surges

medicine

Are More Women Physicians Leaving Medicine as Pandemic Surges?

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

For mid-career oncologist Tanya Wildes, MD, the pandemic was the last straw. In late September, she tweeted: “I have done the academically unfathomable: I am resigning my faculty position without another job lined up.”

She wasn’t burned out, she insisted. She loved her patients and her research. But she was also “100% confident” in her decision and “also 100% sad. This did not have to happen,” she lamented, asking not to disclose her workplace for fear of retribution.



Dr Tanya Wildes and family

Being a woman in medicine “is a hard life to start with,” Wildes told Medscape Medical News. “We all have that tenuous balance going on and the pandemic made everything just a little bit harder.”

She describes her pre-pandemic work-life balance as a “Jenga tower, with everything only just in place.” But she realized that the balance had tipped, when after a difficult clinic she felt emotionally wrung-out. Her 11-year-old son had asked her to help him fly his model airplane. “I told him, ‘Honey, I can’t do it because if it crashes or gets stuck in a tree…you’re going to be devastated and I have nothing left for you.’ “

This was a eureka moment, as “I realized, this is not who I want to be,” she says, holding back tears. “Seventy years from now my son is going to tell his grandchildren about the pandemic and I don’t want his memory of his mom to be that she couldn’t be there for him because she was too spent.”

When Wildes shared her story on Twitter, other women oncologists and physicians responded that they too have felt they’re under increased pressure this year, with the extra stress of the pandemic leading others to quit as well.

The trend of doctors leaving medicine has been noticeable. A July survey from the Physicians Foundation found that roughly 16,000 medical practices had already closed during the pandemic, with another 8000 predicted to close within the next year.

“Similar patterns” were evident in another analysis by the Larry A. Green Center and the Primary Care Collaborative, as reported by The New York Times. In that survey, nearly one fifth of primary care clinicians said “someone in their practice plans to retire early or has already retired because of COVID-19,” and 15% say “someone has left or plans to leave the practice.” About half said their mental exhaustion was at an all-time high, the survey found.



Dr Monica Bertagnolli

“COVID-19 is a burden, and that added burden has tipped people over the edge of many things,” acknowledges Monica Bertagnolli, MD, chief of the Division of Surgical Oncology at Brigham and Women’s Hospital in Boston and former president of the American Society of Clinical Oncology (ASCO).

“It has illustrated that we do have a lot of people who are working kind of on the edge of not being able to handle everything,” she says.

While many

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medicine

Michigan Medicine joins country’s top hospitals in #MaskUp campaign as COVID-19 surges nationwide

ANN ARBOR – Michigan Medicine has partnered with about 100 of the country’s top health care systems urging Americans to mask up as COVID-19 cases reach record-breaking highs.

The news comes as Michigan reached its highest-ever single-day record Friday with 9,779 new cases.

Just this past week alone, one million Americans have tested positive for the novel virus, with 11.5 million testing positive since cases emerged earlier this year. More than 250,000 Americans to date have died from the disease.

As cases surge and more people choose to gather indoors as temperatures drop, hospital leaders are worried that their facilities could reach capacity quickly and experience shortages of healthy caregivers. Over the past two weeks, more than 900 medical workers at Mayo Clinic tested positive for COVID-19. The hospital system said the infections were due mostly to community spread.

Medical experts maintain that wearing a face mask is the best way to protect yourself from contracting the virus. Masks prevent the inhalation of harmful pathogens by the wearer and prevents potential harmful particles to be exhaled by the wearer and expose others.

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Ads for the new #MaskUp campaign are currently running in some of the nation’s top publications. The message reads:

“As the top nationally-ranked hospitals, we know it’s tough that we all need to do our part and keep wearing masks. But, here’s what we also know: The science has not changed. Masks slow the spread of COVID-19. So, please join us as we all embrace this simple ask: Wear. Care. Share with #MaskUp. Together, wearing is caring. And together, we are saving lives.”

The messages will also appear on social media and other digital platforms in order to reach a broader audience.

“After many months of living in social isolation and refraining from some of our favorite activities, this is not easy. We are all fatigued and stressed. However now is exactly the wrong time to let up,” Marschall S. Runge, CEO of Michigan Medicine and dean of the U-M Medical School said in a statement.

“We all must be vigilant in the behaviors that will protect us, our families, and our neighbors: wear a mask, socially distance, and practice frequent hand hygiene. These practices are our best defense against a disease that we still are trying to understand.”

At one point this week, Michigan Medicine had 75 COVID-19 positive patients at the same time, with roughly 20 of them requiring intensive care.

“Scientists and clinicians are learning more and more from this disease, and the outlook for more effective treatment and vaccination looks promising,” Laraine Washer, medical director of infection prevention and epidemiology at Michigan Medicine said in statement. “But for now, we have to use the tools that we know work: wearing masks, staying socially distant and washing hands.

“This, of course, makes the upcoming holidays a challenge. But the traditional gatherings of multiple households is a high risk situation for exposures to

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health

U.S. reports nearly 90,000 new coronavirus cases amid surges in every swing state

Nearly 90,000 new coronavirus infections were reported in the United States on Thursday, a record, as cases surge in every swing state that will be crucial to next week’s presidential election.



a group of people wearing costumes: Voters wearing face masks wait in a nearly four-hour line to cast their ballots during early voting at a polling site in Edmond, Okla., on Thursday.


© Nick Oxford/Reuters
Voters wearing face masks wait in a nearly four-hour line to cast their ballots during early voting at a polling site in Edmond, Okla., on Thursday.

The total number of infections reported nationwide since February is virtually guaranteed to reach 9 million on Friday, just 15 days after the tally hit 8 million. At least 228,000 deaths have been linked to the coronavirus.

Here are some significant developments:

Sign up for our coronavirus newsletter | Mapping the spread of the coronavirus: Across the U.S. | Worldwide | Vaccine tracker | Where states reopened and cases spiked | Has someone close to you died of covid-19? Share your story with The Washington Post.

1:48 AM: California health officials identify first case of simultaneous coronavirus and flu infections



A health care worker prepares a flu shot in California last month.


© Bloomberg/Photographer: Bloomberg/Bloomber
A health care worker prepares a flu shot in California last month.

A coronavirus patient in Solano County, Calif., has also tested positive for influenza — this flu season’s first known case of “co-infection” in the greater San Francisco Bay area, and possibly the entire United States.

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The dual infection prompted health officials to urge residents to get flu shots on Thursday, noting that it takes two weeks for the vaccine to become effective. Solano County health officer Bela Matyas told the San Francisco Chronicle that the patient was a health care worker between the ages of 20 and 65 with no other health conditions, and appears to have recovered.

Little is known about the potential risks of co-infection, since only a small number of cases were documented during last year’s flu season, which coincided with the start of the pandemic. Data presented last week at the annual meeting of the Infectious Diseases Society of America found that people who battled the flu at the same time as the coronavirus did not experience more severe outcomes, but the sample size was limited to 18 people.

A study of 64 patients who were hospitalized with dual flu-coronavirus infections in Wuhan, China last winter produced different results: Scientists found that people who were also infected with the flu took five days longer, on average, to shed covid-19. While their symptoms were not necessarily more severe, coinfection “was a significant risk factor for prolonged hospital stay,” co-author Rui Zeng told the Journal of the American Medical Association.

Generally speaking, public health experts agree that dealing with two viruses at the same time is unlikely to make recovery easier — and they’re worried about what that will mean as flu season ramps and caseloads continue to surge around the United States.

“This is a very clear indication of the potential for this to occur,” Matyas told the Chronicle. “Getting a flu vaccine this year is more important than ever.”

By: Antonia Noori Farzan

1:03 AM: Options dwindle for voters

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health

As virus surges, Trump rallies keep packing in thousands



President Donald Trump gestures as he is introduced by first lady Melania Trump during a campaign rally Thursday, Oct. 29, 2020, in Tampa, Fla. (AP Photo/Chris O'Meara)


© Provided by Associated Press
President Donald Trump gestures as he is introduced by first lady Melania Trump during a campaign rally Thursday, Oct. 29, 2020, in Tampa, Fla. (AP Photo/Chris O’Meara)

WASHINGTON (AP) — There are no crowds at Disneyland, still shut down by the coronavirus. Fewer fans attended the World Series this year than at any time in the past century. Big concerts are canceled.

But it’s a different story in Trumpland. Thousands of President Donald Trump’s supporters regularly cram together at campaign rallies around the country — masks optional and social distancing frowned upon.

Trump rallies are among the nation’s biggest events being held in defiance of crowd restrictions designed to stop the virus from spreading. This at a time when public health experts are advising people to think twice even about inviting many guests for Thanksgiving dinner.

“It doesn’t matter who you are or where you are, when you have congregate settings where people are crowded together and virtually no one is wearing a mask, that’s a perfect setup to have an outbreak of acquisition and transmissibility,” Dr. Anthony Fauci, the nation’s top infectious disease expert, recently told Yahoo News. “It’s a public health and scientific fact.”

The Trump campaign, which distributes masks and hand sanitizer at its rallies, says those who attend are peaceful protesters who, just like Black Lives Matter demonstrators, have a right to assemble. The president says he wants to get the country back to normal.



Vice President Mike Pence speaks during an airport rally, Thursday, Oct. 29, 2020, in Des Moines, Iowa. (AP Photo/Charlie Neibergall)


© Provided by Associated Press
Vice President Mike Pence speaks during an airport rally, Thursday, Oct. 29, 2020, in Des Moines, Iowa. (AP Photo/Charlie Neibergall)

Some states have fined venues that host Trump rallies for violating caps on crowd size. But the rallies continue — even as the U.S. sees cases spike, especially in the Midwest and the Plains. The nation posted a record high number of new infections last week — nearly 500,000.



President Donald Trump and first lady Melania Trump arrive for a campaign rally Thursday, Oct. 29, 2020, in Tampa, Fla. (AP Photo/Chris O'Meara)


© Provided by Associated Press
President Donald Trump and first lady Melania Trump arrive for a campaign rally Thursday, Oct. 29, 2020, in Tampa, Fla. (AP Photo/Chris O’Meara)

And the crowds keep turning out for Trump.

Ysabel Benejam, 69, of West Bloomfield, Michigan, drove about 90 minutes to Lansing and waited more than four hours in rainy, near-freezing temperatures to see Trump on Tuesday.

“I’m not afraid at all,” said Benejam, wearing a “Make America Great Again” hat and a mask emblazoned with “Trump 2020.” “We need to step back into normality.”

Democrat Joe Biden, in contrast, has shunned rallies and instead holds online and drive-in events where people honk their horns to show support. He calls the Trump rallies “super-spreader events” and says he’s listening to the warnings of public health experts.

Since Feb. 7, when Trump told author Bob Woodward that he knew the coronavirus was airborne and deadlier than than the flu, the president has hosted more than 50 rallies in more than two dozen states. They were halted during most of March, April and May because of the

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health

Central Europe sounds alarm facing a shortages of medics as virus surges

KYJOV, Czech Republic (AP) — Soldiers in Poland are giving coronavirus tests. American National Guard troops with medical training are headed to the Czech Republic to work alongside doctors there. A Czech university student is running blood samples to labs, and the mayor of the capital is taking shifts at a hospital.

With cases surging in many central European countries, firefighters, students and retired doctors are being asked to help shore up buckling health care systems.

“This is actually terrifying,” Dr. Piotr Suwalski, the head of the cardiac surgery ward at a Polish hospital said on a day when daily COVID-19 cases rose 20% nationwide. “I think if we continue to gain 20% a day, no system can withstand it.”

Even before the pandemic, many countries in the region faced a tragic shortage of medical personnel due to years of underfunding in their public health sectors and an exodus of doctors and nurses to better paying jobs in Western Europe after the nations joined the European Union in 2004. Now, with the virus ripping through their hospitals, many health workers have been sickened, compounding the shortfall.

Over 13,200 medical personnel across the Czech Republic have been infected, including 6,000 nurses and 2,600 doctors, according to the doctors’ union.

It’s not just clinicians these countries need. Both Poland and the Czech Republic are building field hospitals as beds fill up on wards, and authorities say there are only 12 ventilators left in all hospitals taking COVID-19 patients in the region around Warsaw, the Polish capital.

This may sound familiar, but not for these countries. Many in the region imposed tough restrictions in the spring — including sealing borders and closing schools, stores and restaurants — and saw very low infection rates even as the virus killed tens of thousands in Western Europe.

READ MORE: France, Germany impose new lockdowns to curb virus spread

But now many central European countries are seeing an onslaught similar to the one their western neighbors experienced — and the same dire warnings.

As he announced new restrictions last week, Czech Prime Minister Andrej Babis put a date on when his country’s health system would collapse, if the new regulations were not imposed to slow the virus’s spread: between Nov. 7 and 11.

With one of the highest infection rates in Europe, the Czech Republic’s hospitals are desperately looking for volunteers. The government is deploying thousands of medical students to hospitals and other students to testing sites.

In the capital of Prague, Mayor Zdenek Hrib, who has a degree in medicine, volunteered to help do initial exams of possible coronavirus patients at a university hospital. Soon, 28 medical personnel from the Nebraska and Texas national guards are expected to arrive to help treat patients at Prague’s military hospital and a new field hospital at the city’s exhibition ground.

Croatia has asked former doctors to come out of retirement to help in hospitals, while Slovenia has put retired physicians and current medical students on standby in case its

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health

Short of medics as virus surges, central Europe sounds alarm

KYJOV, Czech Republic (AP) — Soldiers in Poland are giving coronavirus tests. American National Guard troops with medical training are headed to the Czech Republic to work alongside doctors there. A Czech university student is running blood samples to labs, and the mayor of the capital is taking shifts at a hospital.

With cases surging in many central European countries, firefighters, students and retired doctors are being asked to help shore up buckling health care systems.

“This is actually terrifying,” Dr. Piotr Suwalski, the head of the cardiac surgery ward at a Polish hospital said on a day when daily COVID-19 cases rose 20% nationwide. “I think if we continue to gain 20% a day, no system can withstand it.”


Even before the pandemic, many countries in the region faced a tragic shortage of medical personnel due to years of underfunding in their public health sectors and an exodus of doctors and nurses to better paying jobs in Western Europe after the nations joined the European Union in 2004. Now, with the virus ripping through their hospitals, many health workers have been sickened, compounding the shortfall.

Over 13,200 medical personnel across the Czech Republic have been infected, including 6,000 nurses and 2,600 doctors, according to the doctors’ union.

It’s not just clinicians these countries need. Both Poland and the Czech Republic are building field hospitals as beds fill up on wards, and authorities say there are only 12 ventilators left in all hospitals taking COVID-19 patients in the region around Warsaw, the Polish capital.

This may sound familiar, but not for these countries. Many in the region imposed tough restrictions in the spring — including sealing borders and closing schools, stores and restaurants — and saw very low infection rates even as the virus killed tens of thousands in Western Europe.

But now many central European countries are seeing an onslaught similar to the one their western neighbors experienced — and the same dire warnings.

As he announced new restrictions last week, Czech Prime Minister Andrej Babis put a date on when his country’s health system would collapse, if the new regulations were not imposed to slow the virus’s spread: between Nov. 7 and 11.

With one of the highest infection rates in Europe, the Czech Republic’s hospitals are desperately looking for volunteers. The government is deploying thousands of medical students to hospitals and other students to testing sites.

In the capital of Prague, Mayor Zdenek Hrib, who has a degree in medicine, volunteered to help do initial exams of possible coronavirus patients at a university hospital. Soon, 28 medical personnel from the Nebraska and Texas national guards are expected to arrive to help treat patients at Prague’s military hospital and a new field hospital at the city’s exhibition ground.

Croatia has asked former doctors to come out of retirement to help in hospitals, while Slovenia has put retired physicians and current medical students on standby in case its situation deteriorates.

Poland, meanwhile, is mobilizing soldiers to conduct COVID-19 testing,

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health

U.S. pharmacies attract new flu shot customers as coronavirus surges

By Caroline Humer

NEW YORK (Reuters) – Walmart Inc, Walgreens Boots Alliance Inc, CVS Health Corp and Rite Aid Corp have told Reuters demand for flu shots at their U.S. pharmacies is up sharply – in some cases double from last year – as people try to protect themselves from influenza in the midst of a worsening COVID-19 pandemic.The pharmacies are giving millions more flu shots than they have in past years, filling a gap from COVID-19 wary consumers who are avoiding the doctor’s office. The gains represent millions of dollars in potential profit.

U.S. public health officials have been urging Americans for months to inoculate themselves against the flu, which kills about 60,000 people a year, warning of a potential “twindemic” of influenza and the novel coronavirus that could overwhelm hospitals this winter.

More Americans are choosing to get vaccinated at local pharmacies than in the past, partly due to cancellation of annual “flu shot clinics” in workplaces that remain shut by the pandemic. Walmart <WMT.N> reported increased demand from entire families seeking shots.

“Right out of the gate, we saw much more volume than last August,” Rite Aid Chief Pharmacy Officer Jocelyn Konrad said.

She said the company has been able to keep up with the high demand and has not seen any vaccine shortages.

The shift to pharmacies is a potential boost to the country’s biggest chains that may not yet be factored into many Wall Street earnings estimates.

Cowen & Co said in a research note that the flu demand will increase profit at CVS <CVS.N>, forecasting that it would beat Wall Street estimates when the company reports quarterly earnings on Nov. 6.

Rite Aid <RAD.N> flagged a 40% jump in demand and said last month that increased immunizations will help third-quarter retail profit. Fears of coronavirus infection has led to a decrease in U.S. doctor visits, a decline in new prescriptions and a drop in pharmacy retail sales.

Flu shots are typically covered by commercial insurance and government health plans, or can cost about $40 out of pocket at a pharmacy.

Pharmacies make a gross profit of about $15 per shot, according to healthcare services analyst Brian Tanquilut at Jefferies LLC. In addition, the extra trip to the store may entice customers to purchase other items.

Pharmacies began laying the groundwork for increased flu shot demand early this year, anticipating that a potential second wave of coronavirus cases would push more customers their way. An early Reuters poll showed that 60% of Americans planned to get the flu shot in the fall, up from a more typical 50%. A CVS survey found more people saying they would get the shot at a pharmacy.

GlaxoSmithKline Plc <GSK.L>, Sanofi SA <SASY.PA>, and CSL Ltd’s <CSL.AX> Seqirus, which manufacture flu shots used in the United States, increased production by between 10% and 20% this year for a total of about 190 million shots.

DOUBLING OF DEMAND

The rise in flu shots at pharmacies coincides with an

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COVID-19 heart changes raise death risk; virus may be lead killer of young adults during surges



a close up of a flower: A 3D-printed coronavirus model is seen in front of a world map and the words "CoronaVirus Disease (Covid-19)" on display in this illustration


© Reuters/DADO RUVIC
A 3D-printed coronavirus model is seen in front of a world map and the words “CoronaVirus Disease (Covid-19)” on display in this illustration

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Higher death risk found if COVID-19 causes changes to heart

A new study may help identify which COVID-19 patients with signs of heart injury are at higher risk for death. Doctors looked at 305 hospitalized patients with elevated levels of troponin, a protein released when the heart has been injured. They reported on Monday in the Journal of the American College of Cardiology that among these patients, the increased risk for death was statistically significant only when changes in the heart’s size, shape, structure, and function were seen during an echocardiogram. Death rates were 5.2% in patients without troponin in their blood, 18.6% when troponin was high but hearts looked normal, and 31.7% in those with high troponin plus so-called heart remodeling. When other risk factors were considered, high troponin was only tied to death in patients who also had cardiac remodeling. COVID-19 patients with high troponin should undergo echocardiography “to guide further diagnostic testing and treatment strategies,” coauthor Dr. Gennaro Giustino of Icahn School of Medicine at Mount Sinai in New York City told Reuters. “Patients with a bad echo need much closer follow-up and more aggressive treatments,” said Dr. Carl Lavie of Ochsner Health in New Orleans, who coauthored an editorial on the study. (https://bit.ly/34swrQb; https://bit.ly/3dVHch2)

COVID-19 may be top cause of death among young adults in some U.S. regions

In some areas of the United States during COVID-19 outbreaks, the new coronavirus likely became the leading cause of death among adults aged 25-44, researchers say. Using data from the U.S. Centers for Disease Control and Prevention (CDC), they analyzed deaths from any cause in that age group from March through July, along with drug overdose deaths during the same period in 2018, the most recent year for which data are available. In three of 10 regions of the country, as identified by the U.S. Department of Health and Human Services, deaths exceeded 2018 unintentional opioid overdose deaths during at least one month of the pandemic, researchers reported on Sunday on medRxiv, ahead of peer review. They were Region 2 (New York, New Jersey), Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), and Region 9 (Arizona, California, Hawaii, Nevada). It is not clear which states account for the most deaths in each region, coauthor Dr. Jeremy Faust of Harvard Medical School in Boston told Reuters. But data not included in the paper suggests that in New York, New Jersey, and Louisiana more people aged 20 to 39 “were dying of COVID-19 than opioids usually kills during the same time frame there,” he said. “Usually, opioids are the leading cause of death in these demographics all over

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As the coronavirus surges, it is reaching into the nation’s last untouched areas

Then came October. Three residents tested positive, knocking Petroleum off zero-case lists, forcing the county’s lone school to close for a week and proving, as Sheriff Bill Cassell put it, that “eventually we were going to get it,” and that the virus “ain’t gone yet.”

That is a lesson people in many other wide-open places have been learning as the coronavirus surges anew. Months after it raced in successive waves along the nation’s coasts and through the Sun Belt, it is reaching deep into its final frontier — the nation’s most sparsely populated states and counties, where distance from others has long been part of the appeal and this year had appeared to be a buffer against a deadly communicable disease.

In Montana, which boasts just seven people per square mile, active cases have more than doubled since the start of the month, and officials are warning of crisis-level hospitalization rates and strains on rural health care. In Wyoming, which ranks 49th in population density, the National Guard has been deployed to help with contact tracing. Those two states, along with the low-density states of Idaho, North Dakota and South Dakota, now have some of the nation’s highest per capita caseloads. Even Alaska, the least-crowded state, is logging unprecedented increases, including in rural villages.

“People here make the joke that we’ve been socially isolating since before the state was founded,” said Christine M. Porter, an associate professor of public health at the University of Wyoming. “In terms of the reason this happened now and it didn’t happen before, it was essentially luck-slash-geography. It’s a disease that spreads exponentially once it’s taken root, unless you take severe measures to stop it.”

The bulk of these states’ cases are clustered in their relatively small cities, but infections are fanning out. In Montana, about 55 percent of cases were in population centers by mid-month, down from nearly 80 percent over the summer. And although the caseloads may look low, they loom large for local public health officials and facilities.

Sue Woods directs the Central Montana Health District, a Massachusetts-sized area that includes Petroleum and five other rural counties. The district has about 120 active cases, and Woods is working 10- to 12-hour days, mostly on contact tracing.

“The numbers of cases that we see are so small compared to large population centers, but when you take our population into account, we’re right in the same percentages,” Woods said. “Two of us are doing the bulk of the patient contacts. It is overwhelming.”

Some officials point to the positive side of being hit by the coronavirus later in the pandemic. It gave jurisdictions and health-care facilities the opportunity, they say, to collect personal protective equipment, ramp up testing and learn more about the virus and how to treat covid-19, the disease it causes.

“Up until a few weeks ago, we had been very successful in limiting transmission,” said Alexia Harrist, Wyoming’s state health officer and state epidemiologist. “It did buy us very important time

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Fauci says it might be time to mandate masks as Covid-19 surges across US

Dr. Anthony Fauci has been reluctant to support a federal mask mandate.



Anthony S. Fauci wearing a suit and tie standing in front of a sign


© Provided by CNN


“A national mandate probably would not work,” he said on Sept 15 during a news conference with Vermont Gov. Phil Scott.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, has been urging Americans to use masks for months. “I have trust in the American people that if we put a strong emphasis on the importance of wearing masks, that we will come around and do that and get that percentage up above the relatively low percentage of people that are using masks,” Fauci said on July 21 on NPR’s Morning Edition.

But he has said before that he doesn’t think a federal law would be the way to go.

“I don’t like to be authoritarian from the federal government, but at the local level, if governors and others essentially mandate the use of masks when you have an outbreak, I think that would be very important,” Fauci told Alabama Sen. Doug Jones during a Facebook live event in July.

Until now.

“Well, if people are not wearing masks, then maybe we should be mandating it,” Fauci told CNN’s Erin Burnett Friday.

Covid-19 has been worsening across the United States, with cases rising in 32 states Friday and holding steady in 17 more. The University of Washington’s Institute for Health Metrics and Evaluation said the country was entering a winter surge as new infections passed 75,000 in a single day on Friday and more than 800 deaths were reported.

Mask mandates may be tricky to enforce, but it might be time to call for them, Fauci said.

“There’s going to be a difficulty enforcing it, but if everyone agrees that this is something that’s important and they mandate it and everybody pulls together and says, you know, we’re going to mandate it but let’s just do it, I think that would be a great idea to have everybody do it uniformly,” he said.

As cooler weather comes, people need to “double down” on measures that work, Fauci said. “Universal mask wearing” is one, he said, as is keeping a distance from others and frequent hand washing. “They sound very simple. But we’re not uniformly doing that and that’s one of the reasons we’re seeing these surges,” Fauci said.

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