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Los Angeles County, one of the hardest-hit areas in the United States, may face even more dire weeks ahead, and as the national death toll nears 400,000, deaths in the county continue to climb.
Hospitals have run out of room in intensive care units, though new cases and hospitalizations appear to be leveling off in recent days. The county records a coronavirus-related death roughly every seven minutes, and last week was its highest recorded ever for Covid-19 fatalities.
On Saturday alone, 253 people died of Covid-19, and with variants of the virus that could be more contagious now circulating in California, those numbers may rise.
It took nearly 10 months for the county, America’s most populous, to hit 400,000 cases, but little more than a month to add another 400,000, from Nov. 30 to Jan. 2, according to a New York Times database. On Saturday, the county became the nation’s first to surpass one million recorded coronavirus infections, a number only four states other than California have exceeded: Illinois, New York, Florida and Texas. (California on Sunday became the first state to have recorded more than three million cases.)
And the true scale of infections may be much higher than reported: One in three Los Angeles residents is believed to have been infected with the virus since the beginning of the pandemic, according to the Los Angeles Department of Health.
The virus is surging across California, where daily deaths are averaging 528, an increase of over 15 percent from a week ago. Much of the state, including the southern region, remains under a stay-at-home order.
The state is among many dealing with the arrival of a more contagious viral variant, first discovered in Britain; the first confirmed case in Los Angeles was reported on Saturday. It is believed to be potentially 50 percent more transmissible than the initial version of the virus.
Officials said they thought the variant, which has caused infections to soar in London and southeast England, has been spreading through Los Angeles for some time. While more contagious, the variant does not appear to cause more severe illness.
On Sunday night, the California Department of Public Health reported another variant that had grown more common across the state since December. Known as L452R, it was first detected in Denmark in March and appeared in California in May. In December, researchers at the University of California, San Francisco, sequenced genomes of coronavirus gathered around the state and found that the variant was present in just 3.8 percent of their samples. By January, it had jumped to 25.2 percent.
Charles Chiu, who led the sequencing, cautioned that he and his colleagues worked with a small sample size, so they have not yet proven that this variant is more contagious. “But there are worrisome signs that this variant may be highly transmissible,” he said.
Dr. Chiu and his colleagues are now looking more carefully for this variant across the state and are trying to understand how its mutations have altered it. They want to see if the variant can escape from monoclonal antibodies and perhaps even make vaccines less effective. “These are critical studies that need to be done,” Dr. Chiu said.
After weeks under a stay-at-home order, the county’s positivity rate is starting to taper. Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, said the state and Los Angeles seemed to be “in the process of sort of gradually turning a corner here.”
He cautioned against panicking about the more transmissible variant, noting the same cautious behavior will help keep it at bay: stay home, wear a mask, physically distance.
For nearly the entire pandemic, political polarization and a rejection of science have stymied the United States’ ability to control the coronavirus.
That has been clearest and most damaging at the federal level, where President Trump claimed that the virus would “disappear,” clashed with his top scientists and abdicated responsibility for a pandemic that required a national effort to defeat it, handing key decisions to states under the assumption that they would take on the fight and get the country back to business.
But governors and local officials who were left in charge of the crisis squandered the little momentum the country had as they sidelined health experts, ignored warnings from their own advisers and, in some cases, stocked their advisory committees with more business representatives than doctors.
Nearly one year since the first known coronavirus case in the United States was announced north of Seattle on Jan. 21, 2020, the country is hurtling toward 400,000 total deaths, and cases, hospitalizations and deaths have reached record highs.
The situation has turned dire just as the Trump administration, in its final days, begins to see the fruits of perhaps its biggest coronavirus success, the Operation Warp Speed vaccine program. But already, a lack of federal coordination in distributing doses has emerged as a troubling roadblock.
The incoming president, Joseph R. Biden Jr., has said he will reassert a federal strategy to bring the virus under control, including a call for everyone to wear masks over the next 100 days and a coordinated plan to widen the delivery of vaccines.
“We will manage the hell out of this operation,” Mr. Biden said on Friday. “Our administration will lead with science and scientists.”
The strategy signals a shift from the past year, during which the Trump administration largely delegated responsibility for controlling the virus and reopening the economy to 50 governors, fracturing the nation’s response. Interviews by The Times with more than 100 health, political and community leaders around the country and a review of emails and other state government records offer a fuller picture of all that went wrong.
A nurse’s cry pierced the night from the balcony of an Egyptian hospital. She was screaming that the patients in the Covid-19 intensive care unit were gasping for air.
Ahmed Nafei, who was standing outside, brushed past a security guard, dashed in and saw that his 62-year-old aunt was dead.
Furious, he whipped out his phone and began filming. It appeared that the hospital had run out of oxygen. Monitors were beeping. A nurse was distressed and cowering in a corner as her colleagues tried to resuscitate a man using a manual ventilator.
At least four patients died.
Mr. Nafei’s 47-second video this month of the chaos at El Husseineya Central Hospital, about two and a half hours northeast of Cairo, spread rapidly on social media.
As outrage grew, the government denied that the hospital had run out of oxygen.
An official statement issued the following day concluded that the four who died had suffered from “complications” and denied that the deaths had “any connection” to an oxygen shortage. Security officers interrogated Mr. Nafei, and officials blamed him for violating rules barring visits and filming inside hospitals.
A New York Times investigation, however, found witnesses, including medical staff and relatives of patients, who said in interviews that the oxygen had fallen to precipitously low levels. At least three patients, they said, and possibly a fourth, had died of oxygen deprivation. A close analysis of the video by doctors in Egypt and the United States confirmed that the chaotic scene indicated an interruption in the oxygen supply.
The oxygen shortage was the result of a cascade of problems at the hospital, The Times’s investigation found. By the time patients were suffocating, a relief delivery of oxygen was already hours late and a backup oxygen system had failed.
“We’re not going to bury our heads in the sand and pretend everything is OK,” a doctor at the hospital said, speaking on condition of anonymity because he feared arrest. “The whole world can admit there’s a problem, but not us.”
The government’s rush to deny the episode is only the latest example of the lack of transparency in its response to the pandemic, which has led to cynicism and distrust of its public assurances.
Republicans in the Minnesota State Senate were feeling jubilant after the November election. They had held onto a slim majority despite an onslaught by Democrats. Now, it was time to party.
More than 100 senators, their spouses and their staff members gathered for a celebratory dinner at a catering hall outside the Twin Cities on Nov. 5, two days after Election Day. Masks were offered on arrival, but there was little mask wearing over hours of dining and drinking, at a moment when a long-predicted surge in coronavirus infections was gripping the state.
At least four senators in attendance tested positive for the coronavirus in the days afterward. One was the Republican majority leader, Paul Gazelka, an outspoken opponent of mask mandates and shutdown orders. He compared his symptoms to a “moderate flu” and recovered. So did two other senators.
The fourth was Senator Jerry Relph, a Vietnam veteran and grandfather from St. Cloud, Minn. Struggling to breathe after testing positive, he was admitted to a hospital in mid-November. He died on Dec. 18, at age 76.
His daughter Dana Relph is still furious at Republican leaders for holding the dinner and at the refusal of Mr. Gazelka to take responsibility.
“Why are you throwing a party with 100-plus people in the middle of a pandemic?” said Ms. Relph, 44, who was not allowed to visit her father until the day he died. “Why would you choose to do that when we know people are going to be eating and drinking and taking their masks off, where their inhibitions will be lowered?”
Mr. Gazelka declined an interview request, and a spokeswoman said he would not respond to Ms. Relph “out of respect for privacy requested from the family.”
Ten months into the coronavirus crisis, the continuing Republican resistance to mask wearing and social distancing is a striking political phenomenon. Four Democratic members of Congress tested positive this month after being in lockdown at the Capitol on Jan. 6 with Republicans who refused to wear masks.
Luke Letlow, just elected to Congress as a freshman Republican from Louisiana, died of Covid-19 in December, days before he was to be sworn in.
According to the election data site Ballotpedia, six state lawmakers have died from Covid-19, including the speaker of the New Hampshire State House and a Virginia state senator who succumbed on New Year’s Day. All six were Republicans.
Kimberly and Kelly Standard, who are twins, assumed that when they became sick with Covid-19 their experiences would be as identical as their DNA.
The virus had different plans.
Early last spring, the sisters from Rochester, Mich., checked themselves into the hospital with fevers and shortness of breath. While Kelly was discharged after less than a week, her sister ended up in intensive care, and spent almost a month in critical condition.
Nearly a year later, the sisters are bedeviled by the divergent paths their illnesses took.
“I want to know,” Kelly said, “why did she have Covid worse than me?”
Identical twins offer a ready-made experiment to untangle the contributions of nature and nurture in driving disease. With the help of twin registries in the United States, Australia, Europe and elsewhere, researchers are confirming that genetics can influence which symptoms Covid-19 patients experience.
These studies have also underscored the importance of the environment and pure chance: Even between identical twins, immune systems can look vastly different.
But at least some of the factors that influence the severity of a Covid-19 case are written into the genome. Recent studies suggest that people with type O blood, for example, may be at a slightly lower risk of becoming seriously sick (though experts have cautioned against overinterpreting these types of findings). Other papers have homed in on genes that affect how cells sound the alarm about viruses.
There even seems to be a measurable genetic influence on whether patients experience symptoms like fever, fatigue and delirium, said Tim Spector, an epidemiologist and the director of the TwinsUK registry based at St. Thomas’ Hospital in London.
Last year, he and his colleagues developed a symptom-tracking app. In a study that has not yet been published in a scientific journal, they reported that genetic factors might account for up to 50 percent of the differences between Covid-19 symptoms.
Still, Dr. Spector said, “It would be wrong to think we can answer this if we just crack the genes.”
Brazil approved two coronavirus vaccines for emergency use while rejecting an application for a third as South America’s most populous nation began a vaccination program that had been mired in chaos.
On Sunday, Brazil’s health regulator, Anvisa, authorized the vaccine from Sinovac, a private Chinese company that developed it in partnership with the Butantan Institute in São Paulo. It approved the vaccine produced by the University of Oxford in partnership with AstraZeneca, the British-Swedish pharmaceutical company.
A day earlier, regulators rejected an application for the Sputnik V vaccine developed by Russia, saying more documentation was needed.
Mônica Calazans, 54, a nurse in the state of São Paulo, was given the first shot of Sinovac’s CoronaVac vaccine on Sunday. Federal officials said vaccinations were expected to begin in all Brazilian states on Wednesday.
The first vaccination was attended by João Doria, the governor of São Paulo, who has feuded with Jair Bolsonaro, the president of Brazil, over the approval and rollout of vaccines. Mr. Bolsonaro had dismissed the seriousness of the pandemic and cast doubt on the Sinovac vaccine, while Mr. Doria negotiated directly with the Chinese to acquire doses. Brazil has had one of the worst outbreaks in the world, with the third-highest number of cases after the United States and India and the second-highest number of deaths after the United States, according to a New York Times database.
New questions about the efficacy of the Chinese vaccine emerged last week after officials at the Butantan Institute downgraded its efficacy to just over 50 percent, far below the 78 percent level announced earlier but still above the benchmark that the World Health Organization has said would make a vaccine effective for general use. That announcement signaled potential obstacles for China’s vaccine diplomacy as well as the epidemic control measures of countries that plan to use the Sinovac vaccine. So far at least 10 countries have ordered CoronaVac, seeking a total of 380 million doses.
Manuela Andreoni contributed reporting.
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