CDC Chief Says Coronavirus Cases May Be 10 Times Higher Than Reported

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The number of people in the United States who have been infected with the coronavirus is likely to be 10 times as high as the 2.4 million confirmed cases, based on antibody tests, the head of the Centers for Disease Control and Prevention said Thursday.

CDC Director Robert Redfield's estimate, shared with reporters in a conference call, indicates that at least 24 million Americans have been infected so far.

The antibody tests examine a person's blood for indicators that the immune system has mounted a response to an infection. The serological surveys are being done around the country as epidemiologists try to measure the reach of the virus to date. Redfield said he believes 5 to 8 percent of the population has been infected so far.

Significantly, that would mean 92 to 95 percent remain susceptible to a coronavirus infection. Experts say this is the critical data point showing that the pandemic remains in its early stages and people need to continue to try to limit the viral spread.

The CDC director's comments came as case counts continued to surge to record levels in many states, particularly in the South and West, during warm-weather months that many had hoped would provide a lull in the pandemic.

Alabama, Nevada, and Missouri reported single-day records for new coronavirus cases, a day after the national total hit a single-day high of 38,173 cases.

Amid signs that Texas has lost control of the epidemic, Gov. Greg Abbott, a Republican, announced the state would pause its reopening to try to halt the flow of infections. He said he is focused on strategies to slow the viral spread "while also allowing Texans to continue earning a paycheck to support their families. The last thing we want to do as a state is go backwards and close down businesses."

As part of that pause, he suspended elective surgeries at hospitals in hard-hit Bexar, Dallas, Harris, and Travis counties - home to the cities of San Antonio, Dallas, Houston, and Austin, respectively. The rolling average of daily new cases in Texas has increased 62 percent from the past week, jumping from 2,610 on June 18 to 4,227 on Thursday, according to data tracked by The Washington Post. The daily count has set a record each day for 13 consecutive days.

The economic crisis triggered by the pandemic continues to roil the corporate sector. Macy's said it is laying off 3,900 corporate employees and managers. Chuck E. Cheese's parent company filed for bankruptcy protection. Both actions were due to the virus's impact on sales, the companies said.

Apple said Thursday it is re-closing 14 stores in Florida. The state reported a second consecutive day of more than 5,000 new confirmed coronavirus cases.

Larry Kudlow, the White House's top economic official, said during an appearance on Fox Business Network that the administration does not anticipate a second wave of infections, which has been projected by health experts, and that new hot spots popping up across the country are scenarios Americans will "just have to live with."

Some officials in the Trump administration, including the president, argue the surging cases simply reflect expanded testing. But infectious-disease experts, including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, dispute that, saying they also reflect increased community transmission.

Redfield said that younger people are the leading edge of that transmission. "Young people, many newly mobile after months of lockdowns, have been getting tested more often in recent weeks and driving the surge in cases in the South and West," he said.

"In the past, I just don't think we diagnosed these infections," he said.

Redfield's comments oscillated between downplaying the latest news bulletins and declaring that the rising numbers are indeed worrisome.

He said that a color-coded map of infections can make the country look as though the surge is widespread - "substantial portions of the United States are in red" - but said that only 3 percent of counties nationwide have actually become "hot spots."

He also repeatedly pointed out that young people, who are less likely to have a severe outcome from the virus, are getting tested more often. But under questioning, he said he was not downplaying the significance of the surge in cases in places such as Texas, Florida, and Arizona.

"This is a significant event," he said. "We had a significant increase in cases. . . . We need to interrupt that."

Redfield said Americans need to weigh their individual risks as they go about their lives. "When you must go out into the community, being in contact with few people is better than many, [and] shorter periods are better than longer," he said.

Above all, he said, people should maintain social distancing, wash hands frequently, and properly wear a face covering when they are unable to socially distance.

The death toll nationally from COVID-19, the disease caused by the novel coronavirus, has dropped since it peaked in April, during the catastrophic outbreak in New York City and nearby areas. Many experts have warned that the effects of the reopening of the economy in May and the increased mobility and decline in social distancing could reverse that recent trend. COVID-19 can lead to a protracted illness, and in those cases there is typically a lag of several weeks between an infection and death.

On Thursday, the CDC also made significant changes in how it categorizes people at elevated risk of a severe outcome from COVID-19. The agency had previously said that people over 65 face higher risk. But it removed that age marker, saying that risk increases steadily with age.

Conditions that pose a higher risk for serious illness include chronic kidney disease, serious heart disease, COPD (chronic obstructive pulmonary disease), a weakened immune system from a solid organ transplant, Type 2 diabetes, obesity and newly added: sickle cell disease, an inherited blood disorder that affects 90,000 to 100,000 people in the United States, mainly African Americans.

Officials clarified that obesity means a body mass index of 30 or higher. Roughly 40 percent of the adult population is obese under that definition. A person who is 5-foot-5 and weighs 180 pounds has a BMI of 30. That same person who weighs 240 pounds would have a BMI of 40.

For the first time, agency officials said pregnant women with COVID-19 may face a higher risk of hospitalization and treatment in intensive care units and respiratory help with a mechanical ventilator. The same data, however, shows that pregnant women are not at higher risk of dying. Officials said they are still researching the effects on newborns.

Although pregnant women are at risk for severe disease associated with other respiratory illnesses, such as influenza, there has been limited data related to COVID-19 on pregnancy until now, health experts said.

In the CDC report on pregnancy and COVID-19 released Thursday, researchers compared the impact of the disease on more than 8,000 pregnant women and 83,000 nonpregnant women from Jan. 22 to June 7.

Pregnant women were over five times as likely to be hospitalized as nonpregnant women, 1.5 times as likely to be admitted to intensive care units, and 1.7 times as likely to require mechanical ventilation, the report said. There was no higher risk for death among the pregnant women.

The CDC report also found that black and Hispanic pregnant women appear to be disproportionately hit by COVID-19.

"This is the most convincing evidence that pregnant women with COVID-19 are more likely to have severe disease, although the absolute risk is still low," said Denise Jamieson, chair of the gynecology and obstetrics department at Emory University School of Medicine and chief of gynecology and obstetrics for Emory Healthcare, who was not involved in the report.

Among pregnant women with confirmed infections who reported race or ethnicity, 46 percent were Hispanic, 22 percent were black and 23 percent were white. That suggests the disproportionate impact of the disease on blacks and Latinos: In 2019, white women accounted for 51 percent of those who gave birth, compared with 24 percent who were Hispanic, and 15 percent who were black.

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