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Argentina’s President Has Preliminary Positive Virus Test Despite Vaccination

BUENOS AIRES — President Alberto Fernández of Argentina had an initial positive test for Covid-19 and is awaiting the results of a more precise analysis to determine whether he has contracted the coronavirus despite being vaccinated earlier this year.

Mr. Fernández sent a series of tweets early Saturday morning saying he took a quick antigen test after suffering from a “light headache” and having a fever of 99.1 degrees.

The president, who received the test result on his 62d birthday, said he will remain in isolation while waiting for the results of the more rigorous PCR test.

“I am physically well, and although I would have liked to end my birthday without this news, I’m also in good spirits,” the president wrote on Twitter.

an efficacy rate of 91.6 percent, it is fully effective in preventing critical cases.

the institute wrote in a statement on Twitter. “We wish you a quick recovery!”

Word of Mr. Fernández’s test result comes shortly after Argentina tightened its borders amid an upsurge of Covid-19 infections. Several of its neighboring countries, particularly Brazil, are experiencing a sharp increase in cases as new, more contagious variants of the virus engulf the region.

Argentina recently canceled all direct flights with Brazil, Chile and Mexico in an effort to block the new strains.

Argentina was the first country in Latin America to approve the use of the Sputnik V vaccine in late December, but mass inoculations are taking longer than the government had initially predicted amid a global shortage of the vaccine. It has also been administering China’s Sinopharm vaccine and Covishield, the Indian version of the AstraZeneca vaccine.

Of the nation’s 45 million people, 683,771 have received two vaccine doses, and there have been 4.18 million doses injected over all.

Argentina said on March 26 it would delay applying the second dose of the Covid-19 vaccine for three months in an effort to ensure as many people as possible get at least one dose. The country has reported nearly 2.4 million Covid-19 infections and more than 56,000 deaths.

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The C.D.C. and N.I.H. launch a rapid, at-home testing initiative in Tennessee and North Carolina.

The Centers for Disease Control and Prevention and the National Institutes of Health announced a new initiative on Wednesday to help determine whether frequent, widespread use of rapid coronavirus tests slows the spread of the virus.

The program will make rapid at-home antigen tests freely available to every resident of two communities, Pitt County, N.C., and Hamilton County, Tenn., enough for a total of 160,000 people to test themselves for the coronavirus three times a week for a month.

“This effort is precisely what I and others have been calling for nearly a year — widespread, accessible rapid tests to help curb transmission,” said Michael Mina, an epidemiologist at Harvard University who has been a vocal proponent of rapid, at-home testing programs.

He added, “Taking 30 seconds out of your day three times a week to perform the test is something any person can do.”

testing remains essential, public health experts say.

“We have all hypothesized that testing at home, at scale could stop the chain of transmission of the virus and allow communities to discover many more cases,” said Bruce Tromberg, who directs the National Institute of Biomedical Imaging and Bioengineering and leads its rapid acceleration of diagnostics program, which is supplying the tests for the initiative. “All the mathematical models predict that. But this is a real world, real life example.”

Residents who decide to participate in the program can have the tests delivered to their homes or pick them up at local distribution sites. An online tool will guide participants through the testing process and help them interpret their results. Residents can also volunteer to complete surveys that will assess whether frequent testing has changed their behavior, knowledge about Covid-19, or opinions on vaccination.

Researchers at the University of North Carolina and Duke University will compare the test positivity, case and hospitalization rates in these two communities to those in other similar communities that are not participating in the program.

A. David Paltiel, a professor of health policy and management at Yale School of Public Health, called the launching of a real-world study of the effectiveness of rapid, at-home screening “just great news.” But he cautioned that the results will need to be interpreted carefully, especially if the residents who choose to participate in the initiative are not representative of the community at large.

“We know that self-selection tends to bring out the worried well and a disproportionate number of people who are already Covid-conscious or Covid-conscientious,” he said.

“It’ll be great to see how it works when in the hands of people who really care,” he added. But, he said, the results may not be widely generally applicable to screening programs in which participation is mandatory, as may be the case with some workplace and school programs.

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Virus Origins Remain Unclear in W.H.O.-China Inquiry

For 27 days, they searched for clues in Wuhan, visiting hospitals, live animal markets and government laboratories, conducting interviews and pressing Chinese officials for data, but an international team of experts departed the country still far from understanding the origins of the coronavirus pandemic that has killed nearly 2.8 million people worldwide.

The 124-page report of a joint inquiry by the World Health Organization and China — to be released officially on Tuesday but leaked to the media on Monday — contains a glut of new detail but no profound new insights. And it does little to allay Western concerns about the role of the Chinese Communist Party, which is notoriously resistant to outside scrutiny and has at times sought to hinder any investigation by the W.H.O. The report is also not clear on whether China will permit outside experts to keep digging.

“The investigation runs the risk of going nowhere, and we may never find the true origins of the virus,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

The report, an advance copy of which was obtained by The New York Times, says that China still does not have the data or research to indicate how or when the virus began spreading. Some skeptics outside the country say that China may have more information than it admits.

new inquiry into the origin of the pandemic. They said such an inquiry should consider the possibility that the virus escaped from a laboratory in Wuhan or infected someone inside it.

The lab leak theory has been promoted by some officials in the Trump administration, including Dr. Robert Redfield, the former director of the Centers for Disease Control and Prevention, in comments to CNN last week. He offered no evidence and emphasized that it was his opinion; the theory has been widely dismissed by scientists and U.S. intelligence officials.

Matt Apuzzo and Apoorva Mandavilli contributed reporting. Albee Zhang contributed research.

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Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic was gaining a foothold and medical facilities were shutting down, the center where she goes canceled her appointment. No one could tell her when to reschedule.

“They just said keep calling back, keep calling back,” said Ms. Lowery, 59, who lives in Rock Hill, S.C.

In August, Ms. Lowery felt a lump under her arm but still couldn’t get an appointment until October.

Eventually, she received a diagnosis of Stage 2 breast cancer, started chemotherapy in November and had a double mastectomy this month.

an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

“We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.

While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease.

“There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,” said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, over all, these missed screenings resulted in more patients with later-stage cancers.

And even though the numbers of mammograms and colonoscopies have rebounded in recent months, many people with cancer remain undiagnosed, doctors are reporting.

Some patients, like Ms. Lowery, could not easily get an appointment once clinics reopened because of pent-up demand. Others skipped regular testing or ignored worrisome symptoms because they were afraid of getting infected or after losing their jobs, they couldn’t afford the cost of a test.

“The fear of Covid was more tangible than the fear of missing a screen that detected cancer,” said Dr. Patrick I. Borgen, the chair of surgery at the Maimonides Medical Center in Brooklyn who also leads its breast center. His hospital treated such large numbers of coronavirus patients early on that “we’re now associated as the Covid hospital,” he said, and healthy people stayed away to avoid contagion.

Even patients at high risk because of their genetic makeup or because they previously had cancer have missed critical screenings. Dr. Ritu Salani, the director of gynecologic oncology at the UCLA Health Jonsson Comprehensive Cancer Center said one woman, who was at risk for colon cancer, had a negative test in 2019 but didn’t go for her usual screening last year because of the pandemic.

When she went to see her doctor, she had advanced cancer. “It’s just a devastating story,” Dr. Salani said. “Screening tests are really designed when patients aren’t feeling bad.”

Ryan Bellamy felt no hurry last spring to reschedule a canceled colonoscopy, even though the presence of blood in his stool had prompted him to look up symptoms. “I really didn’t want to go to the hospital,” Mr. Bellamy said. He decided it was unlikely he had cancer. “They’re not following up with me so I’m OK with Googling,” he told himself.

A resident of Palm Coast, Fla., Mr. Bellamy said that after his symptoms worsened, his wife insisted that he go for testing in December, and he had a colonoscopy in late January. With a new diagnosis of Stage 3 rectal cancer, Mr. Bellamy, 38, is undergoing radiation treatment and chemotherapy.

Colon screening remained significantly lower in 2020, declining about 15 percent from 2019 levels, according to the Epic network data, although overall screenings were down 6 percent. The analysis looked at screenings for more than 600 hospitals in 41 states.

Lung cancer patients have also delayed seeking appropriate care, said Dr. Michael J. Liptay, chairman of cardiovascular and thoracic surgery at Rush University Medical Center in Chicago. One patient had imaging that showed a spot on his lung, and he was supposed to follow up, just as the pandemic hit. “Additional work-up and care was deferred,” Dr. Liptay said. By the time the patient was fully evaluated, the cancer had increased in size. “It wasn’t a good thing to wait 10 months,” Dr. Liptay said, although he was uncertain whether earlier treatment would have changed the patient’s prognosis.

Just as previous economic recessions led people to forgo medical care, the downturn in the economy during the pandemic has also discouraged many people from seeking help or treatment.

“We know cancers are out there,” said Dr. Barbara L. McAneny, the chief executive of New Mexico Oncology Hematology Consultants. Many of her patients are staying away, even if they have insurance, because they cannot afford the deductibles or co-payments. “We’re seeing that, particularly with our poorer folks who are living on the edge anyway, living paycheck to paycheck,” she said.

Some patients ignored their symptoms as long as they could. Last March, Sandy Prieto, a school librarian who lived in Fowler, Calif., had stomach pain. But she refused to go to the doctor because she didn’t want to get Covid. After having a telehealth visit with her primary care doctor, she tried over-the-counter medications, but they didn’t help with the pain and nausea. She continued to decline.

“It got to the point where we didn’t have a choice,” said her husband, Eric, who had repeatedly urged her to go to the doctor. Jaundiced and in severe discomfort, she went to the emergency room at the end of May and was given a diagnosis of Stage 4 pancreatic cancer. She died in September.

“If it wasn’t for Covid and we could have gotten her some place earlier, she would still be with us today,” said her sister, Carolann Meme, who had tried to persuade Ms. Prieto to go to an academic medical center where she might have gotten into a clinical trial.

When patients like Ms. Prieto are not seen in person but treated virtually, doctors may easily miss important symptoms or recommend medication rather than tell them to come in, said Dr. Ravi D. Rao, the oncologist who treated Ms. Prieto. Patients may downplay how sick they feel or neglect to mention the pain in their hip, he said.

“In my mind, telemedicine and cancer don’t travel together,” Dr. Rao said. While he also made use of telemedicine during the height of the pandemic, he says he worked to keep his offices open.

Other doctors defended the use of virtual visits as a critical tool when office visits were too hazardous for most patients and staff. “We were grateful to have a robust telemedicine effort when people simply couldn’t come into the center,” said Dr. Borgen of Maimonides. But he acknowledged that patients were frequently reluctant to discuss their symptoms during a telehealth session, especially a mother whose young children could be listening to what they were saying. “It’s not private,” he noted.

Some health networks say they took aggressive steps to try to counteract the effects of the pandemic. During the initial stay-at-home order last year, Kaiser Permanente, the large California-based managed care outfit, spotted a declining number of breast cancer screenings and diagnoses in the northern part of the state. “Doctors immediately got together” to begin contacting patients, said Dr. Tatjana Kolevska, medical director for the Kaiser Permanente National Cancer Excellence Program.

Kaiser also relies on its electronic health records to make appointments for women who are overdue for their mammograms when they book an appointment with their primary care doctor or even want to get a prescription for new glasses.

While Dr. Kolevska says she is waiting to see data for the system as a whole, she has been encouraged by the number of patients in her practice who are now up to date with their mammograms.

“All of those things put in place have helped tremendously,” she said.

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Coronavirus Reinfections Are Rare, Danish Researchers Report

The vast majority of people who recover from Covid-19 remain shielded from the virus for at least six months, researchers reported on Wednesday in a large study from Denmark.

Prior infection with the coronavirus reduced the chances of a second bout by about 80 percent in people under 65, but only by about half in those older than 65. But those results, published in the journal Lancet, were tempered by many caveats.

The number of infected older people in the study was small. The researchers did not have any information beyond the test results, so it’s possible that only people who were mildly ill the first time became infected again and that the second infections were largely symptom-free.

Scientists have said that reinfections are likely to be asymptomatic or mild because the immune system will suppress the virus before it can do much damage. The researchers also did not assess the possibility of reinfection with newer variants of the virus.

fishing trawler in Seattle, Marine Corps recruits in South Carolina, health care workers in Britain and patients at clinics in the United States.

The new study’s design and size benefited from Denmark’s free and abundant testing for the coronavirus. Nearly 70 percent of the country’s population was tested for the virus in 2020.

The researchers looked at the results from 11,068 people who tested positive for the coronavirus during the first wave in Denmark between March and May 2020. During the second wave, from September to December, 72 of those people, or 0.65 percent, again tested positive, compared with 3.27 percent of people who became infected for the first time.

That translates to a 80 percent protection from the virus in those who had been infected before. The protection fell to 47 percent for those over 65. The team also analyzed test results from nearly 2.5 million people throughout the epidemic, some longer than seven months after the first infection, and found similar results.

“It was really nice to see that there was no difference in protection from reinfection over time,” said Marion Pepper, an immunologist at the University of Washington in Seattle.

She and other experts noted that while 80 percent might not seem superb, protection from symptomatic illness was likely to be higher. The analysis included anyone who was tested, regardless of symptoms.

“A lot of these will be asymptomatic infections, and a lot of these will likely be people who have a blip of virus,” noted Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York. “Eighty percent risk reduction against asymptomatic infection is great.”

The findings indicate that people who have recovered from Covid-19 should get at least one dose of a coronavirus vaccine to boost the level of protection, Dr. Krammer added. Most people produce robust immune response to a natural infection, “but there’s a lot of variability,” he said. Following vaccination, “we don’t see variability — we see very high responses in basically everybody, with very few exceptions.”

Experts were less convinced by the results in people over 65, saying the findings would have been more robust if the analysis had included more people from that age group.

“I wish it had actually been broken down into specific decades over 65,” Dr. Pepper said. “It would be nice to know whether the majority of people who were getting reinfected were over 80.”

The immune system grows progressively weaker with age, and people over 80 typically mount weak responses to infection with a virus. The lower protection in older people seen in the study is consistent with those observations, said Akiko Iwasaki, an immunologist at Yale University.

“I think we kind of tend to forget how the vaccines have been pretty amazing in offering protection in this age group, because you can see that natural infection doesn’t confer the same kind of protection,” she said. “This really does emphasize the need to cover older people with the vaccine, even if they have had Covid first.”

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A $22,368 Bill That Dodged and Weaved to Find a Gap in America’s Health System

John Druschitz spent five days in a Texas hospital last April with fever and shortness of breath. It was still the early days of the pandemic, and doctors puzzled over a diagnosis.

They initially suspected coronavirus and hung signs outside his door warning those entering to wear protective equipment. Mr. Druschitz had already spent two weeks at home with worsening symptoms. He recalls one doctor telling him, “This is what it does to a person.”

Ensuing lab work, however, was ambiguous: Multiple molecular tests for coronavirus came back negative, but an antibody test was positive.

Doctors found that Mr. Druschitz had an irregular heartbeat and blood clots in both his lungs. They sent him home on oxygen, and ultimately did not give a coronavirus diagnosis because of the negative tests. He didn’t think much about the decision until this fall, when he received a $22,367.81 bill that the hospital has since threatened to send to collections.

too narrow, and for covering bills only where coronavirus is the primary diagnosis. A patient with a primary diagnosis of respiratory failure and a secondary diagnosis of coronavirus would not qualify, for example.

The Health Resources and Services Administration, which runs the federal fund, does not have plans to change that policy. So far, it has spent $2 billion to reimburse health care providers for the bills of uninsured coronavirus patients.

“The H.R.S.A. uninsured program is a voluntary claims program, not an insurance program,” said Martin Kramer, an agency spokesman. “The scope is narrow, and its primary function is to help combat Covid-19 by removing financial barriers.”

The hospital that treated Mr. Druschitz — the Baylor, Scott and White Medical Center in Austin, Texas — did not submit his charges for reimbursement because of the negative coronavirus tests, said Julie Smith, a spokeswoman.

“The nucleic amplification Covid-19 test is the standard to diagnose or rule out Covid-19,” she said in an email. “Because the diagnosis for this admission was not Covid-19, his hospital stay is not eligible.”

The positive antibody test, she said, “may indicate a previous infection.”

The hospital has submitted other claims to the uninsured fund, and has so far received a quarter-million dollars in reimbursement. It has applied a 40 percent uninsured discount to Mr. Druschitz’s $34,058 charge. It’s not clear from his billing codes whether the hospital is pursuing him for a larger amount than what the federal fund for uninsured people would have paid.

Multiple clinicians with expertise in Covid-19 reviewed Mr. Druschitz’s medical records for The New York Times. They said that his case was ambiguous: It wasn’t completely clear whether coronavirus had caused his symptoms.

“There is a good chance that he did have Covid-19, and I base that on the fact that his symptoms are consistent with that diagnosis,” said Dr. Alexander McAdam, an associate professor of pathology at Harvard. “The lab data, however, don’t definitively demonstrate that.”

Dr. McAdam was not surprised that a Covid test at the hospital could come back negative even when Mr. Druschitz was very ill.

“People can have persistent symptoms even after the virus is no longer detectable,” he said. “It could be the virus is now in the lower respiratory tract but not the upper,” meaning it might not show up on a test.

But he and Dr. Jha, who also reviewed the records, said they would have expected an earlier test, conducted 10 days before his hospital stay, to be positive. It would be unusual for a test to be negative at that point, as Mr. Druschitz’s was, when he was already symptomatic.

“It’s more likely than not that he did not have Covid, but it’s certainly not a zero chance,” Dr. Jha said. “The fact that it will end up making a big difference in the bill is really problematic.”

Mr. Druschitz’s primary care provider, Dr. Craig Kopecky, who saw him shortly before and after the hospital visit, says that the diagnosis is wrong and that his patient did have coronavirus.

Dr. Kopecky initially suspected bronchitis when Mr. Druschitz came to his office in mid-April with a cough and some shortness of breath. He began to suspect Covid in a follow-up telemedicine visit 10 days later.

“At that point he’d started to lose some of his sense of taste,” he said. “I couldn’t examine him because it was telemedicine, but I could clearly hear him struggling to breathe.”

Dr. Kopecky submitted his bills for Mr. Druschitz’s treatment to the federal fund for uninsured patients, and said he received reimbursement.

The patient advocate that Mr. Druschitz retained, Jan Stone of StoneWorks Healthcare Advocates, has asked the hospital to re-evaluate the diagnosis. She’s now running up against a deadline: Hospitals have one year to submit claims to the uninsured fund. This means the hospital would need to file for reimbursement within the next six weeks.

“The clock is definitely ticking,” she said.

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