Early in the pandemic, public health workers all over the United States launched efforts to trace outbreaks back to their origins, whether at busy restaurants or crowded meatpacking plants. But with the virus now spreading rapidly in much of the country, overwhelmed state and local health officials are scaling back those contact tracing efforts, or even abandoning them altogether.
Revealing the trail of transmission from one person to another is a key tool for containing the spread of an infectious disease. Within 48 hours of testing positive, patients receive a phone call from a trained contact tracer, who conducts a detailed interview, and then hunts down each new person who may have been exposed, warning them to quarantine and get tested.
That, at least, is how it’s supposed to work.
Now, with the United States recording a staggering two million new cases in less two weeks and 42 states recording sustained caseload increases, public health agencies are making hard choices about how much they can still realistically learn, and acknowledging that contact tracing efforts can no longer be expected to contain the virus’s spread.
On Monday, the Centers for Disease Control and Prevention released new guidance that called on health departments to focus contact tracing efforts on people who had tested positive within the past six days and especially those who were at the greatest risk of infecting others. Patients infected more than 14 days ago should not be traced, the new guidance says.
States like Pennsylvania, which had already been revising its tracing protocols, have announced that they will follow the C.D.C.’s new guidance.
Dr. Nirav Shah, who heads Maine’s coronavirus response, explained how his state would scale back its ambitions: Contact tracers would touch base with each new patient only once, and not throughout the course of their illness, to make sure they were well and quarantining.
“Unfortunately, going forward, we have had to make a difficult decision, and I wanted you to hear about that difficult decision from me,” he said when announcing the change.
“Sadly, in Maine and throughout the country, the virus is moving faster and spreading faster than the ability of states to train and deploy new public health investigators.”
Similar decisions were being made all over the country.
New Hampshire last week said that it would only trace cases of people connected to outbreaks or in specific at-risk age or racial groups.
Minnesota’s Itasca County this month said that it was abandoning contact tracing, advising the public that, “if you are in a group setting, just assume that someone has Covid.”
In North Dakota, state officials said last month that they could no longer have one-on-one conversations with everyone who may have been exposed. Aside from situations involving schools and health care facilities, people who test positive were advised to notify their own contacts, leaving residents largely on their own to follow the trail of the outbreak.
Public health experts remain hopeful that contact tracing remains useful in identifying clusters and determining the broad contours of how and where infections are spreading.
“There are diminishing returns when the outbreak is out of control, like it is currently, but the returns aren’t zero,” said Dr. Thomas Tsai, a health policy researcher at Harvard T.H. Chan School of Public Health. “The discourse around our treatments tends to be all or nothing.”
Contact tracing capacity much of in the United States has been weak since the pandemic began, so it is no surprise that it can’t keep up now, said Rich DiPentima, New Hampshire’s former chief of communicable disease and epidemiology. He argued that it should be expanded rather than scaled back, though he placed more faith in the promise of vaccines.
“We have a situation where we missed the boat in the beginning,” he said of the situation in his state. “Then you throw up your hands, saying you can’t do this any more.”
Americans have agonized over Thanksgiving this year, weighing skyrocketing coronavirus numbers and blunt warnings from the Centers for Disease Control and Prevention against gathering with family for a traditional, carbohydrate-laden ritual.
The United States reported more than 2,200 virus-related deaths on Tuesday alone, the highest daily total since May 6. The country’s seven-day average for new cases has also exceeded 175,000 for the first time.
Around 27 percent of Americans plan to dine with people outside their household, according to interviews conducted by the global data-and-survey firm Dynata at the request of The New York Times.
Views on whether to risk Thanksgiving gatherings appear to track closely with political views, with respondents identifying as Democrats far less likely to be planning a multihousehold holiday.
Megan Baldwin, 42, had planned to drive from New York to Montana to be with her parents, but last week, she canceled her plans.
“I thought I would get tested and take all the precautions to be safe, but how could I risk giving it to my parents, who are in their 70s?” she said, adding that they were not happy with the decision.
“All they want is to see their grandkids,” she said, “but I couldn’t forgive myself if we got them sick. It’s not worth it.”
Others decided to take the plunge, concluding that the emotional boost of being together outweighed the risk of becoming infected, after a grim and worrying year.
“We all agreed that we need this — we need to be together during this crazy, lonely time, and we are just going to be careful and hope that we will all be OK,” said Martha Dillon, who will converge with relatives from four different states on her childhood home in Kentucky.
The AAA has forecast a 10 percent overall decline in Thanksgiving travel compared with last year, the largest year-on-year drop since the recession of 2008. But the change is far smaller, around 4.3 percent, for those traveling by car, who make up a huge majority of those who plan to travel — roughly 47.8 million people.
About 917,000 people were screened by the Transportation Security Administration on Monday, less than half of the number seen on the same day in 2019, according to federal data published on Tuesday.
Airlines are struggling from a dramatic decline in demand that has forced them to drop flights and make big capacity cuts, said Katherine Estep, a spokeswoman for Airlines for America, an industry trade group. “Currently, cancellations are spiking, and carriers are burning $180 million in cash every day just to stay operating,” she said. “The economic impact on U.S. airlines, their employees, travelers and the shipping public is staggering.”
Demand for travel by train is down more sharply, at about 20 percent of what it was last year, said Jason Abrams, a spokesman for Amtrak.
Susan Katz, 73, said she canceled plans to spend Thanksgiving with her daughter last Friday, after watching a monologue by Rachel Maddow, the MSNBC host, describing her partner’s bout of coronavirus and her fear that it would prove fatal.
“Her emotion, Rachel Maddow’s emotion, made it so real, it just moved us,” Ms. Katz said. “I probably called her within a few hours of seeing that.”
Ms. Katz, who lives in Raleigh, N.C., said she would spend the holiday alone with her husband. She is trying to decide whether to bother thawing a turkey breast.
Warnings from experts swayed Laura Bult, 33, to cancel her Sunday flight to St. Louis two days before she was scheduled to leave.
“Doing the small part of being one less person circulating through an airport felt important enough to me,” she said.
global roundup
A Malaysian company that makes disposable gloves used around the world for protection against the coronavirus has been hit by a major outbreak among its workers, many of them foreign laborers who live in crowded dormitories.
The outbreak at 28 factories operated by the company, Top Glove Corporation, has infected more than 2,400 workers this month and driven one of Malaysia’s biggest spikes in coronavirus cases since the pandemic began.
Until now, Malaysia has been relatively successful in containing the virus, reporting 59,817 total cases and 345 deaths as of Wednesday. But the country of 32.5 million people reported a new daily high of 2,188 cases on Tuesday, topping the previous record of 1,884 set a day earlier.
Top Glove said Wednesday that it had stopped work at 20 factories in the hope of stemming the outbreak.
The company makes disposable gloves and face masks, and has ramped up production because of the pandemic. The United States and Europe are among its biggest customers.
Most of Top Glove’s workers come from developing countries in Asia — including Bangladesh, Myanmar and Nepal — and live and work in crowded conditions where the virus can easily spread. Malaysia’s minister of human resources, M. Saravanan, toured workers’ quarters days ago and said that the living conditions were “terrible,” according to The Star, a Malaysian newspaper.
“We have started investigations and will spare no one if they were found to have flouted labor laws,” he told The Star.
Andy Hall, a labor activist who has long criticized Top Glove, said its workers live in unsanitary and overcrowded dormitories, sometimes packed more than 30 to a room.
“It was obvious it would happen,” Mr. Hall said. “This company has never focused on the welfare of its staff.”
Company officials defended the company’s treatment of workers and rejected assertions that the quarters were crowded and unsanitary.
They said they were surprised by Mr. Saravanan’s comments and said that conditions in the dormitories have improved since his visit.
Top Glove officials said the company had been upgrading the dormitories since the United States sanctioned the company in July, citing evidence that it had engaged in forced labor practices, and banned the import of some of its products. In response, Top Glove also has begun paying restitution to affected workers.
Top Glove hopes that the outbreak will be under control in two to four weeks. The company sought to assure its customers that the gloves it produced were not contaminated with the coronavirus.
In other news from around the world:
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Japan and China, its largest trading partner, have agreed to restart business travel between the countries later this month, the Japanese foreign minister said on Wednesday. Business travelers will be exempt from quarantine if they test negative for the coronavirus and submit an itinerary of their activities. The arrangement does not apply to tourists and follows similar ones that Japan has begun with Singapore, South Korea and Vietnam.
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President Emmanuel Macron of France said on Tuesday that the country was past the peak of its second wave and that shops could reopen on Saturday. Bars and restaurants are unlikely to reopen until mid-January, he said.
A Chinese state-owned vaccine maker has filed an application with the country’s Food and Drug Administration to market coronavirus vaccines in China before the completion of late-stage trials that will determine their safety and efficacy.
Vaccines made by CNBG, a subsidiary of the state-owned pharmaceutical company Sinopharm, are in late-stage trials with more than 50,000 volunteers in 10 countries, including Argentina, Bahrain, Egypt, Jordan, Morocco, Peru and the United Arab Emirates.
The announcement was made by Sinopharm’s deputy general manager, Shi Shengyi, the state-run Xinhua news agency reported on Wednesday. The article, by the agency’s finance arm, gave no further details and did not specify whether the application was for one or both of the coronavirus vaccines that CNBG manufactures. The company did not respond to requests for comment.
The Chinese government has approved three coronavirus vaccines for emergency use, including two made by CNBG.
Even before the completion of the late-stage trials, Chinese officials had considered those vaccines and one by a rival firm so effective that they allowed tens of thousands of people to be injected. That prompted criticism from scientists that the government was ignoring the risks posed to public health.
Last week, Sinopharm’s chairman, Liu Jingzhen, said the company had injected nearly a million people and that none had reported adverse reactions, with “only a few having some mild symptoms.”
Mr. Liu said those people included construction workers, diplomats and students who took the vaccines before traveling to more than 150 countries. None were infected during their trips, he added.
Many scientists have said that such data is anecdotal and should not be used as evidence that the Sinopharm vaccines are effective.
For the first time since the coronavirus outbreak hit the United States, the country has added more than one million cases in each of the past two weeks. Covid deaths, which lag reported cases by weeks, are also at a level not seen since the spring.
Some epidemiologists project that the number of deaths in the coming weeks could exceed the spring peak, even though treatments have improved.
In the past week, the United States added an average of 173,000 new daily cases. If this growth pattern holds, the total number of cases reported for the full month of November is likely to hit 4.5 million. That would be more than double the number of any previous month.
With several days still left in the month, about 3.3 million people in the United States had already tested positive for the coronavirus as of Monday.
North Dakota continues to have the country’s worst outbreak when adjusted for population, a position it has maintained since early September. Almost one in 10 North Dakotans have tested positive for the virus since the outbreak began, a vast majority in the last two months.
But cases there as well as in other parts of the Upper Midwest and Mountain West that drove the initial fall surge have leveled off slightly, while cases are growing on both coasts and in the South and Southwest.
Bars and restaurants in Pennsylvania have been ordered by the state to stop selling alcohol at 5 p.m. on Wednesday, in an effort to head off uninhibited pre-Thanksgiving gatherings where the virus could spread rapidly.
“It turns out, the biggest day for drinking is the day before Thanksgiving,” Gov. Tom Wolf said at a news conference on Monday. “I don’t like addressing that more than anyone else does, but it’s a fact. And when people get together in that situation, it leads to the exchange of the fluids that leads to the increased infection.”
“We’re going to defeat this virus,” the governor added. “That should be what we’re focused on, not whether we want to get a transitory benefit from going out with friends the day after tomorrow and having some drinks. Let’s forgo that, this one time.”
The regulation, which allows alcohol sales to resume at 8 a.m. on Thanksgiving Day, was immediately slammed by restaurant and bar owners, who said it put further strain on businesses that are already struggling to survive.
Mr. Wolf said he was fully aware of the ill will the decision had engendered. “The virus is what’s doing this — it’s not me, and it’s not the administration, it’s not the government,” he said. “The more we learn about it, the more we know that this is the kind of place that speeds the transmission of the disease.”
Facing the same concerns in neighboring Maryland, Gov. Larry Hogan announced that the state police and local authorities would step up enforcement of pandemic restrictions on bars, restaurants, nightclubs and catering halls starting on Wednesday, including cutting off alcohol sales at 10 p.m. and other measures the governor imposed last week.
In Utah, on the other hand, Gov. Gary Herbert on Monday partly relaxed the state’s restrictions on casual private gatherings this week for the holiday. The governor said that he was not extending an earlier order that banned indoor gatherings of people from more than one household.
Applications for unemployment benefits in the United States rose for the second week in a row last week, the latest sign that the nationwide surge in coronavirus cases is threatening to undermine the economic recovery.
More than 827,000 people filed first-time applications for state unemployment benefits last week, the Labor Department said Wednesday. That was up 78,000 from a week earlier, before adjusting for seasonal patterns, and more than 100,000 from the first week of November, when weekly filings hit their lowest level since pandemic-induced layoffs began last spring.
Another 312,000 people filed for benefits under the federal Pandemic Unemployment Assistance program, which covers freelancers, self-employed workers and others who don’t qualify for state benefits.
Unemployment filings have fallen dramatically since last spring, when more than six million people a week were applying for benefits. But progress has stalled in recent months, and the data reported Wednesday suggests it could be going in reverse.
Other evidence tells a similar story. Consumer confidence fell in November, the Conference Board reported Tuesday, and private-sector data on job postings, hours worked and consumer spending show either a loss of momentum or outright declines in November.
“We have definitely seen a slowdown since Labor Day, and in the last few weeks it’s actually gone into a decline,” said Dave Gilbertson, a vice president at UKG, which provides time-tracking software to about 30,000 U.S. businesses.
Economists worry that the slowdown could deepen in coming weeks, as consumers pull back on spending and cities and states reimpose business restrictions, something that has already begun to happen in California, Michigan and other states.
Federal health officials may shorten the recommended quarantine period for individuals who have been exposed to the coronavirus in an effort to make the guidance more palatable and to improve compliance, a federal official confirmed on Tuesday.
The official was not authorized to speak about the discussions and asked to remain anonymous. The possible change was first reported by The Wall Street Journal.
A spokeswoman for the Centers for Disease Control and Prevention declined to comment on the change, saying only that the agency “is always reviewing its guidance and recommendations in the light of new understandings of the virus that causes COVID-19,” and that the change will be announced “when appropriate.”
The C.D.C. currently advises people who may have been exposed to the virus to seclude themselves for 14 days in order to avoid spreading the disease, even before they know whether they are infected or develop symptoms.
The proposed change would scale back the required quarantine period to between one week and 10 days, followed by a test for the virus.
If adopted, the more relaxed guidance could lead to some infections being missed. Studies have found that the median incubation period for the virus is five days. A significant majority of people — 97.5 percent of those exposed to the virus — develop symptoms by the 12th day after infection.
Those We’ve Lost
This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.
Honestie Hodges, who was handcuffed by the police outside her home in Grand Rapids, Mich., when she was 11, a frightening incident that drew outrage and national headlines in 2017, died on Sunday. She was 14.
Her death, at the Helen DeVos Children’s Hospital in Grand Rapids, was caused by Covid-19, her grandmother Alisa Niemeyer wrote in a post on the website GoFundMe.
On Dec. 6, 2017, Honestie and her family were confronted outside their home by police officers with their guns drawn.
The police, who said they had been searching for a 40-year-old woman in connection with a stabbing, briefly handcuffed the 11-year-old, an incident that caused a widespread uproar and led to a soul-searching within the Grand Rapids Police Department.
This year, Honestie developed severe stomach pains on Nov. 9, her 14th birthday. Taken to the hospital, she tested positive for the coronavirus, and she was placed on a ventilator a few days later.
Then, on Sunday, Ms. Niemeyer wrote: “It is with an extremely heavy heart that I have to tell you that my beautiful, sassy, smart, loving granddaughter has gone home to be with Jesus.”
Ms. Niemeyer told WOOD-TV that Honestie had been “healthy and happy” with no underlying health issues.
Though her mother lives in Arizona, Cecily Smith typically spends Thanksgiving in New York City with friends who feel like family.
Some years, they shared holiday meals at restaurants. Other times, they held potlucks in cramped apartments.
But with the country in the grip of a surging pandemic, Ms. Smith will spend Thanksgiving this year alone in her Harlem apartment, making herself cocktails and binge-watching Netflix. Her friends, she said, plan to do the same.
“I know I’m going to be lonely,” said Ms. Smith, 46, who has lived in the city for about 20 years. “It is lonely. This is a whole lonely experience.”
The pandemic has altered holiday plans all over the United States this year. But in a bustling city where traditions often extend beyond family to bring friends, acquaintances, castoffs and transplants around the table, the loneliness can especially gnaw.
With a second wave bearing down, officials have urged Americans not to travel, Gov. Andrew M. Cuomo limited private gatherings to 10 people for the foreseeable future and Mayor Bill de Blasio implored people to skip the crowded feasts that generally mark the holiday.
The city’s holiday staples will also be missing. The Macy’s Thanksgiving Day Parade has cut its route to one block, and movie theaters, long an antidote for holiday loneliness, remain closed. Restaurants have limited capacity, a rainy forecast does not favor outdoor dining and many people remain uncomfortable eating indoors.
Listen to ‘The Daily’: A Day at the Food Pantry
Soaring numbers of New York City residents face food shortages as a result of the pandemic. Here are some of them.
Amid numerous game cancellations and players and coaches alike testing positive for the coronavirus, the men’s college basketball season will start Wednesday with more than 100 games being played nationwide. This burst of games and the travel — some of which will happen on commercial flights — come at a time when universities are urging their non-basketball-playing students to exercise great caution as they head home for Thanksgiving.
Some coaches are wondering how long a season can go on like this.
Rick Pitino, head coach at Iona College, believes that with vaccines being readied and flu season just arriving, the best way to rescue college basketball’s moneymaker — the N.C.A.A. tournament — may be to move the season back. He suggests starting the season in March and ending it with May Madness.
Dedrique Taylor, the coach at Cal State Fullerton, said one of his players tested positive last Thursday, prompting his team to quarantine for two weeks. The next day, the University of Washington tournament they had entered was canceled. Mr. Taylor said that in the normal rhythms of a season, coaches want their teams to build toward playing at their best in March, just as the Titans did when they reached the N.C.A.A. tournament in 2018.
Now, though, instability will be baked in — along with many questions. Mr. Taylor wonders about injury risks when players return from quarantine, about whether the country will loosen up or lock down and how he can support his players and assistants.
“I don’t understand why we’re playing or why we’re opening up when we’re trying to do away with the virus,” he said. “We’re almost encouraging the virus by bringing people together.”
As Australia emerges from coronavirus lockdowns, a battle over access to public green spaces in its cities has started and is largely being fought on the country’s golf courses.
In Melbourne, a need for parks was acutely felt during its harsh lockdown, when exercise was one of the permitted reasons to leave the house. With outdoor sports — including golf — banned, local councils threw open the gates of courses to the public.
But when the lockdown ended and golf was allowed to resume, some residents in the suburb of Northcote wanted to keep their local golf course open to the public.
Golfers were outraged. Bill Jennings, a semiregular at the course for over two decades, framed it as a matter of fairness: “You can’t just walk in and go, ‘We’ll have this,’” he said.
Now the council is examining whether to cut the size of the golf course to unlock more parkland. In Sydney, a similar proposal has spurred equal parts support and backlash.
With populations growing in Australia’s cities, the provenance of public green spaces has become a hot-button issue. Reappropriating golf courses is a compelling solution: They take up huge quantities of land, and the number of golfers in Australia has been slowly decreasing for over two decades.
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