Home featured Manila Religious Event Raises Concerns That It Could Become a ‘Super-Spreader’ Event

Manila Religious Event Raises Concerns That It Could Become a ‘Super-Spreader’ Event

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Michael Zarro, a police sergeant in Mount Olive, N.J., rolled up his sleeve for a coronavirus vaccination on Friday.
Credit…Pool photo by Sarah Blesener

At least 151,000 people in the United States have been fully vaccinated against Covid-19, according to a New York Times survey of all 50 states.

Both of the vaccines being used across the country require patients to receive two doses spaced weeks apart, so the process of administering second shots to Americans has only just begun.

The Times sent surveys to state health departments, as well as health officials for territories and federal agencies that have received vaccine allotments from the Centers for Disease Control and Prevention. The tally of fully vaccinated people is an undercount because some states did not provide that information.

The C.D.C., which is not yet reporting the number of people nationally who have gotten a second shot, said on Friday that about 6.7 million people had received a first dose of a vaccine. That falls far short of the goal federal officials set to give at least 20 million people their first shots before the end of 2020.

On Friday, the transition team for President-elect Joseph R. Biden Jr. announced a plan to accelerate vaccinations that includes reversing course and releasing nearly all available doses. That would provide more people with first doses but raise the risk that second doses would not be administered on time; however, ramped up vaccine production is expected to keep enough in the pipeline for timely second doses. Officials from the Food and Drug Administration have spoken out strongly against changing the dosing schedule.

Despite the slower-than-expected rollout, many states have started broadening the pool of people eligible to receive vaccines. After initially focusing on health care workers and people who lived or worked in long-term care facilities, some states are now offering shots to older adults or to people who have other high-risk jobs.

Indiana started offering vaccines to anyone over age 80. West Virginia said teachers over age 50 were now eligible. And the United States Virgin Islands authorized grocery store workers, bus drivers and police officers to receive vaccines.

After frictions with the mayor of New York City, Bill de Blasio, New York’s governor, Andrew M. Cuomo, expanded the groups eligible for vaccines to include three million more people, including those 75 and older.

More states are expected to expand their vaccine programs in the coming days. On Monday, Michigan residents over age 65, as well as corrections workers and child care providers, are expected to begin receiving vaccines. Detroit’s health department said it would begin vaccinating at buildings for older residents and homeless shelters next week.

Doctors intubated a Covid-19 patient at a Mission Viejo, Calif., hospital on Friday.
Credit…Lucy Nicholson/Reuters

A sustained surge of coronavirus infections has locked Southern California in crisis, overwhelming intensive care wards, ambulance services, funeral homes and local officials.

Dozens of overcrowded hospitals have had to shut their emergency-room doors to ambulances for hours at a time. Medical wards are running dangerously low on a vital necessity: oxygen, and the portable canisters to supply it to patients. Los Angeles County has a coronavirus-related death every eight minutes, a grim toll accompanied in many neighborhoods by the soundtrack of shrieking sirens.

“We’re having our New York moment,” said Dr. Robert Kim-Farley, an infectious disease expert at the University of California, Los Angeles Fielding School of Public Health, recalling the weeks in March and April when New York City was the epicenter of the virus.

It took nearly 10 months for Los Angeles County to hit 400,000 cases, but little more than a month to add another 400,000, from Nov. 30 to Jan. 2. In the coming days, the county, the nation’s most populous, will reach a level where one in 10 residents has tested positive for the virus.

Los Angeles County averaged 171 deaths a day in the seven-day period ending Thursday, the most of any U.S. county and about double the nation’s per capita rate. High as that toll is, it is far smaller than New York City’s daily average of around 800 deaths in the spring, when less was understood about the disease and fewer treatments were available.

California reacted swiftly at the start of the pandemic with the country’s first stay-at-home orders, and had largely avoided the widespread infection and death experienced early on in places like New York. Now many epidemiologists, health officials and elected leaders are trying to understand what went so wrong.

“People are really, really, really in desperate shape,” President-elect Joseph R. Biden Jr. said on Friday as he vowed to work to address the virus crisis and the economic woes of the nation.
Credit…Kriston Jae Bethel for The New York Times

President-elect Joseph R. Biden Jr. on Friday promised an accelerated response to a daunting and intensifying array of challenges as the economy showed new signs of weakness and the coronavirus pandemic killed more Americans than ever.

On a day the Labor Department reported that the economy lost 140,000 jobs in December, ending a seven-month streak of growth after the country’s plunge into recession in the spring, Mr. Biden said there was “a dire, dire need to act now.”

He pledged to move rapidly once he becomes president to push a stimulus package through Congress to provide relief to struggling individuals, small businesses, students, local governments and schools.

Mr. Biden and his aides have not yet finished the proposal or settled on its full amount. Forecasters expect further job losses this month, a casualty of the renewed surge of the pandemic and state and local officials’ impositions of lockdowns and other restrictions on economic activity meant to slow the spread.

“The price tag will be high,” Mr. Biden told reporters in Wilmington, Del.

He pledged to ramp up efforts to slow the spread of the virus, which is now claiming 4,000 lives each day — more than those who perished during the Battle of Antietam during the Civil War, the attack on Pearl Harbor in 1941 or the terrorist attacks on Sept. 11, 2001. Mr. Biden’s team said the president-elect would immediately provide more vaccines to states when he takes office, breaking sharply from Mr. Trump’s practice of holding back some shots for second doses.

“People are really, really, really in desperate shape,” Mr. Biden said.

The decision is part of an aggressive effort to “to ensure the Americans who need it most get it as soon as possible,” the Biden transition team said on Friday. The vaccination plan, to be formally unveiled next week, also will include federally run vaccination sites in places like high school gyms and sports stadiums, and mobile units to reach high-risk populations.

The president-elect has vowed to get “at least 100 million Covid vaccine shots into the arms of the American people” during his first 100 days in office.

Dr. Deborah Birx, White House coronavirus response coordinator, during a news conference in November.
Credit…Stefani Reynolds for The New York Times

Reports of a highly contagious new variant in the United States, published on Friday by multiple news outlets, are based on speculative statements made by Dr. Deborah Birx and are inaccurate, according to several government officials.

The erroneous report originated at a recent meeting where Dr. Birx, a member of the White House coronavirus task force, presented graphs of the escalating cases in the country. She suggested to other members of the task force that a new, more transmissible variant originating in the U.S. might explain the surge, as another variant did in Britain.

Her hypothesis made it into a weekly report sent to state governors. “This fall/winter surge has been at nearly twice the rate of rise of cases as the spring and summer surges. This acceleration suggests there may be a USA variant that has evolved here, in addition to the UK variant that is already spreading in our communities and may be 50% more transmissible,” the report read. “Aggressive mitigation must be used to match a more aggressive virus.”

Dismayed, officials at the C.D.C. tried to have the speculative statements removed, but were unsuccessful, according to three people familiar with the events.

C.D.C. officials did not agree with her assessment and asked to remove it but were told no, according to one frustrated C.D.C. official, speaking on condition of anonymity for fear of retaliation.

Dr. Birx could not immediately be reached for comment.

The news of a possible new variant first appeared Friday afternoon on CNN, quickly spread to other outlets. Responding to media inquiries about the variant, the C.D.C. issued a formal statement refuting the theory.

“Researchers at the Centers for Disease Control and Prevention are monitoring all emerging variants of the coronavirus, including in 5,700 samples collected in November and December,” according to Jason McDonald, a spokesman for the agency. “To date, neither researchers nor analysts at C.D.C. have seen the emergence of a particular variant in the United States,” he said.

Among the variants circulating in the U.S. are B.1.1.7, first identified in Britain and now driving a surge and overwhelming hospitals there. The variant has been spotted in a handful of states, but the C.D.C. estimates that it accounts for less than 0.5 percent of cases in the country so far.

Another variant circulating at low levels in the U.S., known as B 1.346, contains a deletion that is also present in B.1.1.7. “But I have seen nothing on increased transmission,” said Michael Worobey, an evolutionary biologist at the University of Arizona who discovered that variant.

That variant has been in the United States for three months and also accounts for fewer than 0.5 percent of cases, so it is unlikely to be more contagious than other variants, according to a C.D.C. scientist who spoke on condition of anonymity because he was not authorized to speak about the matter.

All viruses evolve, and the coronavirus is no different. “Based on scientific understanding of viruses, it is highly likely there are many variants evolving simultaneously across the globe,” Mr. McDonald, of the C.D.C., said. “However, it could take weeks or months to identify if there is a single variant of the virus that causes Covid-19 fueling the surge in the United States similar to the surge in the United Kingdom.”

Carl Zimmer contributed reporting from New Haven and Noah Weiland from Washington D.C.

(Correction: Jan. 9, 2021 — An earlier version of this article misidentified the news outlet that first published the report of a possible new variant. It was CNN, not CNBC.)

Tulio De Oliveira, a geneticist whose  lab at the Nelson Mandela School of Medicine in Durban, South Africa, first identified a new, more transmissible variant of the coronavirus. He consulted with a British scientist, who found a similar variant had been circulating in England. 
Credit…Joao Silva/The New York Times

The coronavirus has evolved as it has made its way across the world, as any virus is expected to do. But experts have been startled by the pace at which significant new variants have emerged.

Much remains unknown about the new variants, or even how many are sprouting worldwide. Scientists are racing to sequence enough of the virus to know, but only a handful of countries have the wherewithal or commitment to do so with regularity.

With the world stumbling in its vaccination rollout and the number of cases steeply rising to peaks that exceed those seen last spring, experts see a pressing need to immunize as many people as possible before the virus evolves enough to render the vaccines impotent.

“It’s a race against time,” said Marion Koopmans, a Dutch virologist and a member of a World Health Organization working group on coronavirus adaptations.

It was in late October that doctors and nurses at a hospital group in Durban, South Africa, noticed an odd spike in the number of Covid-19 patients in their wards.

“Is this a different strain?” one hospital official asked in a group email in early November.

The ensuing genetic investigation found a more transmissible variant, tipping off researchers in Britain, who found another more transmissible variant that was driving up infections in England. That variant has been found in at least 45 countries, leading to border closures, quarantines and lockdowns.

Vaccines alone will not be enough to get ahead of the virus: It will take years to inoculate enough people to limit its evolution. In the meantime, social distancing, mask-wearing and hand-washing — combined with aggressive testing, tracking and tracing — might buy some time and avert devastating spikes in hospitalizations and deaths along the way.

Yet in the course of the pandemic, governments have often proven reluctant or unable to galvanize support for those basic defenses. Many countries have all but given up on tracking and tracing. Mask-wearing remains politically charged in the United States, despite clear evidence of its efficacy. Cities like Los Angeles have been gripped by a spike in cases linked to Christmas festivities, and national public health officials are bracing for surges, driven by people who ignored advice and traveled during the holidays.

The rapid spread of the new variants is a reminder of the failings and missteps of major countries to contain the virus earlier. Just as China failed to stop travelers from spreading the virus before the Lunar New Year last year, Britain failed to move fast enough ahead of the new variant’s spread. And just as China became a pariah early on in the pandemic, Britain now has the unfortunate distinction of being called Plague Island.

Pedestrians shop in Dublin in December. Ireland has announced it has contained several cases of the new virus variant from South Africa.
Credit…Paul Faith/Agence France-Presse — Getty Images

Three cases of the coronavirus variant first identified in South Africa have been contained, Irish health authorities said on Saturday, amid growing concerns that a similar, more transmissible version of the virus first found in England is driving up infections to levels that threaten to overwhelm an already overstretched health care system.

“The good thing about the South African variant is we know exactly where those cases came from, they have been contained, controlled and contact traced, and to the best of my knowledge there was no onward transmission,” Cillian De Gascun, the head of Ireland’s national virus laboratory, said on national television.

“The U.K. variant is of more concern to us purely because of the amount of virus that’s on the island, and we know that it’s transmitting in the community,” Mr. De Gascun added.

Ireland’s 14-day infection rate has quadrupled in the past two weeks, and the so-called British variant has been showing up more in test samples. Irish authorities announced a new lockdown this week, and reported over 8,200 new cases on Friday, a record.

“Already exhausted health care workers now face a tsunami of infection even greater than the first wave,” Prime Minister Micheal Martin said as he announced the new measures.

Countries around the world have grappled to contain the new variants. Infections and hospitalizations in Britain have skyrocketed since the country found the variant last month, which has since been identified in about 45 countries.

On Friday, Britain suffered its deadliest daily toll since the beginning of the pandemic, with 1,325 deaths. On Saturday, the toll was 1,035 lives.

Workers carried coronavirus test samples in Shijiazhuang, China, the capital of Hebei Province, on Friday.
Credit…Mu Yu/Xinhua, via Associated Press

The Chinese authorities have imposed a stay-at-home order on more than 17 million people in two cities in the northern province of Hebei, an effort to stop the country’s worst coronavirus flare-up in months from spreading to nearby Beijing, the capital.

Officials in the two cities, Shijiazhuang and Xingtai, told residents on Friday to stay at home for seven days to prevent further spread of an outbreak that has caused 349 reported infections in the past week, mostly in Shijiazhuang.

Residents of Shijiazhuang, a city of 11 million that is scheduled to host several events for the 2022 Winter Olympic Games, were barred earlier this week from leaving the city. Major highways have been blocked, train and bus stations closed and most flights canceled. On Saturday, subway, bus and taxi services were also suspended.

Millions of people across Hebei have been tested in recent days, while people who recently traveled to Shijiazhuang and Xingtai are being scrutinized. Chifeng, a city in the northern region of Inner Mongolia, announced on Friday that it was shifting to “wartime” footing after discovering that more than 3,600 people from the two Hebei cities had visited in recent days.

The stay-at-home order on Friday came suddenly, leaving some residents without time to stockpile food. Some people in Shijiazhuang said they had been instructed by their residential compounds to stay at home for 14 days, a week longer than the government requires.

Hebei’s aggressive measures are part of an ongoing effort by the authorities to keep the number of new infections in China close to zero, particularly ahead of the Lunar New Year travel rush that is expected in February. Health officials on Saturday urged the public to reduce travel during the upcoming holiday — which, for tens of millions of migrant workers, is often their only chance of the year to return home from their jobs in distant cities.

Getting the current outbreak under control is especially important, officials say, given the region’s proximity to Beijing, which borders Hebei. Earlier this week, Wang Dongfeng, Hebei’s Communist Party secretary, pledged to make the province “the moat to safeguard Beijing’s political security.”

Parishioners attended the Orthodox Christmas celebrations in western Ukraine with few wearing masks or maintaining social distancing.
Credit…Evgeniy Maloletka/Associated Press

Lyudmyla Boiko’s family has already had a harrowing, and lethal, encounter with the coronavirus.

Several family members fell ill, and her daughter-in-law’s mother died. Now, Ms. Boiko, a 61-year-old employee of a botanical garden in eastern Ukraine, is worried about her husband, who has underlying health problems but has not yet caught the virus. She is pinning her hopes on a vaccine.

“I don’t care where the vaccine is produced as long as I’m sure it is safe,” Ms. Boiko said. “Safety should be the first priority.”

But in Ukraine, it is hardly the only consideration.

The country, already caught up in the broader tug-of-war between East and West in European politics, has now also become a focal point in the geopolitics of coronavirus vaccines — so far, to Ukraine’s detriment.

First, talks with Pfizer and other Western vaccine makers to obtain early shipments collapsed after the Trump administration banned vaccine exports. Now, unless the incoming Biden administration steps in, the earliest commercial purchases of Western vaccines will not be delivered before late 2021.

Ukraine’s plight has caught the eye of Russia’s state-controlled news outlets, which have highlighted the failure of Ukraine’s Western allies to step up in a moment of need — and offering Russia’s vaccine as an alternative.

Ukraine’s leaders, who have raised worries about the safety and efficacy of the Russian vaccine and would, in any event, almost literally die before accepting help from Russia, their blood enemy, turned to China, buying its first vaccine in a hurried negotiation in the final two weeks of December.

“Russia, as always, uses this in its hybrid war, as an information weapon,” Maksym Stepanov, Ukraine’s health minister, said in a telephone interview of the country’s effort to inoculate its population. “The issue of vaccines is politicized.”

The ban caused outrage on social media, with some Iranians posting to Twitter that Ayatollah Ali Khamenei, Iran’s supreme leader, does not have the right to impose his personal views on public health.
Credit…Iranian Supreme Leader’s Office

Iran’s supreme leader, Ayatollah Ali Khamenei, has banned the import of any Covid-19 vaccines made in the United States or Britain, repeating his conspiracy theory that vaccines made by Western countries could not be trusted and could harm Iranians.

“Importing vaccines from the U.S. and the U.K. is prohibited,” Mr. Khamenei said in televised comments on Friday. “They are completely untrustworthy.”

Mr. Khamenei’s comments are likely to significantly hinder the country’s already chaotic efforts to secure vaccines as it battles the coronavirus. Iran’s Red Crescent Society then announced it would cancel the import of 150,000 donated doses of the Pfizer-BioNTech vaccine.

For weeks, Iranian health officials and activists inside and outside Iran had been lobbying for exemptions from U.S. sanctions that would allow Iran to make payments for vaccines through Covax, an international body established to promote global access to Covid vaccines.

Before Mr. Khamenei’s announcement, ordinary Iranians had taken to social media with a campaign calling on the government to purchase European and American vaccines that they deemed more trustworthy than Russian and Chinese versions.

Mr. Khamenei’s ban on Friday caused outrage on social media, with some Iranians posting to Twitter that he does not have the right to play with people’s health and to impose his personal views on public health.

Shima Ghoosheh, a lawyer based in Tehran, posted on Twitter that she doubted that the scope of the supreme leader’s authority, as defined by Iran’s Constitution, extended to deciding what types of vaccines should be imported.

Twitter itself also took action, hiding a tweet by Mr. Khamenei about vaccine conspiracy theories and labeling it with a warning: “This Tweet is no longer available because it violated the Twitter Rules.”

Iran last month started a clinical trial on domestically produced Covid-19 vaccines, and some hard-line officials have said inoculation should wait until Iranian-made vaccines are available.

A report by the government’s Center for Strategic Studies said Iran was negotiating with China to purchase vaccines and that acquiring vaccines from Russia and Cuba was also on the agenda.

Transit passengers in Stockholm on Friday. Sweden is enacting more serious measures in the fight against the coronavirus as cases rise.
Credit…Jessica Gow/Agence France-Presse — Getty Images

Sweden, which has long shunned the imposition of lockdowns and face mask orders as tools for fighting the coronavirus crisis, has given its government power to act more forcefully to try and stem the spread of the virus.

Parliament on Friday passed an emergency law that will allow the government to limit the number of people in shops, businesses and public places, like theaters and public swimming pools, or even order their closure in case of violations. The government will also be able to fine individuals for breaking virus rules.

The new powers go into effect on Sunday.

Previously, the government was able to only make recommendations on such restrictions. But with the country struggling to battle a second wave, and with emergency wards filling up to critical capacity, the government said it needed more tools.

As of Saturday, Sweden’s total death toll stood at 9,433. The country now has 93 deaths per 100,000 people, less than Britain, which has 120, but far more than its neighbor Norway, with nine.

In a separate decision put in effect Thursday, face masks, long deemed ineffective by Swedish health officials, are now being recommended for use during rush hour on public transport, although they will not be mandatory.

In April, when much of the rest of the world went into lockdowns, Swedes were able to keep going to bars and restaurants, with government and health officials saying they didn’t believe in lockdowns. The country’s Public Health Authority issued some prevention recommendations, but the government legally wasn’t able to order the sort of blanket stay-at-home measures used in other European countries.

Some experts are calling for even stricter measures.

“This law is great but not enough,” said Dr. Fredrik Elgh, a professor of clinical virology at Umea University. “We need a four-week lockdown badly to stop this increase. If we do this now in two weeks time we will see a decrease.”

Catholic devotees flocked near the Quiapo Minor Basilica in Manila to celebrate the annual feast of the Black Nazarene on Saturday.
Credit…Jes Aznar for The New York Times

A religious event that drew nearly 10,000 people in Manila on Saturday risked becoming a super spreader of the coronavirus in the Philippines, whose infection numbers have been among the worst in Southeast Asia.

For the event, which celebrates the feast of the Black Nazarene, an ebony statue of Jesus Christ that many Filipino Catholics believe to be miraculous, the statue is traditionally marched around the city’s Quiapo district. Participants typically clamber over one another to wipe it with handkerchiefs in the belief that it makes wishes come true. Last year, over two million people joined the gathering.

Although Manila’s mayor, Francisco Domagoso, broke with tradition this year and kept the icon in a church, thousands of people nonetheless arrived to pray in the surrounding streets.

Security was tight, with police officers in full combat gear patrolling and reminding people about social distancing guidelines. Others carried batons as they struggled to direct the crowd.

The country’s health secretary, Francisco Duque, said in a statement that he had received reports early in the day of people violating health protocols, although he added that the authorities had been “quick to disperse” those gathered and “ensure strict implementation of physical distancing.”

Mr. Duque had earlier appealed to devotees to opt for virtual Masses rather than physically going to Quiapo.

A passenger wears multiple pieces of personal protective equipment for a flight last June.
Credit…Mario Tama/Getty Images

A coronavirus outbreak aboard a September flight from Dubai to New Zealand offered researchers — and airlines — an opportunity to study in-transit contagion.

After the 18-hour flight from Dubai landed in Auckland, local health authorities discovered evidence of an outbreak that most likely occurred during the trip. Using seat maps and genetic analysis, the new study determined that one passenger initiated a chain of infection that spread to four others en route.

Previous research on apparent in-flight outbreaks focused on flights that occurred last spring, when few travelers wore masks, planes were running near capacity and the value of preventive measures was not broadly understood. The new report, of a largely empty flight in the fall, details what can happen even when airlines and passengers are aware of and more cautious about the risks.

The findings deliver a clear warning to both airlines and passengers, experts said.

“The key message here is that you have to have multiple layers of prevention — requiring testing before boarding, social distancing on the flight and masks,” said Dr. Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School who was not part of the study team. “Those things all went wrong in different ways on this flight, and if they’d just tested properly, this wouldn’t have happened.”

The new infections were detected after the plane landed in New Zealand; the country requires incoming travelers to quarantine for 14 days before entering the community. The analysis, led by researchers at the New Zealand Ministry of Health, found that seven of the 86 passengers on board tested positive during their quarantine and that at least four were newly infected on the flight. The aircraft, a Boeing 777-300ER, with a capacity of nearly 400 passengers, was only one-quarter full.

The seven passengers, from five countries, were seated within four rows of one another for the 18-hour duration of the flight. Two acknowledged that they did not wear masks, and the airline did not require mask-wearing in the lobby before boarding. Nor did it require preflight testing, although five of the seven passengers who later tested positive had taken a test, and received a negative result, in the days before boarding.

The researchers found that the passenger whom they believe initiated the outbreak had in fact tested negative, but four or five days before boarding.

“Four or five days is a long time,” Dr. Karan. “You should be asking for results of rapid tests done hours before the flight, ideally.”

Patients who recovered from Covid-19 lined up to be tested again at a hospital in Wuhan, China in March 2020.
Credit…Agence France-Presse — Getty Images

For millions of coronavirus survivors, it’s an increasingly important question: How common, serious and long-lasting are the physical and mental aftereffects of Covid-19?

A new study — believed to be the largest so far in which doctors evaluated patients six months after they became ill — suggests that many people will experience lingering problems like fatigue, insomnia, depression, anxiety or diminished lung function.

The study of 1,733 coronavirus patients who were discharged from a hospital in Wuhan, China, the original epicenter of the pandemic, found that more than three-quarters of them had at least one symptom six months later.

“This is one of the first publications that really describes in some level of detail longer-term outcomes among quite a large group of people,” said Dr. Michael Peluso, an infectious disease physician at the University of California San Francisco, who was not involved in the study. “It documents what people providing clinical care to Covid patients have known for a while now — that a large proportion of people do have long-term health consequences.”

The study, published Friday in the journal Lancet, involved in-person evaluations of people who had been admitted to Jin Yin-tan Hospital for a median of 14 days from Jan. 7 to May 29 last year. The patients, whose median age was 57, were given physical exams, lab tests and a standard measure of endurance and aerobic capacity called a six-minute walk test. They were also interviewed about their health. About 350 of them also underwent lung function tests, chest CT scans and ultrasounds.

The most common issue was ongoing exhaustion or muscle weakness, experienced by 63 percent of the patients. About one-quarter of the patients reported difficulty sleeping and 23 percent said they experienced anxiety or depression.

“It shows that a substantial portion of people, far higher than you would expect in the general population, are exhibiting symptoms that are having an impact,” said Dr. Steven Deeks, a professor of medicine at the University of California, San Francisco, who is leading a study on long-term coronavirus symptoms that will follow patients for up to two years. “And importantly, there’s no specific pathway, there’s multiple different outcomes that occur: mental health stuff and pulmonary stuff and quality-of-life stuff. This provides pretty solid confirmation for what we’re all are seeing.”

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