHS has to be operating effectively in a crisis like this.” (Reporting by Aram Roston and Marisa Taylor in Washington. Editing by Ronnie Greene)

-reuters-

US CDC reports 661,712 coronavirus cases, 33,049 deaths

The US Centers for Disease Control and Prevention (CDC) on Friday reported 661,712 cases of new coronavirus, an increase of 29,164 cases from its previous count, and said that the number of deaths had risen by 1,978 to 33,049.

The CDC reported its tally of cases of the respiratory illness known as COVID-19, caused by a new coronavirus, as of 4 pm ET on April 16, compared with its count a day earlier. 

The CDC figures do not necessarily reflect cases reported by individual states. 

This, as New York Governor Andrew Cuomo on Friday launched a blistering attack on President Donald Trump's response to the coronavirus crisis, accusing him of "passing the buck" to the states and favoring big business over communities hardest hit.

Cuomo, who had previously kept his criticism of Trump in check, unleashed a flurry of broadsides following a reporter's question about the president's comments suggesting New York had asked for too much aid that was never fully used.

The governor said the president should "maybe get up and go to work" instead of watching TV and accused him of favoring the airline industry and other business cronies in a recent bailout package that Cuomo said left little for the states.

Cuomo said that he had been quick to praise the president when the state was in dire need of hospital beds and ventilators and that his requests for help with those were motivated by the White House's own dire projections for the virus.

"We built more beds than we needed," Cuomo, said pointing to initial federal projections on the impact of the virus which predicted that as many as 2.2 million people could die. "Our only mistake was believing your numbers and your projections."

Cuomo, whose state is at the epicenter of the US outbreak, accounting for nearly half of the country's deaths, said the president had repeatedly refused to help states with ramping up testing because it was "too complicated."

He said he needs federal funding to significantly ramp up testing capacity and to fill a $10-$15 billion budget shortfall that is hampering the state's ability to fund such efforts on its own. He criticized the aid packages passed by Congress to date for a lack of funds to hard-hit states like New York.

"Is there any funding so I can do these things that you want us to do? 'No,'" Cuomo told a daily briefing on the coronavirus. "That is passing the buck without passing the bucks."

He spoke one day after the Trump administration outlined plans for a phased reopening, starting with the states least affected by the virus.

'ZERO, ZILCH, NADA'

"The federal government has passed three bills to address this crisis. Of those three bills the state governments have gotten precisely zero, zilch, nada in unrestricted aid," Cuomo said.

"Okay, it's up to the states, but then don't ask the states, don't give them this massive undertaking that has never been done before and then not give them any resources to do it."

In a separate briefing, Governor Phil Murphy of neighboring New Jersey said he had been in constant contact with the White House to get "the right testing infrastructure and regime in place," a prerequisite for reopening the state.

Murphy avoided Cuomo's combative rhetoric, calling his teleconference on Thursday with Trump and other White House officials "a good discussion."

On Thursday, Cuomo extended the closure of businesses and schools in his state until at least May 15, but he has started to plan on a phased reopening that would hinge on keeping hospitalizations and other key metrics on a downward trend.

Cuomo said on Friday that a total of 17,316 people were hospitalized across New York because of COVID-19, down from 17,735 a day earlier and the lowest since April 5. Intubations and admissions to intensive care units also fell, he said.

Cuomo said that about 2,000 infected people were newly admitted to hospitals on Thursday, hovering at a high level, while the state recorded an additional 630 deaths, up from 606 deaths the previous day.

New Jersey, which is second after New York in coronavirus cases and fatalities, reported 323 new deaths on Friday for a total of 3,840, and 3,250 new confirmed cases for a total of 78,467.

But the rates of increase in the spread of the virus have "dropped dramatically" over the past several weeks, Murphy said. "This is what we've been working toward, and what we must keep doing," he added.

Emergency Medical Technicians (EMTs) wheel a man out of the Cobble Hill Health Center nursing home in the Brooklyn borough of New York, US, on April 17, 2020, during an ongoing outbreak of the coronavirus disease (COVID-19). Lucas Jackson, Reuters

186,101 coronavirus cases, 3,603 deaths in US - CDC

The US Centers for Disease Control and Prevention (CDC) on Wednesday reported 186,101 cases of coronavirus, an increase of 22,562 cases from its previous count, and said that the number of deaths had risen by 743 to 3,603.

The CDC reported its tally of cases of the respiratory illness known as COVID-19, caused by a new coronavirus, as of 4 p.m. ET on March 31 compared to its count a day ago. 

The CDC figures do not necessarily reflect cases reported by individual states. 

In a study, the US CDC also said people infected with the novel coronavirus can transmit the infection one-to-three days before symptoms start to appear.

The study, which underscored the importance of physical distancing to fight the coronavirus outbreak, looked at 243 cases of COVID-19 reported in Singapore between January 23 and March 16.

It identified seven "clusters" where pre-symptomatic transmission was likely, and in four such groups, where the date of exposure could be determined, pre-symptomatic transmission occurred one-to-three days before symptoms appeared in the source patient.

Of the cases in Singapore, 157 were locally acquired and 10 of these were likely transmitted before symptoms started to show.

The fast-spreading virus has claimed over 43,000 lives globally.

The findings suggest that it might not be enough for people showing symptoms to limit their contact to control the pandemic, the researchers wrote in the CDC's Morbidity and Mortality Weekly Report, published online on Wednesday.

The findings increase the challenges of containment measures, the researchers wrote, but said the magnitude of the impact depends on the extent and duration of transmissibility while a patient is pre-symptomatic and that has so far not been clearly established.

The study authors suggested that public health officials conducting contact tracing should strongly consider including a period before symptom onset to account for the possibility of this type of transmission.

Transmissions might take place through respiratory droplets or even speech and other vocal activities such as singing, with the rate of emission corresponding to voice loudness, according to the researchers.

While the cases were carefully investigated, the CDC said it was possible an unknown source might have caused the clusters.

And, the findings could also be affected by incorrect reporting of cases, especially if people had only mild symptoms.

With the focus currently on testing only people who show symptoms, the researchers expect asymptomatic illness to be under-detected.

Still, the CDC data adds to previous reports of individual cases in China that indicated the virus could spread before symptoms start to appear.

source: news.abs-cbn.com

US CDC releases COVID-19 microscopic image

An isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV or novel coronavirus, is seen in a transmission electron microscopic image obtained from the Centers for Disease Control (CDC) in Atlanta, Georgia, U.S. on Tuesday. At least 29 were reported killed as coronavirus infection rose to almost 1,000 around the country.

source: news.abs-cbn.com

After testing delays, US coronavirus cases surge past 900

WASHINGTON — The number of US cases of the novel coronavirus surged to more than 900 on Tuesday, according to an AFP tally, after public health experts criticized authorities for downplaying the epidemic and lagging behind in testing efforts.

At least 28 people have died and some 910 people have been infected, according to a state-by-state count, a significant jump of some 550 cases the day before.

The rise is linked to an expansion in testing as the bulk of diagnoses have shifted from federal to state laboratories. 

Epidemiologists have said faulty test kits coupled with a diagnostic strategy that initially targeted too few people allowed the disease to spread beyond US authorities' ability to detect it.

Writing in the Journal of the American Medical Association (JAMA) on Monday, academics from Johns Hopkins University and Stanford University said the failings had contributed to the virus taking root across the country.

Speaking at a White House briefing, Vice President Mike Pence defended the federal government's response and said that "a million tests are in the field." He added that more would be added as the government partnered with private companies. 

According to the latest CDC figures, 8,554 tests had been performed as of Monday.

By way of comparison, South Korea, which announced its first case on the same day as the US, has tested more than 189,000 people, according to a report in the Business Insider.

The authors of the JAMA report wrote that the only test initially authorized was one developed by the CDC.

It relied on the same technology as one authorized by the World Health Organization (WHO) and deployed around the world -- except that a fault meant the CDC kit was returning inconclusive results.

It was not until February 29, the date of the first US death and more than a month after the first confirmed US case, that the Food and Drug Administration lifted a ban on state laboratories developing their own kits based on the WHO's tests.

'DON'T OVERREACT' 

"Adopting broader testing criteria and allowing use of a wider range of tests would have been helpful in identifying the first US cases and containing the spread," said Michelle Mello of Stanford, a co-author of the JAMA report.

"Manufacturing problems like the one that arose with CDC's test are always a risk, but the fact that CDC put all its eggs in that one basket made the manufacturing snafu highly consequential," she wrote on her university's blog page.

The CDC was initially only testing people with known exposure, meaning a Californian patient on a ventilator was denied the test for five days, the patient's doctors said. The criteria were changed as a result of this case.

Mello also pointed to several inaccuracies in White House communications on the epidemic -- from declaring that containment efforts were "close to airtight" to claiming a vaccine could be ready within 3 to 4 months.

"The public messaging from Washington about the seriousness of the problem has been neither consistent nor accurate, and I worry it may have led Americans to take fewer steps to prevent community transmission than we should have," she said.

The authors argued against overcorrection, however, saying that health services would be quickly overwhelmed if everyone with a cough or fever -- or exposure to sick patients -- demanded a test. 

Agence France-Presse 

'Never-ending nightmare': Evacuated Americans carried virus from cruise ship to airplane

TOKYO — The ground rules were clear. A day before 328 Americans were to be whisked away from a contaminated cruise ship in Japan, the U.S. Embassy in Tokyo told passengers that no one infected with the coronavirus would be allowed to board charter flights to the United States.

But as the evacuees began filing onto reconfigured cargo planes early Monday for departures to military bases in California or Texas, some noticed a tented area in one of them that was separate from the rest of the cabin.

Then reality hit: After 12 days stuck on the cruise ship as more and more people tested positive for the virus, they would now be sharing a plane with those carrying the same pathogen they were desperate to escape.

“I didn’t know until we were in the air,” said Carol Montgomery, 67, a retired administrative assistant from San Clemente, California. “I saw an area of plastic sheeting and tape.”

While the planes were aloft, the State Department and the Department of Health and Human Services said in a joint statement that the results for 14 passengers who had been tested two or three days earlier came back positive just as they were boarding buses to the airport. After consultations with health experts, the U.S. government decided to let the infected evacuees, who were not yet exhibiting symptoms, board the flights.

The reversal was the latest chaotic turn in a two-week quarantine of the ship that has become an epidemiological nightmare.

Even as the Americans were flying home and countries like Australia, Canada and South Korea were preparing to evacuate their own citizens, the Japanese Health Ministry announced Monday that 99 more cases had been confirmed on the cruise ship, bringing the total to 454.


Among them was the third Japanese public health official to contract the virus while tending to passengers and crew members aboard the ship, the Diamond Princess.

The unstinting rise in infections raised questions about how Japanese authorities would handle the offloading of passengers in two days when the quarantine period is supposed to end. Health officials have already raised the possibility that the quarantine could be extended for some passengers.

“The quarantine on the ship ended up being an unprecedented failure,” said Eiji Kusumi, a doctor specializing in infectious diseases at Navitas Clinic in Tokyo. “We should learn from this lesson that a quarantine on a ship is impossible, and we should not repeat this in the future.”

U.S. authorities had strongly encouraged American passengers to accept the offer of a flight out. Getting them off the ship took several hours as they were screened, their passports were checked, and they were loaded onto buses that took them from the port of Yokohama to Haneda Airport in Tokyo.

The State Department said the infected passengers “were moved in the most expeditious and safe manner to a specialized containment area on the evacuation aircraft to isolate them in accordance with standard protocols.”

The U.S. passengers were taken to either Travis Air Force Base in California or Joint Base San Antonio in Texas, and they will remain under quarantine for an additional 14 days.

When one of the planes landed in California, a line of officials from the military, the Centers for Disease Control and Prevention, and the Department of Homeland Security welcomed the passengers with banners that read “Welcome home.”

After being ushered through an isolation tent, they were assigned to apartments on the base.

“They have flown in specialists from across the country,” said Sarah Arana, 52, a medical social worker from Paso Robles, California. “It’s a phenomenal amount of resources. I’m kind of blown away.”

Epidemiologists said U.S. officials had made a difficult decision to allow infected passengers onboard the charter flights.

“The degree of difficulty in getting someone sick home is much greater than repatriating people who are otherwise well and possibly incubating,” said Dr. Allen Cheng, an infectious disease specialist at Monash University in Melbourne, Australia.

Cheng added, “You don’t want to expose anyone on the plane who hadn’t otherwise been exposed before on the boat.”

Australia is planning to take approximately 200 passengers off the Diamond Princess on Wednesday. Cheng said that Australia had decided that “anyone who is sick or becomes sick in the next 48 hours will stay in Japan and stay in the hospital.”

With Australia and other countries preparing to help transport their citizens off the boat, the captain told the more than 2,000 people still on board that Japanese health authorities could swab everyone for the coronavirus by the end of Monday and begin letting guests leave the ship Wednesday.

“This disembarkation will be an ongoing process” until Feb. 22, the captain said in an onboard announcement.

The captain said the cruise line was “coordinating closely with your embassies to understand the arrangements for you once you are cleared from the quarantine on the Diamond Princess and how we can best support you.”

In a briefing Monday, Shigeru Omi, president of the Japan Community Healthcare Organization, said that Japan had made the right decision to put the ship in quarantine based on the information available when the ship arrived in Yokohama on Feb. 3.

“At that time, the international community was trying to contain the virus,” Omi said.

According to the Japanese Health Ministry, at least 55 Americans on the ship were infected with the coronavirus. Many of them remain in hospitals around Japan.

John Haering, 63, a retired operations manager for Union Pacific Railroad who lives in Tooele, Utah, was taken to a hospital in Chiba prefecture last week with a fever and tested positive for the virus. He said he felt stranded as he lay in an isolation room.

His wife, Melanie, left on one of the charter flights.

“I’m happy for her that she got out of here and that she’s going to get some attention in the U.S.,” said John Haering, who retired in November and was about a third of the way through a six-month trip around the world. “But at the same time I’m sad. You feel that loss of somebody leaving.”

Haering, who said that he no longer had any symptoms or a fever but that a CT scan showed signs of pneumonia, said he was not sure how much longer he would have to stay.

“They did swab me today again, and I’ll get my test back tomorrow,” he said. “I asked the doctor if the swab shows that I’m negative, and he just shook his head and said, ‘I don’t know.’ There’s a lot of stuff that they don’t know.”

Haering said he had not heard from anyone at Princess Cruises, the company that operates the Diamond Princess, since he arrived at the hospital. Until Sunday, he had not heard from anyone at the U.S. Embassy in Tokyo, either.

He received a call and a follow-up email urging him to get in touch with the cruise ship company for further information about how he will get home.

“It’s very scary,” he said. “It feels like a little bit of abandonment.”

The spread of the virus on the ship was illustrated by one extended family.

Tung Pi Lee, 79, a retired physician, was left in a Tokyo hospital with a coronavirus infection while his wife, Angela, flew to California on one of the charter flights. Several of her siblings and their spouses were among the 14 infected passengers who flew home. Two were taken to Nebraska, and another was in California for treatment.

“I am glad for my aunts and uncles to be in the U.S. and to be receiving treatment here,” said JoAnn LaRoche Lee, one of Lee’s daughters. “Had they been left in Japan, I wonder what would have happened to them.”

Trying to coordinate her father’s care in Tokyo with her siblings in the United States, she said, “feels like a never-ending nightmare.”

2020 The New York Times Company

US confirms second case of Wuhan coronavirus

The US Centers for Disease Control and Prevention (CDC) on Friday confirmed a second US case of the new coronavirus from China in a Chicago woman, and said as many as 63 potential cases were being investigated as the sometimes deadly illness continues to spread around the globe.

Of the 63 people under investigation from 22 states, 11 have so far tested negative, CDC said on a conference call with reporters.

News of the woman in Chicago infected with the virus that originated in Wuhan, China, followed the announcement earlier this week of a man from Washington state who was diagnosed with the virus after returning from Wuhan.

The newly discovered virus has killed 26 people and infected more than 800. Most of the cases and all of the deaths so far have been in China, where officials have imposed severe restrictions on travel and public gatherings.

The virus has created alarm, but there are a still many unknowns surrounding it, such as just how dangerous it is and how easily it spreads between people. It can lead to pneumonia, which has been deadly in some cases.

"CDC believes the immediate risk to the American public is low at this time, but the situation continues to evolve rapidly," Dr. Nancy Messonnier, director of the CDC's Center for Immunization and Respiratory Diseases, said on the call.

More US cases are likely, she added.

Dr. Julie Gerberding, a Merck & Co executive who was CDC director during the 2003 SARS outbreak, said it is too early to predict the course the disease.

"I would caution against jumping to any premature conclusions about the severity of this because the epidemic is still unfolding," she said in a phone interview.

"As we learn from basically every new outbreak, we don't know where it's going to end up until it gets there."

The 60-year-old woman from Chicago had traveled to Wuhan in December and returned Jan. 13.

Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said on a conference call that the woman is in stable condition and remains in an unnamed Chicago hospital primarily for infection control purposes.

She had not taken public transportation and was not ill when she traveled, Arwady said.

A few days after arriving home, the patient began to feel unwell and called ahead to alert her doctor to her illness. The physician asked about her travel history, quickly put a mask on the patient, and directed her to a hospital with infection control capabilities, Arwady said.

Hospital staff performed a full clinical examination and worked with public health officials to arrange testing for the novel coronavirus at the CDC.

Dr. Michael Ison, an infectious disease expert at Northwestern Medicine in Chicago, which is not caring for the patient, said the announcement of the second U.S. case means the system is working. "I don't think the severity of the threat has changed," he said.

In a local news briefing, Arwady said the health risk to Chicago residents remains low, adding there is no need for people to change their behavior in any way.

The World Health Organization on Thursday declared the virus an "emergency in China", but stopped short of declaring it a global health emergency

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How Purdue's aggressive sales of a painkiller blew up in its face

NEW YORK - In 2002, Andrew Kolodny, a resident in psychiatry, attended a training session on pain treatment in Philadelphia.

Seventeen years later, he still shakes his head over the surprising enthusiasm of the lecturer, an authority on the topic, for prescribing opioids.

"The message was that people are suffering because of an overblown fear, and the correct and compassionate way to treat pain is to prescribe aggressively," Kolodny recalled.

The lecturer, Thomas McLellan, had shown the class a short film examining the case of a man seeking relief from chronic back pain.

The patient had been prescribed a strong regimen of OxyContin, the pain medication produced by Purdue Pharma -- but he wanted more, complaining of crippling agony.

After the film, McClellan asked the doctors in the class for their diagnosis.

"For me and for most of the people in the room, the obvious diagnosis was that this patient became addicted to their medicine," said Kolodny, who is now the co-director of opioid policy research at Brandeis University's Heller School in Boston.

"The surprise was that the person teaching the class said it's not true addiction. It's a pseudo-addiction."

McLellan insisted the problem facing the seemingly addicted patient was that he was not getting enough drugs, Kolodny recalled.

At the time, the concept of "pseudo-addiction" was being advanced by Purdue Pharma and other laboratories to promote their opioid products.

OxyContin, an anti-pain medication similar to morphine, was introduced to the American market in 1996 with a campaign that swept aside years of caution on the use of opioids, previously reserved for the gravely ill because of their highly addictive nature.

The campaign featured deceptive marketing, controversial sales practices and endorsements from eminent physicians generously remunerated by Purdue Pharma.

But as a result of the singularly aggressive promotion of the prescription drug, both Purdue and the Sackler family, which owns the firm, now face more than 2,300 lawsuits in the United States.

They stand accused of having provoked the nationwide opioid crisis.

Opioids are blamed for more than 400,000 deaths by overdose since 1999, according to recently published data, and on average for more than 130 deaths a day.

Contacted by AFP, Purdue Pharma declined to comment.

A GREEN LIGHT

The origins of OxyContin, which has generated more than $35 billion in sales for Purdue, date to 1990.

The laboratory, based in the northeastern US state of Connecticut, was looking for a successor to its popular analgesic MS Contin, a morphine-based medication prescribed mainly to cancer patients but which was facing growing competition from generic drugs.

Purdue developed a painkiller based on oxycodone, a semi-synthetic opioid first concocted in Germany in 1916, with effects comparable to those of MS Contin.

Opioids posed well-known risks of dependence, but the laboratory had an answer: the new drug's beneficial effects would last 12 hours, twice as long as similar medications, meaning a patient would take fewer pills and face reduced danger of addiction.

But even before it reached the market, tests showed that OxyContin's effects did not last as long as originally thought, the Los Angeles Times found in a 2016 investigation.

Still, in December 1995, the US Food and Drug Administration (FDA) gave Purdue a green light to market OxyContin for the treatment of moderate to severe pain, authorizing its use for a range of ailments, many less serious than cancer.

"At the time of approval, FDA believed the controlled-release formulation of OxyContin would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate 'rush' or high," an agency spokesman told AFP.

The FDA's approval drew growing criticism after Curtis Wright, a doctor who led the agency committee that authorized OxyContin, left to take a senior position with Purdue in 1998.

Another troubling development: once the drug was being marketed and aggressively promoted, OxyContin generated a huge black market that Purdue, critics say, ignored or minimized for far too long.

Quantities of pills were procured -- stolen from pharmacies or obtained from unscrupulous doctors -- and ground into powder to be inhaled, which multiplied their euphoric effects, according to a confidential US Justice Department report cited by The New York Times in 2018.

The 80-milligram pills, the most common dose, sell for $65 to $80 on the black market, compared to $6 in pharmacies, according to several doctors questioned by AFP.

EXPLOSION IN SALES

Despite the warning signals, Purdue continued to present OxyContin as being less addictive than other opioids.

The company's advertising budget surged from $187,500 in 1996 to $4 million in 2001, according to internal documents.

Purdue also built up a so-called "speakers' bureau" -- mainly physicians highly remunerated for attesting to the "miracle" qualities of OxyContin.

Sales exploded -- rocketing from $80 million in 1997 to $2.1 billion only four years later, internal documents showed.

Purdue also enlisted the help of the American Academy of Pain Medicine (AAPM) and the American Pain Society (APS), two respected professional organizations specializing in pain treatment, to support its campaign to destigmatize opioids.

Purdue helped finance both organizations, and several of their members worked as consultants for the laboratory.

Underscoring the close relationship, David Haddox, who headed an APS committee that endorsed the increased use of opiates, was hired by Purdue in 1999, where he remained until earlier this year.

Purdue's sales pitch to physicians was probably helped by the fact that pain treatment has long been a neglected branch of medicine, said Gregory Terman, director of the Acute Pain Service at the University of Washington and the APS president from 2015 to 2017.

"Until the opioid crisis, NIH (the National Institutes of Health) had never spent more than one percent of their budget on pain -- the most common reason people go to doctors -- let alone chronic pain, which troubles more than 100 million Americans," he said.

The APS, facing lawsuits over its promotion of opioids and unable to pay its lawyers, filed for bankruptcy in late June.

Primary care doctors "have little training in addiction or pain, and many of them believed the promises" made by Purdue, Stanford University psychiatry professor Keith Humphreys said.

LEGAL PROBLEMS MOUNT

In 2006, the medical world finally awoke to the dangers of OxyContin, jolted by an article by Leonard Paulozzi of the Centers for Disease Control and Prevention (CDC), who reported that deaths linked to opioids had exploded by 91 percent from 1999 to 2002.

In 2007, for the first time, Purdue Pharma and three of its executives pleaded guilty, in Virginia, to having deceived physicians, patients and regulatory authorities about the risks posed by OxyContin of dependence or abuse. They agreed to pay $635 million in fines.

Yet when Purdue's legal problems grew in the United States and OxyContin sales fell in 2010, the company simply turned to its international subsidiary Mundipharma to promote sales in other parts of the world.

In Europe, where drug ads targeting the general public are banned, Mundipharma aired one in Spain in 2013 drawing attention to the problem of chronic pain and encouraging people to see a doctor and demand treatment.

Asked about that, a Mundipharma spokesperson said only: "We no longer have any such activity today."

The group has also financed seminars for physicians in other countries -- notably Brazil and China -- to promote opioids as effective pain treatment, the Los Angeles Times reported in 2016.

Joseph Pergolizzi, a Florida doctor who the newspaper said had lectured in 2016 at a Mundipharma-sponsored conference in Brazil, rejected any suggestion of deceptive marketing.

"I was invited to a cancer pain conference," he told AFP, adding that he had spoken about "severe cancer pain treatment and what the options are."

Pergolizzi said he had severed all ties to Mundipharma two years ago.

BANKRUPTCY

Purdue has repeatedly stated that OxyContin is only one of several opioid medications on the market, and that it now fights actively against the abuse of such drugs.

It sought bankruptcy protection in mid-September and is now urging the states and cities suing it to agree to its transformation into a trust, with any future profits to be used to alleviate the harm caused by the opioid crisis.

The laboratory has said it is ready to make payments to the plaintiffs totaling $10 billion to $12 billion -- with $3 billion coming from the Sackler family -- if they drop all legal action.

But nearly 25 states, including New York, have rejected the proposal.

The offer from Purdue and the Sacklers falls far short of paying for "the death and destruction they inflicted on the American people," said New York Attorney General Letitia James.

lo/bbk/sst

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Juul suspends US sales of some flavored e-cigarettes

WASHINGTON - The leading American maker of electronic cigarettes, Juul Labs, announced Thursday it is suspending sales of some flavored vaping products in the United States, as the US government prepares a nationwide ban.

Juul will stop selling mango, cream, fruit and cucumber flavored pods, while federal health authorities finalize new regulations on vaping, Juul said in a statement. Its tobacco, menthol and mint-flavored products will still be available.

"We must reset the vapor category by earning the trust of society and working cooperatively with regulators, policymakers and stakeholders to combat underage use while providing an alternative to adult smokers," Juul CEO CK Crosthwaite said.

The debate over regulating e-cigarettes comes amid a mysterious epidemic of lung conditions linked to vaping that has claimed the lives of at least 33 people in 24 states.

The latest tally by the Centers for Disease Control and Prevention puts the number of confirmed or probable lung injury cases at 1,479 as of October 15.

THC, the active ingredient in cannabis, was involved in more than 3 quarters of cases in which patients reported using e-cigarettes in the 3 months prior to their injuries.

E-cigarettes have soared in popularity among young people since they were introduced about a decade ago, according to multiple surveys.

The industry defends vaping as a healthier alternative to cigarettes that can help people quit smoking. But lawmakers around the country, and overseas, are seeking to impose total or partial bans.

President Donald Trump's administration has chosen the path of barring flavored e-cigarettes, including the popular mint and menthol flavors.

Health Secretary Alex Azar announced plans for a ban in September. The text has not been made public yet but will soon be, according to the Federal Drug Administration, which is responsible for regulating tobacco and e-cigarettes.

Juul assured that it would not challenge the FDA's coming regulations, but its action Thursday indicates it believes its mint and menthol flavored products should be authorized.

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New York state bans flavored e-cigarettes over vaping concerns

NEW YORK - New York became the second US state to ban flavored e-cigarettes Tuesday, following several vaping-linked deaths that have raised fears about a product long promoted as less harmful than smoking.

A health council passed emergency legislation proposed by Governor Andrew Cuomo outlawing flavored vaping products amid an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.

The ban comes into force with immediate effect. Michigan became the first state to declare a ban earlier this month, but that law has yet to be implemented.

"It is undeniable that vaping companies are deliberately using flavors like bubblegum, Captain Crunch and cotton candy to get young people hooked on e-cigarettes -- it's a public health crisis and it ends today," said Cuomo.

President Donald Trump's administration announced last week that it would soon ban flavored e-cigarette products to stem a rising tide of youth users.

The move could later be extended to an outright prohibition of vaping if adolescents migrate to tobacco flavors, seen as more legitimate products that help smokers quit their habit, said the Food and Drug Administration (FDA), which regulates e-cigarettes.

"New York is not waiting for the federal government to act, and by banning flavored e-cigarettes we are safeguarding the public health and helping prevent countless young people from forming costly, unhealthy and potentially deadly life-long habits," Cuomo added.

POPULAR WITH ADOLESCENTS

Shops in New York now have two weeks to remove vaping products from their shelves. The ban does not prohibit menthol or tobacco-flavored e-cigarettes.

E-cigarettes have been available in the US since 2006 and are sometimes used as an aid to quit smoking traditional tobacco products like cigarettes.

Their use among adolescents has skyrocketed in recent years: some 3.6 million middle and high school students used vaping products in 2018, an increase of 1.5 million on the year before.

The Centers for Disease Control and Prevention (CDC) recently that there were now more than 450 possible cases of pulmonary illness associated with vaping in the US.

The CDC has cautioned against vaping as officials investigate the precise cause of the deaths. No single substance has been found to be present in all the laboratory samples being examined.

New York's health department found very high levels of vitamin E oil in cannabis cartridges used by dozens of people in the state who had fallen ill after using e-cigarettes.

Vitamin E is a commonly used nutritional supplement but is dangerous when inhaled.

San Francisco, the home of market leader Juul Labs, became the first American city to ban e-cigarettes in June last year.

The FDA has warned Juul to stop advertising itself as a less harmful alternative to smoking, noting in particular the company's attempts to attract young people.

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US records 22 new measles cases, bringing year's total to 1,044

The United States recorded 22 new measles cases last week, bringing the year's total number of cases to 1,044 in the worst outbreak of the disease since 1992, federal health officials said on Monday.

The US Centers for Disease Control and Prevention said the number of cases of the highly contagious and sometimes deadly disease rose 2.2% in the week ended June 13 from the prior week. The 2019 outbreak, which has spread to 28 states, is the worst since 1992, when 2,126 cases were recorded.

Most of the new cases occurred in New York, with 13 occurring in Rockland County and eight in New York City, a CDC spokesman said.

Health experts say the virus has spread among school-age children whose parents declined to give them the measles-mumps-rubella vaccine, which confers immunity to the disease. A vocal fringe of U.S. parents, some in New York's ultra-Orthodox Jewish communities, cite concerns that the vaccine may cause autism, despite scientific studies that have debunked such claims.

The disease has mostly affected children who have not received the vaccine.

Measles was declared eliminated in the United States in 2000, meaning there was no continuous transmission of the disease for a year. Still, cases of the virus occur and spread via travelers coming from countries where measles is common.

CDC officials have warned that the country risks losing its measles elimination status if the ongoing outbreak, which began in October 2018 in New York, continues until October 2019.

The outbreak has escalated since 82 people in 2018 and more than 40 people in 2019 brought measles to the United States from other countries, most frequently Ukraine, Israel, and the Philippines, federal officials said.

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US risks losing measles 'elimination status' as cases breach 1,000

The number of measles cases in the United States this year has reached 1,001, health officials said Wednesday, as they vowed to stop the spread of misinformation about vaccines.

The announcement comes days after authorities declared the US was in danger of losing its "elimination status" on the contagious respiratory disease if the current outbreaks continue.

"The 1,000th case of a preventable disease like measles is a troubling reminder of how important" it is to ensure that people understand that vaccines are safe, Health and Human Services (HHS) Secretary Alex Azar said in a statement.

Azar vowed to "continue our efforts to support local health departments and health care providers in responding to this situation, with the ultimate goal of stopping the outbreak and the spread of misinformation about vaccines."

"We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak."

The previous record number of cases came in 1992 when 963 cases were reported across the year -- a figure now surpassed in less than the first 6 months of 2019.

The Centers for Disease Control and Prevention (CDC) were giving health care providers guidelines for recognizing and preventing measles, and developing a toolkit for physicians to counter misinformation, Azar said.

Authorities declared measles eliminated in the US in 2000, a goal set in 1966 with the introduction of the vaccine. 

Measles is considered eliminated when there is an absence of continuous disease transmission for 12 months or more in a specific geographic area, according to the CDC.

An ongoing outbreak in and around New York that started last fall is threatening the nation's "elimination status" -- if it continues for four more months, the country will no longer be able to say it has eliminated measles. 

Even though New York city officials began requiring residents in heavily affected areas, many with large Orthodox Jewish communities, to be vaccinated starting in April, the city still had 173 cases that month and 60 in May. 

The US has never counted zero measles cases. 

Since 2000, the number has fluctuated between a few dozen and a few hundred cases per year, with 667 cases recorded during a 2014 outbreak in Ohio, especially in Amish communities. 

The disease's resurgence can mostly be traced back to un- or under-vaccinated travelers who brought the infection back with them from abroad -- that's what happened last year when cases were reported throughout the country, originating from the Philippines, Israel and Ukraine. 

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US records 695 measles cases, highest since elimination in 2000 -CDC

NEW YORK - The United States has confirmed 695 measles cases so far this year, the highest incidence recorded since the country declared it had eliminated the virus in 2000, the U.S. Centers for Disease Control and Prevention said on Wednesday.

The resurgence of the contagious disease is linked mainly to large outbreaks in Washington state and two in New York that began late last year, the agency said in a statement.

"The longer these outbreaks continue, the greater the chance measles will again get a sustained foothold in the United States," the agency's statement warned.

Although the disease was eliminated from the country in 2000, meaning the virus was no longer continually present year round, outbreaks still happen via travelers coming from countries where measles is still common, the CDC says.

As of Wednesday, the number of measles cases so far this year exceeds the 667 cases reported in all of 2014, which had been the highest annual number recorded since the elimination in 2000.

The largest outbreak has been in New York City where officials on Wednesday said 390 cases had been recorded since October, mostly among children in Orthodox Jewish communities in Brooklyn.

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Hundreds vaccinated after measles emergency in New York

NEW YORK, United States - A New York county which declared a state of emergency over a measles outbreak is on the "right path" after administering hundreds of vaccinations in two days, the chief of the US district said on Friday.

Under the emergency, Rockland County banned non-vaccinated minors from public places in a bid to prevent the once-eliminated disease from spreading.

Planned for 30 days from midnight Wednesday, the emergency comes during a US surge in measles cases, linked to an anti-vaccination movement.

"We have already seen over 500 (new vaccinations) in the last couple of days," Rockland County Executive Ed Day said on CNBC TV.

"People simply understand now that we are serious about this," added Day, whose district is 25 miles (40 kilometers) north of downtown New York.

"We believe we are on a right path now to get at least a 93 percent immunization rate with the first shot," close to the level considered necessary to end the outbreak.

Although measles was declared officially eliminated from the United States in 2000, outbreaks have occurred in five states this year, according to the Centers for Disease Control and Prevention (CDC).

The outbreaks are linked to travelers who brought the illness back from other countries, and the majority of people who got measles were unvaccinated, the CDC said.

The World Health Organization has warned that the growing anti-vaccine movement in richer nations constitutes a top-10 global health threat.

The phenomenon has adherents in several Western nations, including Britain and France, but is particularly high profile in the US.

Between January 1 and March 21, there were 314 cases of measles in the United States, the CDC said.

Rockland County, with a population of more than 300,000, had registered 157 cases as of Friday.

Despite major vaccination campaigns since the outbreak began in October, around 27 percent of minors aged one to 18 in the county remained unvaccinated, Day said earlier in the week.

The worst affected neighborhoods are those with a high ultra-Orthodox Jewish population, where many oppose vaccines on religious grounds.

Many vaccines are theoretically mandatory for children to attend school in the United States. But 47 out of 50 states allow exemptions on religious, moral, or personal grounds.

Washington state, in the country's northwest, in January declared a state of emergency over an outbreak of measles, an airborne infection causing fever, coughing and rashes that can be deadly in rare cases.

Day on Friday called for a tightening of the school vaccination legislation and said a draft law to that effect was being discussed at the state level.

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Low vaccination rates, global outbreaks fuel US measles spread

A measles outbreak that has stricken at least 225 people in New York state since October began with a traveler who visited Israel during the Jewish high holidays and returned to a predominantly ultra-Orthodox Jewish neighborhood of Rockland County.

A similar pattern unfolded three months later and nearly 3,000 miles (4,800 km) away when a person who visited Eastern Europe returned to a community with strong ties to a local church group in Vancouver, Washington. More than 50 people fell ill there.

In both instances, US travelers picked up measles in foreign countries where the highly contagious disease was running rampant and brought it back to places where vaccination rates were too low by U.S. public health standards, setting off the worst outbreaks seen in those states in decades.

The US Centers for Disease Control and Prevention says New York’s outbreak marks the highest tally of imported cases since measles was declared eradicated in the United States in 2000.

The two outbreaks appear to be winding down, health officials say, after concerted efforts to pinpoint the origins and isolate and inoculate those who were exposed but unprotected and educate parents who had resisted vaccines.

The disease has spread mostly among school-age children whose parents declined to get them vaccinated. Most cited philosophical or religious reasons, or concerns - debunked by medical science - that the three-way vaccines against measles, mumps and rubella (MMR) could cause autism, authorities said.

New York State Health Commissioner Dr. Howard Zucker said another key factor was mere “complacency” in an age where the potential ravages of measles are unfamiliar to parents who came of age after the vaccine was introduced in 1957.

In Rockland County, the suburb north of Manhattan accounting for the bulk of cases, the state has vaccinated 15,000 children since the outbreak began there last autumn, Zucker said. The Brooklyn borough of New York City was another hot spot.

Still, officials say the measles crisis in New York and Washington states offer a lesson about the importance of maintaining a minimum level of “herd” immunization against dangerous, preventable diseases such as measles.

It also highlights the global nature of disease control, in which a hot spot of infection in one country can ignite a distant outbreak in an immunization-weak spot of another, said Dr. Scott Lindquist, Washington’s top epidemiologist.

Here are some key facts about measles and immunization, according to public health experts and the CDC.

WHAT IMMUNIZATION RATES ARE IDEAL?

A 95 percent rate of immunization is required to provide sufficient “herd” protection in a given population. Rates as low as 60 percent were found in parts of New York where measles spread, Zucker said.

HOW BAD CAN MEASLES GET?

Symptoms typically include high fever, cough, runny nose and watery eyes, followed by tiny white spots inside the mouth and a red rash that can cover the body.

Serious and potentially fatal complications, especially in young children and pregnant women, can include pneumonia and swelling of the brain. Ear infections occur in about 10 percent of children with measles and can lead to permanent hearing loss.

One rare but fatal complication is subacute panencephalitis (SSPE), which can attack the central nervous system seven to 10 years after a person has recovered from measles.

HOW CONTAGIOUS IS MEASLES?

Measles is spread through casual contact with the virus, which can linger and remain infectious in the air of an enclosed space for up to two hours after it is breathed out by someone carrying the disease. The rate of transmission from an infected person to another individual nearby who lacks immunity is about 90 percent.

ORIGINS OF LATEST OUTBREAKS?

Health authorities say the strain of the virus identified in Washington state matches the one circulating widely in Ukraine since last year. The New York outbreak has been tracked back to separate flare-ups of measles in Israel and in Eastern Europe.

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