International clinical trials published on Wednesday confirmed the hope that cheap, widely available steroid drugs can help seriously ill patients survive Covid-19, the illness caused by the coronavirus.
Following release of the new data, the World Health Organization on Wednesday strongly recommended steroids for treatment of patients with severe or critical Covid-19 worldwide. But the agency recommended against giving the drugs to patients with mild disease.
The new studies include an analysis that pooled data from seven randomized clinical trials evaluating three steroids in over 1,700 patients. The study concluded that each of the three drugs reduced the risk of death.
That paper and three related studies were published in the journal JAMA, along with an editorial describing the research as an “important step forward in the treatment of patients with Covid-19.”
Corticosteroids should now be the first-line treatment for critically ill patients, the authors added. The only other drug shown to be effective in seriously ill patients, and only modestly at that, is remdesivir.
Steroids like dexamethasone, hydrocortisone and methylprednisolone are often used by doctors to tamp down the body’s immune system, alleviating inflammation, swelling and pain. Many Covid-19 patients die not of the virus, but of the body’s overreaction to the infection.
The analysis of pooled data found that steroids were linked with a one-third reduction in deaths among Covid-19 patients. Dexamethasone produced the strongest results: a 36 percent drop in deaths in 1,282 patients treated in three separate trials.
In June, researchers at Oxford University discovered that dexamethasone seemed to improve survival rates in severely ill patients. Researchers had hoped that other inexpensive steroids might help these patients.
Taken together, the new studies will bolster confidence in the use of steroids and address any lingering hesitancy on the part of some physicians, said Dr. Todd Rice, an associate professor of medicine and critical care physician at Vanderbilt University School of Medicine.
“This shows us steroids are clearly beneficial in this population and should clearly be given, unless you absolutely can’t for some reason, which needs to be a pretty rare occasion,” he said.
Dr. Scott W. Atlas has argued that the science of mask wearing is uncertain, that children cannot pass on the coronavirus and that the role of the government is not to stamp out the virus but to protect its most vulnerable citizens as Covid-19 takes its course.
Ideas like these, ideologically freighted and scientifically disputed, have propelled Dr. Atlas, a radiologist and senior fellow at Stanford University’s conservative Hoover Institution, into President Trump’s White House.
Mr. Trump has embraced Dr. Atlas even as he upsets the balance of power within the White House coronavirus task force with ideas that top government doctors and scientists find misguided — even dangerous — according to people familiar with the task force’s deliberations.
That might be the point.
“I think Trump clearly does not like the advice he was receiving from the people who are the experts — Fauci, Birx, etc. — so he has slowly shifted from their advice to somebody who tells him what he wants to hear,” said Dr. Carlos del Rio, an infectious disease expert at Emory University. He was referring to Dr. Anthony S. Fauci, the country’s leading infectious disease scientist, and Dr. Deborah L. Birx, the White House coronavirus response coordinator.
Dr. Atlas is neither an epidemiologist nor an infectious disease expert, but his frequent appearances on Fox News and his ideological surety caught the president’s eye.
The core of his appeal in the West Wing rests in his libertarian-style approach to disease management akin to one used to disastrous effect in Sweden. The argument: Most people infected will not get seriously ill, and at some point, enough people will have antibodies to deprive the virus of carriers — “herd immunity.” His embrace of this has alienated his colleagues.
“Trying to get to herd immunity other than with a vaccine isn’t a strategy. It’s a catastrophe,” said Dr. Tom Frieden, the former C.D.C. director.
Joseph R. Biden Jr., pressing his argument that President Trump is failing the country with his handling of the coronavirus, plans on Wednesday to make the case that Mr. Trump is hurting the nation’s parents, teachers and schoolchildren with his push for schools to reopen.
Mr. Biden and his wife, Jill Biden, a community college professor, are scheduled to receive a briefing in Wilmington, Del., from a group of experts, including Sylvia Mathews Burwell, who served as secretary of health and human services for President Obama and is now the president of American University, and Linda Darling-Hammond, the president of the California State Board of Education.
Mr. Biden will then give a speech on what his campaign described as Mr. Trump’s failures on the pandemic as well as Mr. Biden’s plan to reopen schools safely.
Symone Sanders, a senior adviser for the Biden campaign, said Mr. Trump was “barreling forward trying to reopen schools because he thinks it will help his own re-election.”
“We believe this is a key contrast for voters,” Ms. Sanders said. “President Trump, who continues to ignore the science and has no plan to get the virus under control, and Joe Biden, who is working with the experts and putting together an effective plan to beat the virus and reopen schools safely.”
Mr. Trump has demanded that schools reopen this fall and threatened to cut federal funding for school districts that defied his wishes. But his effort to pressure schools did not have the effect he desired, and many districts decided to begin the school year with remote instruction.
As Iowa has faced the most new cases per capita of any state over the last seven days, Joni Ernst, the state’s junior senator and a Republican in a tight race for re-election, echoed a debunked conspiracy theory that coronavirus death tolls were being greatly inflated and suggested that health care providers had a financial motive to falsify cases.
Ms. Ernst said she was “so skeptical” of the government’s national statistics about virus fatalities, according to an account in The Courier newspaper of a campaign stop she made in Waterloo, a city of about 70,000.
“They’re thinking there may be 10,000 or less deaths that were actually singularly Covid-19,” Ms. Ernst said. “I’m just really curious. It would be interesting to know that.”
The confirmed death toll from the pandemic in the United States is at least 184,000, and independent analyses have said the figure is probably even higher — most likely around 200,000 — in part because some deaths connected to infection from the virus have not been recognized as such.
Ms. Ernst’s comments seemed to track a false claim spread by President Trump over the weekend. Twitter removed the president’s tweet on the subject for violating the site’s disinformation rules, because the claim is linked to the baseless QAnon conspiracy theory.
The claim inaccurately said the Centers for Disease Control and Prevention “quietly updated the Covid number to admit that only 6%” of the people counted in the death toll — or about 9,000 people — “actually died from Covid.”
“It’s not 9,000 deaths from Covid-19, it’s 180-plus-thousand deaths,” Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said on Tuesday.
Dr. Fauci made clear that the mere fact that a person had other health problems, or comorbidities, as well as the coronavirus does not mean that they did not die of Covid-19. He said there should “not be any confusion about that.’’
A superspreader event on a bus focuses scientists on the likelihood of airborne transmission.
In late January, as the new coronavirus was beginning to spread from China’s Hubei Province, a group of lay Buddhists traveled by bus to a temple ceremony in the city of Ningbo — hundreds of miles from Wuhan, center of the epidemic.
A passenger on one of the buses had recently dined with friends from Hubei. She apparently did not know she carried the coronavirus. Within days, 24 fellow passengers on her bus were also found to be infected.
It did not matter how far a passenger sat from the infected individual on the bus, according to a study published in JAMA Internal Medicine on Tuesday. Even passengers in the very last row, seven behind the infected woman, caught the virus.
The incident adds to a large body of evidence indicating that the coronavirus can be transmitted by tiny particles that linger in the air, and not just through large respiratory droplets that fall quickly to the ground.
The new study “adds strong epidemiological evidence that the virus is transmitted through the air, because if it were not, we would only see cases close to the index patient — but we see it spread throughout the bus,” said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and a leading expert on airborne viruses.
The potential for airborne transmission in close confined spaces raises concern about the winter months, when people will be spending more time indoors, Dr. Marr said. Her advice: “Avoid crowded indoor spaces where people are not wearing masks and the ventilation is poor.”
In his first public general audience since the pandemic hit, Pope Francis met a few hundred faithful on Wednesday in an imposing courtyard inside the Vatican.
Many from the cheerful crowd stood up from their socially distanced seats as Francis got out of his car, waving and filming him on their cellphones. Some talked with him from behind masks as he walked by the barriers with a large smile.
As he began speaking, Francis said that it was “beautiful” to encounter people “face to face and not screen to screen,” referring to the weekly virtual audiences from the papal library that he has been holding since March.
“The current pandemic has highlighted our interdependence,” Francis said, calling for solidarity. “We are all linked to each other, for better or for worse.”
Francis, whose papacy has been marked partly by concern for the earth, has often also urged the faithful to use the current situation to make significant changes in their lives and rediscover simpler and sustainable lifestyles. On Tuesday, he called for an examination of our energy usage, consumption, transportation and diet, and said the earth could recover “if we allow it to rest.”
He brought attention to the most vulnerable countries affected by the pandemic, which now need “regeneration packages,” and he announced a day of prayer and fasting for Lebanon, which suffered an explosion on Aug. 4 that leveled parts of the capital, killed more than 100 people and injured thousands more.
A German company began marketing an at-home antibody test.
A German company has begun marketing a coronavirus antibody test that allows patients to prick their fingers at home and mail in a test strip for evaluation, forgoing the need to visit a doctor.
The test, called AProof and made by Adversis Pharma, is among the first at-home antibody tests, according to Dr. Alexander Edwards, who tracks antibody testing at the University of Reading in Britain. He called the new test a “significant development.”
The test kit contains two finger-pricking lancets, a paper card, and a return envelope addressed to a lab in Leipzig, Germany. The customer pricks a finger, places blood droplets on the paper, encloses it in a plastic bag and returns the sample to the lab.
Results are available online to people in Germany 24 to 48 hours after the lab receives the card, according to the company, and later to customers outside the country. The kit, developed with the University of Leipzig, costs $59 (or 49 euros).
Adversis Pharma said that the test is highly sensitive for coronavirus antibodies but acknowledged that false-positive results do occur.
Antibodies may develop days or weeks after infection with the coronavirus, and antibody testing is not recommended for diagnosis of the infection. Dr. Jörg Gabert, a director of the company, said he expected the test to be used by people who believe they might have been infected in the past but were not diagnosed.
It’s not clear what consumers should do about a positive antibody test. While researchers generally assume that antibodies confer some protection against the coronavirus, no one is yet certain how strong the immunity may be or how long it may last.
Antibodies to the virus decline within weeks or months of recovery from the infection, and scientists are struggling to understand what role another branch of the body’s disease-fighting machinery, so-called cellular immunity, plays in protecting people who have recovered.
Already scientists are finding cases of reinfection — patients who apparently recovered from the coronavirus but were infected again just weeks later. Until more is known, the World Health Organization has warned against using antibody tests to certify that people are immune.
Australia falls into its first recession in almost 30 years.
After nearly three decades of economic growth, Australia officially fell into recession after its economy shrank 7 percent in the second quarter, the government said on Wednesday.
The drop in quarterly G.D.P. is the largest since record-keeping began in 1959, Michael Smedes, head of national accounts at the Australian Bureau of Statistics, said in a statement.
Restrictions that were imposed in March during the virus’s first surge greatly reduced domestic spending on transportation, hotels and restaurants, while border bans hit the tourism and education industries.
Australia’s second-most populous state, Victoria, remains under lockdown as it fights a surge that was driven by returning travelers. Officials on Wednesday extended Victoria’s state of emergency for six months, a designation that gives them broad powers to enact virus-related restrictions as needed.
In the end, more than $150 billion in stimulus packages could not ward off a recession.
“Today’s devastating numbers confirm what every Australian knows: that Covid-19 has wrecked havoc on our economy and our lives like nothing we have ever experienced before,” Josh Frydenberg, the country’s treasurer, said on Wednesday.
The new data marked a sobering end to what had once seemed an endless boom driven by immigration, rising trade with Asia and careful monetary policy. More than a million Australians were unemployed in July, and the unemployment rate of 7.5 percent was the worst in 22 years.
“The road ahead will be long,” Mr. Frydenberg said. “The road ahead will be hard. The road ahead will be bumpy.”
Australia has recorded 663 coronavirus deaths and more than 25,000 cases, according to a New York Times database.
Greece reported the first case of the coronavirus in the Moria camp for migrants on the Aegean island of Lesbos. The migration ministry said the facility would be locked down for two weeks as health inspectors tested other residents. Living conditions at the camp have been decried by human rights groups as it hosts nearly 12,000 people, four times its maximum capacity of 3,000. The patient is a 40-year-old man from Somalia who left after securing refugee status but “returned illegally to Moria and had been living in a tent outside the camp’s perimeter,” the ministry said.
In other news around the world:
As the number of new virus cases in Indonesia surges, the virus has taken a heavy toll on medical professionals. The Indonesian Medical Association said on Tuesday that 102 doctors and nine dentists had died from Covid-19, and the Indonesian National Nurses Association said 70 nurses had died. As of Wednesday, Indonesia had reported 7,505 deaths and 177,571 cases, including about 20,000 cases in the past week, according to a New York Times database. Independent experts say the actual number could be much higher because Indonesia lags behind in testing and its positivity rate is nearly 15 percent.
Direct international flights to Beijing, the capital of China, will gradually resume, the Civil Aviation Administration of China said Wednesday, as the coronavirus outbreak comes under control in the region. Flights from eight countries — Thailand, Cambodia, Pakistan, Greece, Denmark, Austria, Sweden and Canada — may fly to Beijing again, starting Thursday, the authorities said.
Hungary reported a daily record on Wednesday, with 365 new cases. The number is higher than even what it reported in April, when the pandemic was worsening in many countries. Last week, several members of the government entered quarantine after coming into contact with someone who later tested positive for the coronavirus. Hungary has barred most foreign travelers and is making returning citizens isolate themselves. It has had relatively few cases, 6,257, and just over 600 deaths, according to a New York Times database.
After mass demonstrations in Berlin last weekend against the government’s coronavirus regulations, the city decided to require masks at large protests. Now, organizers say they’re planning a large event elsewhere in Germany, but they deny that has anything to do with Berlin’s mask rule. The head of the group, Michael Ballweg, said in a radio interview Tuesday that the protests, timed for the 30th anniversary of German reunification on Oct. 3, would be at Lake Constance, in the south.
Also in Germany, the state of Saxony will allow 8,500 fans to attend the opening match that RB Leipzig will host against Mainz 05 on Sept. 20. The Bundesliga, Germany’s top league, shut down in March, but it restarted to finish the season without fans in a series of “ghost matches.” Despite federal guidelines that limit mass gatherings, RB Leipzig convinced local and state authorities that it could limit the risk of infection. The stadium, which usually holds 43,000, will only be 20 percent full; alcohol will not be sold, and masks will be required.
The pharmaceutical giant Roche, in Switzerland, announced that new antigen tests would be going on sale in several countries in Europe by the end of September. The tests are advertised as giving reliable results in 15 minutes. The company will have 40 million tests available for the launch, it said in a statement.
NEW YORK ROUNDUP
N.Y.C. residents can now work out at local gyms. Here’s what to expect.
Most New Yorkers have lived without communal workouts since mid-March, when the governor closed gyms across the state.
Gyms seem an intuitively high-risk environment, and New York waited until August to give the go-ahead. New York City gyms had to wait until Wednesday to reopen.
Gyms offering weights and exercise machines are allowed to reopen, with limits, but many other exercise facilities have not been approved and gym-goers must wear face coverings.
Indoor pools and places that only offer group fitness classes, like spinning, Zumba, yoga and Pilates, are not allowed to reopen because the city sees those activities as higher risk.One-on-one sessions with personal trainers or yoga teachers are allowed.
Elsewhere in the New York area:
In New York City, where indoor dining remains prohibited, the mayor said on Wednesday that he felt like the industry was owed more clarity this month on a possible timeline and set of standards for reopening. “We need to decide that in the next few weeks,” the mayor said, “whether its good news or bad news.”
As colleges reopen despite the pandemic, students, including in the New York area, must decide whether they are willing to blow the whistle on their classmates to protect against an outbreak at their schools by policing campus safety.
Reporting was contributed by Troy Closson, Trip Gabriel, Thomas Kaplan, Juliana Kim, Niki Kitsantonis, Isabella Kwai, Benjamin Novak, Richard C. Paddock, Gaia Pianigiani, Roni Caryn Rabin, Christopher F. Schuetze, Michael D. Shear, Dera Menra Sijabat, Daniel E. Slotnik, Sheryl Gay Stolberg, Eileen Sullivan, Jim Tankersley, Noah Weiland and Elaine Yu.