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Coronavirus Case Reached France in December, Doctors Find: Live Updates - The New York Times

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Credit...Dmitry Kostyukov for The New York Times

One of France’s first coronavirus cases may have been in December, about a month before the outbreak officially started in Europe, French doctors reported this week after retesting a patient’s samples.

The case pushes up the timeline of the emergence of the disease in France by over a month, to before China had even alerted the World Health Organization about the coronavirus within its own borders.

The detection of the confirmed case earlier than anyone knew the disease was active in the country follows similar instances across the world — including in the United States, where deaths were identified as caused by the disease weeks earlier than first reported and a model suggested that silent outbreaks had spread for weeks before detection.

The case also implies that person-to-person transmission was taking place in Europe far earlier than previously known, making even more clear that measures to contain the disease both in China and Europe were hopelessly late.

Dr. Yves Cohen, the head of intensive care at the Avicenne and Jean Verdier hospitals, in the northern suburbs of Paris, said on Sunday that his staff had decided to test samples from patients diagnosed with atypical pneumonia in December and January for the coronavirus.

At the time, the patients were checked for seasonal flu and for other coronaviruses, but not for the new coronavirus, which was little known and not thought to have reached Europe. Dr. Cohen told the BFM TV news channel that they detected one case of Covid-19 from a Dec. 27 sample, adding that staff had tested it several times to rule out a false positive.

The patient, a 42-year-old man born in Algeria who has lived in France for many years, had not been abroad since August, according to Dr. Cohen and others in their study, pre-proofed for publication in the International Journal of Antimicrobial Agents.

“He could be patient zero, but maybe there were others in other regions,” Dr. Cohen said.

It is not yet entirely clear how the man caught the infection. But experts have long suspected that the coronavirus may have spread internationally before the first officially reported cases.

The regional health authority for Ile-de-France, which contains the Avicenne and Jean Verdier hospitals, said on Tuesday that it was in touch with the doctors who worked on the case and that the government’s strategy to fight the outbreak remain unchanged, although it added that further investigations could be carried out “if necessary.”

France’s national health authority and the Ile-de-France hospital system did not immediately respond to a request for comment.

Experts also warned that the case could not be directly tied to France’s current outbreak without a genomic analysis.

“One really has to make a distinction between the epidemic wave and isolated cases,” Samuel Alizon, an infectious diseases and epidemics specialist at the CNRS, France’s national public research organization, said in a telephone interview. “It is quite possible that there were isolated cases that led to transmission chains that died down.”

Mr. Alizon said it was common for epidemics imported from abroad into a given country to undergo several false starts, with transmission chains that died down on their own before one of the imported cases led to an actual epidemic.

“So the question is more: how many importation events did it take to launch the epidemic wave?” he said.

Just as President Trump has extolled the promise of a malaria drug in the desperate hunt for coronavirus treatments, Japan’s prime minister, Shinzo Abe, was selling the world on a pale yellow pill that he said could be crucial to fighting the pandemic.

Mr. Abe has pushed the homegrown drug, an antiviral medicine known as Avigan, in news conferences and in meetings with world leaders, including a call with Mr. Trump and the other heads of the Group of 7. He has allocated nearly $130 million to triple a stockpile of the medication. And he has offered to provide it free to dozens of other countries.

The prime minister, however, has glossed over one crucial fact: There is no solid evidence that Avigan works against Covid-19. While it has shown potential for treating some deadly diseases like Ebola in animal studies, there are limited findings that it works for any illness in humans.

What Avigan, whose generic name is favipiravir, does have is a peculiar regulatory history and one dangerous potential side effect — birth defects. Mr. Abe himself noted in a news conference on Monday that the side effect was “the same as thalidomide,” which caused deformities in thousands of babies in the 1950s and ’60s.

His pitches for the medication, like Mr. Trump’s testimonials for the antimalarial medicine hydroxychloroquine, are adding to concerns that national leaders could warp drug approval processes.

The Indian government is set to begin an enormous repatriation mission using jumbo jets and naval warships to rescue thousands of Indian citizens stranded in other countries, especially in the Persian Gulf.

Flights are scheduled to start Thursday. Only passengers without coronavirus symptoms will be allowed to travel, the Indian government said.

The country has so far been spared a high death toll, and remains cautious about letting in foreigners or Indians from abroad. India was one of the first major countries to shut down all international flights.

Millions of Indians work in the Arab world — particularly in the oil-rich countries of the gulf, also known as Arabian Gulf — and many have lost their jobs in recent weeks as Arab economies have contracted under lockdown.

“We have been getting distress calls from the Gulf,” said Mahesh Kumar, a spokesman for India’s foreign ministry.

Indian media reported that more than 150,000 Indians in the United Arab Emirates have asked to be evacuated and that several large naval warships have already been dispatched to the United Arab Emirates and the Maldives.

Upon arrival, the returnees would be quarantined for 14 days.

There are also thousands of Indians studying abroad, including many in Europe and the United States, who want to come home.

“With universities and colleges closed, they have few options left,” Mr. Kumar said.

This spring, Beijing energetically promoted its exports and overseas donations of medical supplies and asked foreign politicians to thank China publicly for the shipments. But a study released on Tuesday found that the shipments were slow to get started.

By mid-March, China was already pursuing “mask diplomacy” after an ambitious, nationwide mobilization of medical supply production through February. The study, however, cast doubt on whether the humanitarian aid blitz really took place, since China’s exports were down in March from a year earlier.

The tonnage of China’s net exports of respirators and surgical masks was down 5 percent in March from the same month a year earlier, according to an analysis by Chad Bown, a trade specialist at the Peterson Institute for International Economics in Washington.

The analysis, based on Beijing’s own customs data, also found that China cut way back on exports of medical supplies in January and February and stepped up imports in those months.

China locked down the city of Wuhan in response to the virus on Jan. 23, and waged a national “war” on the novel coronavirus through February while much of the rest of the world was not yet aware of the extent of the virus’s spread.

But Mr. Bown’s study did not include China’s exports of medical supplies in April, for which official data is not yet available. China continued to promote these exports last month, although complaints from foreign governments about defective products prompted Beijing to institute time-consuming quality checks on April 10 that delayed many shipments.

As the pandemic lengthens from weeks into months, reminders of the continuing threat have become a part of normal life, even in countries that are beginning to open up: school cafeterias divided by plastic partitions, sports matches played in empty arenas, and “travel bubbles” between countries with few cases.

As of Tuesday, the confirmed death toll has surpassed 250,000, the number of new infections was still steadily rising in many parts of the world, with more than 3.5 million confirmed cases, and fears that the crisis will escalate had not ebbed.

In the United States, where President Trump is pressing for states to reopen their economies, his administration is privately projecting a steady rise in the number of coronavirus cases and deaths over the next several weeks.

According to an internal document obtained by The New York Times, the death toll will reach about 3,000 a day on June 1, a 70 percent increase from the current figure, about 1,750 a day.

Frightening details have also emerged about the broader health implications of the virus. New York City doctors raised the alarm on Monday after 15 children, many of whom had the coronavirus, were recently hospitalized with symptoms associated with toxic shock or Kawasaki disease, a rare illness in children that involves inflammation of the blood vessels, including coronary arteries.

Pediatricians in several European countries, including Italy, Britain, France and Spain, have reported dozens of cases of children showing such symptoms, but doctors have said it is too early to link them to the coronavirus. They have, however, been asked to begin collecting case studies.

But even as the cases raised concerns for children, some countries are reimagining what education in the coronavirus-era would look like. In South Korea, which is preparing for students to return to classrooms after reporting fewer than 15 new cases per day for the last two weeks, that meant installing plastic partitions on tables in school cafeterias this week.

In Spain, where the return to school had already been pushed back until after the summer, the government is now preparing to halve the number of students allowed inside the classroom at the start of the coming school year.

It’s not just schools that will look different. Sports events have been canceled across much of the world, and the authorities are trying to reconcile the requirements of halting a pandemic with the usually packed stadiums and arenas where many teams play.

In Taiwan and South Korea, which have both been out front in controlling their national outbreaks, professional baseball seasons have begun, but with one element missing: the crowds.

Instead, the stands are filled with fake spectators, and the locker rooms are stocked with bottles of sanitizer.

A fund-raising conference on Monday organized by the European Union brought pledges from countries around the world — including Japan, Canada, Australia and Norway — to fund laboratories that have promising leads in developing and producing a vaccine.

Prime ministers, a king, a prince and Madonna all chipped in to an $8 billion pot to fund a coronavirus vaccine, but President Trump skipped the chance to contribute. Officials in his administration noted that the United States is pouring billions of dollars into its own research efforts.

For more than three hours, one by one, global leaders said a few words over video link and offered their nations’ contribution, small or large, whatever they could muster. For Romania, it was $200,000. For Canada, $850 million. The biggest contributors were the European Union and Norway, with each pledging one billion euros, or $1.1 billion.

The details of how the money raised will be distributed remain to be sorted out. The European Commission, the executive branch of the European Union that spearheaded the initiative, said the money would be spent over the next two years to support promising initiatives around the globe. The ultimate goal is to deliver universal and affordable access to medication to fight Covid-19, the disease caused by the coronavirus.

The multilateral effort stood in sharp contrast to the solo road the United States is on as scientists everywhere scramble to develop a vaccine to stop the virus that has ravaged most parts of the globe, leaving 250,000 dead so far.

In Washington on Monday, senior Trump administration officials sought to talk up American contributions to coronavirus vaccine efforts worldwide, but did not explain the United States’ absence at the European-organized conference.

The U.S. government has spent money on vaccine research and development, including $2.6 billion through the Biomedical Advanced Research and Development Authority, an arm of the Health and Human Services Department. Jim Richardson, the State Department’s director of foreign assistance, said American companies had also provided $7 billion so far toward a coronavirus vaccine and treatment.

And the United States was not the world’s only major power to be absent from the teleconference. Russia, too, did not participate.

China, where the virus originated, was represented by its ambassador to the European Union and made no financial pledge.

Leaders in China are desperate to protect their people and deflect growing international criticism of how it has handled the coronavirus, wants to come out on top in the race to find a coronavirus vaccine — and by some measures it is doing so.

The country has slashed red tape and offered resources to drug companies in a bid to empower the country’s vaccine industry. Four Chinese companies have begun testing their vaccine candidates on humans, more than the United States and Britain combined.

Lines nearly a mile long. Police officers thumping shoppers with sticks. Gates suddenly slamming shut.

These were the scenes playing out as chaos erupted at liquor stores in India, allowed to open for the first time in six weeks since the government imposed one of the strictest coronavirus lockdowns anywhere in the world.

Firoz Alam, an out-of-work factory worker, had been waiting for five hours on Tuesday to buy a bottle of whiskey from a Delhi shop. He said he hadn’t had a drink for weeks.

“I haven’t been able to sleep well lately,” he explained. “So I just wanted to buy some liquor and sleep for a couple hours.”

But his dry spell was destined to continue. Police officers summarily closed the liquor shop, as they have done at many locations, because the crowd was too big and getting out of control.

“That’s not good,” Mr. Alam said. “We’re not like the rich people who can get this through the black market.”

Starting Monday, India’s central government permitted liquor shops to reopen outside virus hot spots as long there were no crowds and people maintained social distance. But in some places, lines snaked for more than a kilometer. Picture thousands of men, pressed together, cheek by jowl, eager for a drink.

“Why are you out of line? Maintain your distance! Go away!” a clearly frustrated police officer at another shop in Delhi yelled as he lashed out with a long wooden stick.

Officials in the southern state of Kerala opted to keep liquor shops shut entirely, fearing that the risk was still too high. India’s states have some autonomy to set their own standards as long as they do not undermine the national lockdown rules. A couple of states in the northeast had allowed alcohol sales for a few days in April before the central government cracked down.

In India, liquor taxes are a crucial source of government revenue. By Tuesday some states had imposed “a special corona fee,” hiking alcohol prices by 50 to 70 percent.

With sports events canceled across much of the world because of the coronavirus pandemic, Taiwan and South Korea, which have both been world leaders in controlling the outbreak, are pushing forward with the rarest of spectacles: a professional baseball season.

South Korea’s season starts Tuesday, while Taiwan got underway last month. To adapt the game to the coronavirus age, live spectators are banned. The relative quiet makes the games now feel more like practice rather than the typically raucous regular season competitions.

In Taiwan, the stands are filled with fake spectators instead of real ones, locker rooms stocked with bottles of sanitizer, and players and coaches urged to keep a distance.

Chewing sunflower seeds is frowned upon — what would one do with the shells? Players are encouraged to bump elbows rather than give each other high-fives.

Players and coaches say they feel fortunate to be able to host games at all when many cities in the world remain under lockdown.

“We know many people are still keeping their eyes on us, even though there are no fans,” said Chiu Chang-Jung, the manager of the CTBC Brothers team, which on Saturday took on the Rakuten Monkeys at the stadium in Taoyuan, about 30 miles west of Taiwan’s capital, Taipei. “Playing these games is a very lucky and blessed thing.”

For a while, as the pandemic worsened, Queen Elizabeth II appealed for solidarity, and a seriously ill Prime Minister Boris Johnson was hospitalized, relations between Britain’s government and its news media got a bit less testy.

That’s over.

The culture minister recently accused the BBC of bias in reporting on the shortage of protective gear in hospitals. The health secretary heatedly claimed that The Sunday Times of London had misstated policy on shielding older people.

And 10 Downing Street has posted lengthy rebuttals, by unnamed officials, of newspaper articles that detailed its missteps in dealing with the outbreak.

Mr. Johnson has opened his daily briefings to questions and comments from members of the public as well as the press corps, making the famously sharp-tongued British reporters seem meaner by comparison.

“It positions the government and the public against the media, at the very moment that the media is presenting itself as the representative of the people in holding the government to account,” said Meera Selva, the director of the Reuters Journalism Fellowship Program at Oxford University.

The government was on the defensive in March and into April, amid revelations of testing foul-ups, shortages of protective gear, a fast-rising death toll and the inadequacy of its relaxed initial approach to social distancing, which forced a sharp policy turn. Then came Mr. Johnson’s personal ordeal and weeklong hospital stay, winning some sympathy.

The criticism has not abated, but now that Mr. Johnson and his allies have ramped up testing and declared that the worst is over, they have gone back on the offensive with the media, trying to put any talk of failure behind them. It is a return to a pugnacious populism that has served them well in the past.

But Andrea Ammon, director of the European Center for Disease Prevention and Control, contradicted the claim that the worst was over during a Monday news conference, when she said that Britain was one of four European nations that had seen “no substantial changes” in the past two weeks.

Ms. Ammon said that, as of Saturday, the wave of transmission in Europe had seemingly passed its peak with the exception of Bulgaria, where numbers were still increasing, and Poland, Romania, Sweden, and Britain, where there had been no substantial decrease or change.

Researchers at two Harvard-affiliated hospitals are adapting a proven form of gene therapy to develop a coronavirus vaccine, which they expect to test in people later this year, they announced on Monday.

Their work employs a method already used in gene therapy for two inherited diseases, including a form of blindness: It uses a harmless virus as a vector, or carrier, to bring DNA into the patient’s cells. In this case, the DNA should instruct the cells to make a coronavirus protein that would stimulate the immune system to fight off future infections.

So far, the team has studied its vaccine candidates only in mice. Tests for safety and potency in monkeys should begin within a month or so at another academic center, the researchers said. But two of seven promising versions are already being manufactured for studies in humans.

At this early stage, Dr. Luk H. Vandenberghe, director of the Grousbeck Gene Therapy Center at Massachusetts Eye and Ear, estimates the manufacturing cost per dose of vaccine to be from $2.50 to $250.

“We are presenting a different angle from everybody else,” Dr. Vandenberghe, director said. Several other vaccine projects involve viral vectors, but no others use adeno-associated viruses.

The approach has several advantages, he added.

One is that the type of vector, an adeno-associated virus, or AAV, is a harmless virus that is already used in two approved forms of gene therapy and has been tested in many patients and found to be safe. Another plus is that the technique requires very small amounts of the vector and DNA to produce immunity, so the yield of doses would be high. In addition, many drug and biotech companies, large and small, already produce adeno-associated virus and could easily switch to producing the form needed for the vaccine.

The research is one of at least 90 vaccine projects speeding ahead around the world in desperate efforts that hold the best and probably only hope of stopping or at least slowing the pandemic.

One potential problem that every vaccine project will be on the lookout for is disease enhancement: the possibility that a vaccine, instead of preventing infection, could actually make the disease worse.

The two scientists said the many research groups forging ahead with vaccine projects were racing not against one another, but against the coronavirus.

Credit...via Ben Becher

The generation that endured Nazi death camps is especially vulnerable to the pandemic.

The New York area is home to just under 40,000 Holocaust survivors, down from nearly twice that many in 2011, according to Selfhelp Community Services, which serves Nazi victims. Now those survivors, mostly in their 80s and 90s, face a new menace that targets people like them.

“This pandemic is the greatest threat to this generation since the Second World War,” said Stephen D. Smith, executive director of the USC Shoah Foundation, which interviews survivors of genocide.

In New York State, the coronavirus has killed more than twice as many people age 80 and up as it has people under 60.

One got out of Nazi Germany on a Kindertransport train to Sweden, never again seeing his parents, who were exterminated in the death camps. One survived two notorious concentration camps, Auschwitz and Bergen-Belsen, and was discovered by British troops on a pile of bodies, half-dead with typhus. One endured freezing temperatures and near starvation in a slave-labor camp in Siberia.

Last month, all three died by the same tiny microorganism, isolated once more from their family members.

And for survivors who have eluded the virus, memories of that dark time, never far out of mind, find new salience in the present plague.

For Diana Kurz, 83, who escaped Vienna with her mother when she was 4 years old, said the coronavirus reminded her of those years in Vienna, when any random encounter might be deadly.

“I guess I picked that up as a child,” she said, “that feeling of dread all the time. That’s what it is like now. You never know if other people on the street are going to give you the virus, or were going to turn you in to the Gestapo because you were a Jew.”

For months, Japanese clinics have been reporting data about the coronavirus to the authorities using fax machines.

That will change on May 17, when medical facilities across the country will be able to report through online portals, streamlining a process that doctors have complained is stuck in the last millennium.

In a country where warehouse workers use mechanized exoskeletons to lift heavy packages and a chart-topping pop singer is a hologram, many in Japan are frustrated and perplexed by the government’s insistence on using old technologies for a wide range of bureaucratic tasks.

The coronavirus is forcing a reckoning with Japan’s paper-hungry working practices — most notably the use of the hanko, a seal stamped on official documents.

The move from paper to pixels seems to have been driven by one doctor’s angst-ridden tweet, lamenting the difficulty of sharing information with the government.

On April 23, pulmonologist Kyuto Tanaka posted on Twitter, “Let’s stop already… handwriting outbreak reports… someone needs to draw attention to this loudly,” along with a copy of the form.

The message received more than 25,000 likes. The most important one came from Defense Minister Taro Kono, who directed it to the attention of Masaaki Taira, a deputy cabinet minister for information technology policy, among other roles.

Within a week, Mr. Taira announced that the process would be moved online.

Australia and New Zealand are moving closer toward creating a “travel bubble” that would allow people to fly between the two countries without quarantines — a resumption of traffic that would be a boost for both countries’ economies.

Prime Minister Jacinda Ardern of New Zealand, who joined Australia’s cabinet meeting on Tuesday to discuss the steps required, said on Monday that the move would depend on continued progress in testing and tracing of coronavirus infections in both countries. That could take weeks or months.

But she emphasized that the prospect of revived travel reflected the shared success of Australia and New Zealand, which have crushed the peaks of their initial outbreaks faster than expected.

“Both our countries’ strong record of fighting the virus has placed us in the enviable position of being able to plan the next stage in our economic rebuild,” she said.

Ms. Ardern and Prime Minister Scott Morrison of Australia told reporters on Tuesday that the ‘bubble’ is an important part of the road back to normalcy for both nations.

Such a travel arrangement could potentially be extended into the Pacific — Fiji has only a handful of reported cases and zero deaths. And plans are also being laid for limited travel between other countries that have controlled the spread of infection.

China and South Korea began easing quarantine requirements for some business travelers on Friday. A day later, trade ministers from Australia, Canada, South Korea, New Zealand and Singapore agreed to a collective effort to resume the flow of not just goods and services, but also people traveling “for purposes such as maintaining global supply chains, including essential business travel,” according to a joint statement.

Public health experts say that any resumption of travel comes with risks, but they also note that conditions vary by country. Travelers from the United States, the main source of coronavirus infections in Australia, may have to wait far longer to book flights around the world without being subject to 14-day quarantines.

The Carnival Corporation, the giant cruise company widely criticized for its handling of the coronavirus pandemic, announced on Monday that some of its ships may begin sailing again as soon as August.

For months, lawmakers and epidemiologists have blamed Carnival for failing to contain outbreaks on its ships and spreading the virus across the world. Its response to the pandemic is the subject of a criminal investigation by the Australian police and a congressional investigation in the United States.

Despite that growing scrutiny, the company’s flagship cruise line said that eight of its ships could begin sailing on Aug. 1, about a week after a government order banning cruises in the United States is set to expire.

It would be only a partial reopening, and the timing could change as the company devises new safety protocols for its cruises. The eight ships that are slated to return to service are a small portion of the Carnival Corporation’s fleet of 105 vessels. Carnival Cruise Line said voyages on several of its other ships would be canceled through the beginning of October.

After a series of deadly outbreaks, critics of the cruise industry remain skeptical that the companies have the medical expertise to curb the spread of the coronavirus, which has sickened hundreds of cruise passengers over the last four months.

Last month, the U.S. Centers for Disease Control and Prevention extended its “no sail order,” banning all cruise travel in the United States until July 24. A C.D.C. spokeswoman, Caitlin Shockey, said the agency has not consulted with any of the cruise companies on the timeline for restarting cruises.

In February and March, the Carnival Corporation fumbled its response to outbreaks on several ships, including the Diamond Princess, where eight people died and more than 700 were infected.

Since the coronavirus started spreading in Asia, the Carnival Corporation has been at the center of the pandemic, with outbreaks on at least seven of its ships.

Reporting was contributed by Jeffrey Gettleman, Sameer Yasir, Raphael Minder, David Yaffe-Bellany, Kai Schultz, Keith Bradsher, Aurelien Breeden, Ben Dooley, Choe Sang-Hun, Elian Peltier, Megan Specia, Iliana Magra, Mark Landler, Stephen Castle, Andrew Keh, Javier C. Hernández, Damien Cave, Andrew E. Kramer, Denise Grady, Matina Stevis-Gridneff, Lara Jakes and John Leland.

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