Prescriptions for hydroxychloroquine, the anti-malaria drug promoted by President Trump as a treatment for the virus, skyrocketed in March and April after the Food and Drug Administration issued an emergency waiver for its use against Covid-19, but tapered off to more normal levels in May and June, the Centers for Disease Control and Prevention reported on Thursday.
The F.D.A. withdrew its emergency use authorization for hydroxychloroquine (and its less-prescribed sister drug, chloroquine) in June after scientists concluded that its benefits did not outweigh its risks for Covid-19; the review that led to the revocation found more than 100 cases — including 25 deaths — of serious heart disorders in Covid-19 patients taking the drug. Clinical trials also showed it was of little benefit in treating the disease.
Even so, the C.D.C. reported that more than 1.3 million prescriptions — new and refills — were written in March and April, up from about 819,000 during the same period last year. The strong spike in usage suggests the influence that Mr. Trump and emergency waivers from the F.D.A. can have in driving medical decision-making — even in the absence of limited evidence of a drug’s effectiveness.
But perhaps the most striking finding was that “nonroutine prescribers” — specialists who are not primary care doctors and would not typically have a reason to prescribe the drug — wrote more than 75,000 hydroxychloroquine or chloroquine prescriptions in the month of March alone. That is 80 times the number written during March 2019.
Hydroxychloroquine and chloroquine are approved to treat autoimmune diseases like lupus as well as malaria. Mr. Trump, who said he took hydroxychloroquine himself, called it a possible “game changer” and repeatedly promoted it during his daily briefings this spring.
The disease control centers analyzed prescriptions of the drug to gauge the effects of the F.D.A.’s emergency waiver, which was issued March 28 to allow the drugs to be distributed from the national stockpile. “During March and April 2020, nonroutine prescribers accounted for the largest percentage increase in new prescriptions compared with the same period in 2019,” the agency wrote, adding, “ The nonroutine prescribing specialties with the highest prescribing volume and growth in March 2020 were ophthalmology, anesthesiology, and cardiology.”
But new prescriptions written by such prescribers have tapered off considerably. In June, roughly 1,900 were written.
With the pandemic still raging as fall approaches, the government’s efforts to support development and deployment of a variety of testing methods are a rare if belated bright spot amid widespread failures to contain the coronavirus.
In the latest round of U.S. government backing, the National Institutes of Health said on Wednesday that it was providing nine more companies with $123.3 million from a $2.5 billion pot of money allocated last spring by the stimulus bill to support testing. That will bring the total amount disbursed so far by the N.I.H. to $372 million across 16 companies.
The goal is to support production of a broad spectrum of tests, making them more widely available and perhaps ultimately as easy to use as a home pregnancy test. Tests must show that they meet the Food and Drug Administration’s standards for safety and accuracy before they can be sold.
“It’s going to be a wonderful competition,” Dr. Francis S. Collins, the N.I.H. director, said in an interview on Tuesday evening.
Yet even as the government helps rush new tests to market, the administration continues to issue conflicting — and sometimes flatly contradictory — messages about how many and what types of tests are needed, when they should be administered and to whom.
President Trump has long derided testing, complaining that it drives up the number of confirmed cases. The lack of a clear national strategy has confused the public, deeply frustrated public health officials and befuddled pharmaceutical executives.
But as testing options have multiplied, easing some of the shortages and laboratory bottlenecks that hampered the early response to the pandemic, universities, employers, state and local governments and other institutions have been increasingly filling in some of the vacuum left by the administration with their own testing plans.
A growing number of businesses — ranging from Soupergirl, a small company in Washington, D.C., with 30 employees that makes vegan soups, to Amazon, the world’s biggest retailer — are testing their workers.
In a recent interview, Dr. Bruce J. Tromberg, who directs the N.I.H.’s test development program, estimated that the United States needed to test about six million people a day, citing reports by experts at the Rockefeller Foundation and other organizations. Without federal assistance, he said, companies would at best produce only half that number by the end of the year.
Trump administration officials like Adm. Brett P. Giroir, the testing czar and an assistant secretary of health, say they want states and localities to create their own testing plans that fit their specific needs rather than to be forced to follow federal dictates. But many experts complain that the lack of federal decision-making — including how many tests a day the United States should aim for — is an impediment in the nation’s battle against the virus, which so far has killed more than 184,000 people and infected more than six million.
“Let’s not just say we are ramping up and hope we get there. Let’s have a goal in mind,” said Dr. Mark McClellan, the director of the Duke-Margolis Center for Health Policy and the commissioner of the Food and Drug Administration under former President George W. Bush. “It’s not just a matter of getting the tests to market.”
A former longtime spokeswoman for the Iowa Department of Public Health accused the state and Gov. Kim Reynolds of “a deliberate effort to thwart open communication” about the coronavirus pandemic. The spokeswoman, Polly Carver-Kimm, who was forced out in July, made the accusation in a wrongful termination lawsuit she filed Thursday in state court.
In the suit, Ms. Carver-Kimm says that she tried to comply with the state’s open records law and help reporters get answers to questions about the pandemic, but her efforts were met with resistance and criticism from superiors. She says she was then steadily stripped of her responsibilities, and no longer allowed to respond to open records requests or any media inquiries involving infectious disease.
“The only explanation I ever received was that I was not a team player and causing friction with the governor’s staff,” she said in a Zoom call with reporters on Thursday morning.
In the suit, she asserts that she was told in mid-July that she could either resign or be terminated because of “restructuring.”
The health department declined to comment on the lawsuit, and email and phone messages left with the governor’s spokesman were not returned. Ms. Reynolds is named in the suit.
Iowa had the second highest rate of new coronavirus cases in the country over the last week, and two of its major college towns, Ames and Iowa City, are among the five metro areas with the greatest number of new cases per capita. The state also has the third highest rate of positive tests in the country, according to data collected by the Covid Tracking Project.
A report from the White House on Aug. 30 urged Iowa to adopt much more stringent safety measures than Ms. Reynolds, a Republican, has taken, including a statewide mask mandate, which the governor has rejected as unenforceable.
On Wednesday, Senator Joni Ernst, Republican of Iowa echoed a debunked conspiracy theory that government statistics were greatly inflating the number of Covid-19 deaths; she also suggested that health care providers were falsely overstating death numbers because they are “reimbursed at a higher rate if Covid is tied to it.”
Ms. Carver-Kimm is not the only official in state government to complain of being ousted for not toeing the state’s line on the pandemic. Rebekah Jones, a data scientist who was fired by the Florida Department of Health in June, said she was forced out because she refused to manipulate data to make the coronavirus situation in the state look better than it was. She went on to make her own dashboard tracking the state’s Covid-19 cases.
Pfizer may know if its vaccine is effective by next month, its chief executive says.
Pfizer’s chief executive, Dr. Albert Bourla, said Thursday that the company expects to know whether its vaccine is effective by the end of October, and that it would apply immediately for approval if that was the case.
His remarks, made to the International Federation of Pharmaceutical Manufacturers and Associations, a global trade group, come as a handful of companies are racing to finish a vaccine that could help end the pandemic, and as scientists have increasingly worried that the Trump administration is pushing prematurely for a vaccine approval before the Nov. 3 presidential election.
Dr. Bourla said that about 23,000 people have enrolled in the company’s late-stage clinical trial, out of a goal of about 30,000, and that “a significant number” of them have received the second booster shot. Half of the participants receive the vaccine, half receive a placebo, and then researchers wait to see how many people in each group develop Covid-19.
If significantly more people get Covid-19 on the placebo than the vaccine, that is evidence that the vaccine is effective. The F.D.A. has indicated that vaccine makers should aim for 50 percent protection in order to be considered effective.
“If we have enough events, we may be able to say the product is safe and efficacious in the October time frame and submit it immediate for approval or authorization,” Dr. Bourla said.
Two other companies, Moderna and AstraZeneca, are in late-stage trials in the United States, but neither has laid out a similarly aggressive timeline, instead saying they expect to have a vaccine by the end of the year.
In planning documents sent last week to public health agencies around the country, the Centers for Disease Control and Prevention described preparations for two coronavirus vaccines they refer to simply as Vaccine A and Vaccine B. The technical details of the vaccines, including the time between doses and their storage temperatures, match well with the two vaccines furthest along in clinical tests in the United States, made by Moderna and Pfizer.
Here’s what you need to know about how the vaccines work, how they’re being tested and how they might be rolled out to the public — if, and it’s still a big if, they are proven to work.
A surge in government borrowing in the face of the pandemic recession has put the United States in a position it has not seen since World War II: In order to pay off its national debt this year, the country would need to spend an amount nearly as large as its entire annual economy.
And still, economists and many fiscal hawks are urging lawmakers to borrow even more to fuel the nation’s economic recovery.
The amount of U.S. government debt has grown to nearly outpace the size of the nation’s economy in the 2020 fiscal year and is set to exceed it next year, as the virus downturn saps tax revenues, spurs government spending and necessitates record amounts of federal borrowing, the Congressional Budget Office said on Wednesday. Federal debt, as a share of the economy, is now on track to smash America’s World War II-era record by 2023.
The budget office report underscored the scrambled politics of deficits in 2020: It showed debt held by the public climbing to 98 percent of the size of the economy for the fiscal year ending Sept. 30.
Forecasters had previously expected the nation to reach those levels at the end of the decade, a time frame that had already alarmed fiscal hawks in Washington, who warned ballooning deficits would consume federal budgets and chill private investment.
But the virus has upended those predictions, prompting even longtime champions of fiscal prudence to urge lawmakers on Wednesday to keep borrowing more for the time being, in order to help people and businesses survive the lingering pain of a sharp recession and now-slowing recovery.
“We should think and worry about the deficit an awful lot, and we should proceed to make it larger,” said Maya MacGuineas, the president of the Committee for a Responsible Federal Budget in Washington, which has for years pushed lawmakers to take steps to reduce deficits and debt.
Tech stocks stumbled sharply on Thursday, setting the S&P 500 up for its worst daily performance since June.
The S&P 500 dropped about 3.5 percent, while the tech-heavy Nasdaq composite was down 5 percent. Apple was down nearly 7 percent. Amazon and Microsoft were both down more than 5 percent.
As investors have bet that the coronavirus crisis would amplify the dominance of the tech companies’ business models, share prices of large cap technology companies have surged, generating the lion’s share of the stock market’s gains.
The rip-roaring race for tech shares has increasingly pulled in armchair investors, who have taken up speculating on stocks amid the work-from-home environment. Many of those traders have opted not to buy actual shares, but instead to speculate in options trades, which are essentially leveraged bets on where share prices will go.
While stocks have fallen, the number of U.S. workers filing new state jobless claims remained at a historically high level last week, though it is gradually falling.
The government reported on Thursday that 833,000 workers filed new claims for state unemployment benefits last week. An additional 759,000 claims were filed by unemployed freelancers, part-time workers and others who are receiving federal relief under a separate emergency relief program. Neither figure is seasonally adjusted. On that basis, both totals represented an increase from the previous week. The seasonally adjusted number of new state claims was 881,000.
In other U.S. developments:
Temple University, which had planned to be online-only for just the first two weeks of classes, said Thursday that it would remain virtual for the rest of the fall term because of the continued spread of the virus. . As of Tuesday, the university had reported 212 active Covid-19 cases among students on and off campus, and none of them had more than moderate symptoms.
The federal Bureau of Prisons plans to reopen its facilities to visitors in October, citing a need for inmates to see friends and family. Visitors will be screened for the virus when they arrive, and other precautionary measures will be in place as well. The bureau began to restrict visitation in late March.
Malls in N.Y.C. and casinos statewide can reopen on Sept. 9, the governor says.
Malls in New York City and casinos across the state will be allowed to reopen on Sept. 9 with certain limits, Gov. Andrew M. Cuomo announced on Thursday.
Casinos will be allowed to operate at 25 percent capacity and malls at 50 percent capacity. Both will need to be equipped with specialized air conditioning systems capable of filtering out virus particles.
The announcement is the latest effort to return some semblance of normalcy to New York, which has for weeks managed to keep positivity rates and hospitalizations low after the virus ravaged the state, killing more than 30,000 people.
The governor said he was eager to restart indoor dining in New York City, where it remains prohibited since mid-March even as he has permitted indoor dining to resume in the rest of the state. Dining will still not be permitted inside the city’s malls and casinos. This week, New Jersey announced indoor dining would restart with limits on Friday.
Mr. Cuomo said he was concerned about New York City’s ability to enforce social distancing and capacity rules inside restaurants, and suggested the New York Police Department be involved in enforcement efforts. But involving the police could prove a delicate issue in the wake of protests against police brutality and after the police’s uneven enforcement of social distancing rules in the spring led predominantly to arrests of Black people.
The governor, who has the final say on authorizing indoor dining, said he would speak with the speaker of the City Council, Corey Johnson, who expressed support for indoor dining this week.
Mayor Bill de Blasio, who controls the city’s police department, said on Wednesday that he felt the restaurant industry was owed more clarity on a possible timeline and set of standards for reopening. “We need to decide that in the next few weeks,” he said, “whether it’s good news or bad news.”
On Thursday, Mr. de Blasio declined to respond to Mr. Cuomo’s remarks about using the police to enforce indoor-dining regulations, noting the city and state had been in discussions over reopening plans.
Take a look at how some American families are struggling to put food on the table.
A shadow of hunger looms over the United States. In the pandemic economy, nearly one in eight households doesn’t have enough to eat. Long lines at food banks have revealed what was hidden in plain sight: that food insecurity has become a persistent problem for millions of Americans.
Brenda Ann Kenneally set out across the country, from New York to California, beginning in May, to capture the routines of Americans who are struggling to piece together various forms of food assistance, community support and ingenuity to make it from one month to the next.
Food insecurity is as much about the threat of deprivation as it is about deprivation itself and its psychological toll. Like many hardships, this burden falls disproportionately on Black and Hispanic families, who are almost twice as likely to experience food insecurity as white families are.
Moving to combat its worst recession in decades, France unveiled a huge 100 billion euro ($118 billion) stimulus plan Thursday aimed at restoring the battered economy to pre-crisis levels by 2022, handing large tax cuts and hiring subsidies to companies in hopes of stimulating investment and creating jobs.
“We have to learn to live with the virus, and to survive it,” Prime Minister Jean Castex said at a news briefing.
The package, the biggest spending effort in Europe, comes on top of nearly €400 billion that President Emmanuel Macron made available to help keep thousands of businesses from going bankrupt and millions of people employed since a nationwide quarantine caused the economy to crater. Growth is expected to contract by 11 percent this year because of the Covid-19 epidemic.
But a new wave of infections is rolling across France, and with it the prospect of a protracted downturn.
The government effort focuses on supply-side stimulus and transitioning to so-called “green” technology across the economy. Industrial companies will get €35 billion in production tax breaks to stimulate investment and job creation, and the state will subsidize industrial development in hard-hit regions.
Around a third of the money will go toward making the nation’s infrastructure more environmentally sound. All told, the government said it hoped to create at least 160,000 jobs through the stimulus measures next year.
Madrid leader issues dire warning on children as schools start reopening.
Returning to school this fall has been fraught for parents everywhere. But in Spain, a message from the leader of the Madrid region that all schoolchildren would probably end up with the coronavirus was particularly alarming.
Speaking to a local radio station, Isabel Díaz Ayuso, who heads the Madrid region’s government, said Wednesday that it was “probable that all children would get infected, one way or another.”
But, she added, school was probably as safe as any place to be as a child was just as likely to catch Covid-19 at a family weekend gathering, or while out in the park.
“We don’t know, because the virus is everywhere,” she told esRadio. Ms. Díaz Ayuso did not say what scientific evidence she used to predict that the infection rate would be so high among children.
Madrid is once more the epicenter of Spain’s virus pandemic, accounting for almost one quarter of the 1,830 patients hospitalized in the country in the past week.
In response, Madrid is now requiring testing of all teachers returning to school, as is the case in other regions.
The result on Wednesday was chaotic: huge queues of school staff outside packed test centers forced the testing process to be suspended.
As the situation worsens in Madrid, some other regional leaders have been voicing their concerns about allowing residents from the capital region into their towns.
But Salvador Illa, Spain’s health minister, on Thursday ruled out the idea of imposing a lockdown around the Madrid area.
In other developments from around the world:
Thailand has gone 100 days without a reported case of local transmission, but its success in halting the spread of the virus has come at a significant financial cost. Thailand’s last reported case of community transmission was confirmed on May 24. Hundreds of cases have been found since then among residents returning from abroad, but all were detected during the required 14-day quarantine periods. As of Thursday, Thailand had reported 3,425 cases and 58 deaths, according to a Times database.
India reported 83,883 new cases on Thursday, breaking its own global record. It has the third-highest number of cases and deaths after the United States and Brazil.
The Czech Republic reported 650 new cases on Thursday, its highest single-day increase.
Turkey will impose restrictions on weddings and other social events amid a surge in new cases. The daily number of cases has reached almost 1,600 in the last week.
The police in Australia arrested a 28-year-old pregnant woman who had created a Facebook event encouraging people to come out and protest the government’s lockdown orders. The woman, who live-streamed the arrest, was the fourth person in the state of Victoria to be charged in the past week with incitement related to protests against strict stay-at-home orders and other measures intended to curtail spread of the virus.
The Venice Film Festival, the first large movie extravaganza to take place since the pandemic began, opened on the Lido island on Wednesday with numerous protective measures. Anyone with a temperature above 99.5°F (37.5°C) is denied entry. Masks are worn inside screening spaces and in the open air, although they get removed for speeches, news conferences and red carpet appearances.
Reporting was contributed by Liz Alderman, Ilise S. Carter, Choe Sang-Hun, Patricia Cohen, Ben Casselman, Michael Gold, Luis Ferré-Sadurní, Jacey Fortin, Ethan Hauser, Jennifer Jett, Juliana Kim, Sharon LaFraniere, Raphael Minder, Campbell Robertson, Eleanor Stanford, Isabella Kwai, Jim Tankersley, Katie Thomas, Neil Vigdor, Allyson Waller, Katherine J. Wu and Carl Zimmer.