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CDC is aware of recent reports of suspected cases of SARS-CoV-2 reinfection among persons who were previously diagnosed with COVID-19 [1–3]. There is currently no widely accepted definition of what constitutes SARS-CoV-2 reinfection and the reports use different testing methods, making reinfection diagnoses difficult. To develop a common understanding of what constitutes SARS-CoV-2 reinfection, CDC proposes using both
1) investigative criteria for identifying cases with a higher index of suspicion for reinfection and2) genomic testing of paired specimens.
CDC examined appropriate time periods following initial SARS-CoV-2 infection or illness to investigate reinfection. Since August 2020, CDC has recommended against the need for retesting persons with asymptomatic infection within 90 days of first SARS-CoV-2 infection or illness because evidence to date suggests that reinfection does not occur within this time window (CDC Guidance on Duration of Isolation and Precautions for Adults with COVID-19).
At this time, we propose two time windows for investigation as listed below:
For persons with or without COVID-19–like symptoms ≥90 days after initial infection/illness; and
For persons with COVID-19–like symptoms 45–89 days after initial infection/illness.
For persons with detection of SARS-CoV-2 RNA from a respiratory specimen ≥90 days after their first laboratory-confirmed SARS-CoV-2 infection/illness, we apply a standard set of criteria detailed below. Investigating highly suspicious COVID-19–like cases in the 45–89-day window is also important. However, we propose stricter criteria to select cases in this earlier timeframe using a higher index of suspicion for reinfection. If evidence of reinfection during this time window is identified, it will further inform future prevention efforts and guideline development.
CDC notes that SARS-CoV-2 reinfection is a rapidly evolving area of research. This initial set of proposed criteria might not capture all instances of reinfection; we offer these initial investigative criteria in an effort to better understand the potential for reinfection. This initial set of proposed criteria will be refined if new evidence suggests other avenues of investigation, with the goal of creating a standardized case definition of SARS-CoV-2 reinfection.
Investigate cases that meet criterion A or B

For persons with detection of SARS-CoV-2 RNA ≥90 days since first SARS-CoV-2 infectionPersons with detection of SARS-CoV-2 RNA* ≥90 days after the first detection of SARS-CoV-2 RNA, whether or not symptoms were presentANDPaired respiratory specimens (one from each infection episode) are available*If detected by RT-PCR, only include if Ct value 30 with 99% of the genome covered
1000x average genome coverage recommended for analysis of minor variation
Removal of amplicon primer contamination from assembly
In addition:
Use of high-fidelity sequencing platforms (Q score per read >30) preferred for consensus generation
If low fidelity sequencing platforms (Q score per read 2 nucleotide differences per month* in consensus between sequences that meet quality metrics above, ideally coupled with other evidence of actual infection (e.g., high viral titers in each sample, positive for sgmRNA, or culture)
Poor evidence but possible
≤2 nucleotide differences per month* in consensus between sequences that meet quality metrics above or >2 nucleotide differences per month* in consensus between sequences that do not meet quality metrics above, ideally coupled with other evidence of actual infection (e.g., high viral titers in each sample, positive for sgmRNA, or culture)
* The mutation rate of SARS-CoV-2 is estimated at 2 nucleotide differences per month; thus if suspected reinfection occurs 90 days after initial infection, moderate evidence would require >6 nucleotide differences.

At this time, only paired specimens are being tested to determine reinfection, as protocols for determining reinfection from a single specimen do not yet exist.
Other information can provide supporting but not definitive evidence for reinfection, such as culture or sub-genomic mRNA analysis (to detect the presence of replication-competent virus) or serology, which could be useful to document a serologic response to SARS-CoV-2. Aside from laboratory evidence, other supporting evidence for reinfection could include clinical course (COVID-19–like symptoms) and epidemiologic links to a confirmed case.

In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected. We are still learning more about the virus that causes COVID-19. Ongoing COVID-19 studies will help us understand:
How likely is reinfection
How often reinfection occurs
How soon after the first infection can reinfection take place
How severe are cases of reinfection
Who might be at higher risk for reinfection
What reinfection means for a person’s immunity
If a person is able to spread COVID-19 to other people when reinfected
What CDC is doing
CDC is actively working to learn more about reinfection to inform public health action. CDC developed recommendations for public health professionals to help decide when and how to test someone for suspected reinfection. CDC has also provided information for state and local health departments to help investigate suspected cases of reinfection. We will update this guidance as we learn more about reinfection.
Prevention
At this time, whether you have had COVID-19 or not, the best way to prevent infection is to take steps to protect yourself:
Wear a mask in public places
Stay at least 6 feet away from other people
Wash your hands
Avoid crowds and confined spaces

Amy Coney Barrett will replace the late liberal icon, Justice Ruth Bader Ginsburg on the Supreme Court.

The storm is expected to hit Louisiana on Wednesday.

October 26, 2020, 11:56 PM
• 6 min read

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Hurricane Zeta strengthened as it made its way toward Mexico’s Yucatan Peninsula on Monday, and is set to make landfall along the Louisiana coast later this week.
Zeta strengthened into a hurricane on Monday and is expected to make landfall along the northern Gulf Coast by Wednesday, according to the National Weather Service. The hurricane was moving northwest at about 10 mph with its eye located about 90 miles southeast of Cozumel, Mexico. It had maximum winds of about 80 mph as of Monday evening.

The hurricane is forecast to bring strong winds and a “dangerous storm surge” to portions of the Yucatan Peninsula, according to the National Weather service. Coastal areas along the Northern Gulf Coast were placed under hurricane and storm surge watches, and Louisiana, Florida and Alabama were given warnings, the NWS said Monday, noting threats of coastal flooding, heavy rain and possible tornadoes.

Clouds gather over Playa Gaviota Azul as Tropical Storm Zeta approaches Cancun, Mexico, Oct. 26, 2020.

Clouds gather over Playa Gaviota Azul as Tropical Storm Zeta approaches Cancun, Mexico, Oct. 26, 2020.

Louisiana declared a state of emergency in anticipation of the storm Monday night. Louisiana Gov. John Edwards said he issued the order despite uncertainty surrounding the storm’s final path and urged residents to follow the guidelines.
“While there is some uncertainty in Zeta’s track, it is likely that Louisiana will see some impacts from this storm, and the people of our state need to take it seriously. It’s easy to let your guard down late in the hurricane season, but that would be a huge mistake,” Edwards said.

He said state officials were already assisting local authorities with “critical items like pumps, generators and food and water” for first responders.
“We stand ready to expand that assistance as needed,” Edwards said in a statement. “Everyone should be monitoring the news for information and should heed any direction they get from their local leaders.”

Hurricane Zeta satellite map.

Hurricane Zeta satellite map.

A storm surge watch is in effect in several areas between Intracoastal City, Louisiana and Navarre, Florida, including Lake Pontchartrain, Pensacola Bay and Mobile Bay.
A hurricane watch is in effect from Morgan City, Louisiana, to the Mississippi/Alabama border, putting residents in areas like Lake Maurepas and metropolitan New Orleans on alert.

The storm also triggered several tropical storm watches from the Mississippi/Alabama border to the Okaloosa/Walton County Line in Florida, and from west of Morgan City, Louisiana, to Intracoastal City, Louisiana.
The NWS said residents in and around those areas should monitor the storm closely, as the agency will likely issue additional hurricane and storm surge watches as Zeta progresses.

Hurricane Zeta forecast track map.

Hurricane Zeta forecast track map.

Zeta is forecast to make landfall along Louisiana’s northern coast Wednesday night. Meteorologist said the storm could decrease in strength by that time, but it’s expected to be at or near hurricane strength at the time of landfall.
It’s expected to bring heavy rainfall across the Yucatan Peninsula of Mexico, the Cayman Islands and central to western Cuba through Tuesday, causing flash floods in some urban areas.
Portions of the central U.S. Gulf Coast, the southern Appalachians and some Mid-Atlantic states will likely experience heavy rain as well between late Tuesday and Thursday, according to the NWS.
ABC News’ Melissa Griffin and Josh Hoyos contributed to this report.

The fire has burned through 2,000 acres and none of it is contained.

October 26, 2020, 11:35 PM
• 3 min read

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Two Orange County Fire Authority firefighters have been critically injured while battling the Silverado Fire in Southern California.
The fire started Monday morning on vegetation at Santiago Canyon Road and Silverado Canyon Road, according to the City of Lake Forest.

The firefighters were injured near the fire’s point of origin around noon, OCFA Captain Jose Gonzalez told reporters during a news conference.

As of Monday afternoon, the blaze had burned 2,000 acres and remained at 0% containment, fire officials said. About 20,000 homes were evacuated, and 500 personnel were fighting the fire.

Firefighters are seen as the Silverado Fire approaches, near Irvine, Calif., Oct. 26, 2020.

Firefighters are seen as the Silverado Fire approaches, near Irvine, Calif., Oct. 26, 2020.

The injured firefighters are ages 31 and 26 and are both intubated at the hospital, Orange County Fire Authority Chief Brian Fennessy said at a press conference.
One of the firefighters suffered second- and third-degree burns on 65% of his body, while the other sustained second- and third-degree burns on 50% of his body, Fennessy said.

“It’s one of the hardest things any fire chief can do, is to report one of the firefighter family members have been injured or worse,” Fennessy said. “This is tough for me, tough for all my firefighters.”

The fire is continuing to spread due to winds of 20-30 mph, Gonzalez said. The windy conditions were expected to continue into the night.

University of Washington professor San Dubal has been missing since Oct. 11.

October 26, 2020, 8:48 PM
• 6 min read

The search for a University of Washington anthropology professor who went missing while hiking in Mt. Rainier National Park has resumed after a snowstorm in the area halted efforts to locate and rescue him, officials said.
Sam Dubal, 33, was reported missing on Oct. 11 when he failed to return home from the hiking trip, according to the National Parks Service.

The search resumed on Sunday after officials had scaled back rescue efforts on Friday due to a storm that blanketed the wilderness area in snow and because rescuers had turned up no signs to narrow down the professor’s whereabouts.
“Searchers have spent long hours scouring the area and not locating Dr. Dubal is heavy on our hearts,” Chip Jenkins, the park’s superintendent, said in a statement. “We continue to be in close contact with Dr. Dubal’s family and will keep them updated as new information becomes available.”

Dubal started his hike on Oct. 9 and was last spotted that day hiking on the park’s Mother Mountain Loop trail near Mowich Lake, officials said.
He was expected to return home on Oct. 10. His family reported him missing the following day.
When the search was suspended last week, Dubal’s friends and family started a petition on Change.org in hopes of getting the National Parks Service to keep aggressively searching for Dubal for another 72 hours. The petition was signed by more than 46,000 people.
“We cannot bear the thought of an abandoned search during this narrowing period of survivability,” Dubal’s sister, Dena Dubal, said in a Twitter post on Friday.

Dubal was described in the Change.org petition as being very fit and “a skilled hiker with tremendous experience including in the Himalayas.”
Dubal, according to family members, had taken overnight gear on the trip, including a tent, sleeping bag, rain and snow gear as well as a cellphone and a charger.
“There is a very high chance that Sam is alive. He is still in a window of survivability, even with hunger and hypothermia, which many medical experts estimate between 2–3 weeks with the type of gear he was carrying,” the petition reads.

Mount Rainer National Park on Washington’s Olympic Peninsula, June 28, 2020.

Mount Rainer National Park on Washington’s Olympic Peninsula, June 28, 2020.

The petition noted that experienced hiker Holly Coutier, a 38-year-old mother from California, was found alive last week in Utah’s Zion National Park after she went missing for 12 days. Family members told ABC News that Coutier became disoriented after injuring her head on a tree while she exploring the park.

The National Parks Service said Dubal is the fourth hiker to be reported missing in Mt. Rainier National Park since June.
Vincent Djie, 25, an Indonesian student living in Seattle, was reported missing on June 19 after he failed to return home from a hiking trip to the park. A search has failed to turn up any sign of Djie, officials said.

On Aug. 4, rescuers found the body of 27-year-old Talal Sabbagh, who had been reported missing on June 22. Sabbagh’s body was found off a trail in the park’s Paradise area near the south slope of Mt. Rainier, officials said.

On June 29, the body of Matthew Bunker, 28, was discovered in the park after he was reported missing by his climbing partner on June 19, officials said. The climbing partner told officials he became separated from Bunker as they descended the snow-covered 10,400-foot Thumb Rock on the north flank of Mt. Rainier.

Raniere will be in court Tuesday to learn his sentence for running the organization prosecutors labeled a “criminal enterprise” that exploited for power, profit and sex.

U.S. stocks are slumping sharply in afternoon trading Monday and deepening last week’s losses, as a troubling climb in coronavirus counts threatens the global economy. The sell-off comes as doubts mount on Wall Street that Washington will come through with more stimulus for the economy before Election Day.The S&P 500 was 2.1% lower and on track for its worst day in more than a month. The Dow Jones Industrial Average was down 737 points, or 2.6%, at 27,597, as of 3 p.m. Eastern time, and the Nasdaq composite was down 1.9%.

Stocks also weakened across much of Europe and Asia. In another sign of caution, Treasury yields were pulling back after touching their highest level since June last week.
“It’s kind of a perfect storm,” said Ross Mayfield, investment strategy analyst at Baird. “The record case numbers and the kind of rolling lockdowns across Europe are getting the headlines. Oil is down on some supply and demand issues. Stimulus seems more and more unlikely by the day, at least pre-election.”
Coronavirus counts are spiking in much of the United States and Europe, raising concerns about more damage to the still-weakened economy. The U.S. came very close to setting back-to-back record daily infection rates on Friday and Saturday. In Europe, Spain’s government declared a national state of emergency on Sunday that includes an overnight curfew, while Italy ordered restaurants and bars to close each day by 6 p.m. and shut down gyms, pools and movie theaters.
Hopes are fading, meanwhile, that Washington will be able to provide more support for the economy anytime soon. House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin spoke several times last week on a potential deal to send cash to most Americans, restart supplemental benefits for laid-off workers and provide aid to schools, among other things.
But deep partisan difference remains on Capitol Hill, and time is running out for anything to happen before Election Day on Nov. 3. Any compromise reached between House Democrats and the White House would also likely face stiff resistance from Republicans in control of the Senate. Another concern is that possible delays in sorting out the results of next week’s elections could end up pushing a stimulus deal back indefinitely.
Worries about the diminishing prospect for more stimulus in the short term helped drive the S&P 500 to a 0.5% drop last week, its first weekly loss in the last four.
“While we are seeing nations attempt to stifle the spread of the virus through more localised and tentative restrictions, it seems highly likely that we will eventually see a swathe of nationwide lockdowns if the trajectory cannot be reversed,” said Joshua Mahony, senior market analyst at IG in London.
The U.S. economy has recovered a bit since the stay-at-home restrictions that swept the country early this year eased, and economists expect a report on Thursday to show it grew at an annual rate of 30.2% during the summer quarter after shrinking 31.4% during the second quarter.

But momentum has slowed recently after a prior round of supplemental unemployment benefits and other stimulus that Congress approved earlier this year expired.
Stocks of companies that need the virus to abate and the economy to return to normal were logging some of the sharpest losses in morning trading.
Norwegian Cruise Line Holdings fell 11.1%, Marathon Oil dropped 6.8% and United Airlines lost 7.3%.
Energy stocks dropped to the largest loss among the 11 sectors that make up the S&P 500, falling in concert with oil prices. Nearly 95% of the stocks in the index were lower.
Among the market’s few gainers were companies that can succeed even in a stay-at-home economy. Zoom Video Communications gained 1.7%.
Amazon fared much better than the broader market, shedding a mere 0.5%, while Apple lost an early gain to fall 1%. Expectations are high for them, and analysts say they’ll report strong results for their latest quarter this week. They and other Big Tech stocks have soared through the pandemic on hopes their growth will only continue as work-from-home and other trends that benefit them accelerate.
This upcoming week is the busiest of this quarter’s earnings season, with more than a third of the companies in the S&P 500 index scheduled to report. Besides Amazon and Apple, Ford Motor, General Electric and Google’s parent company, Alphabet, are also on the docket.
Across the S&P 500, profit reports for the summer have been mostly better than Wall Street had feared, though they’re still on pace to be more than 16% lower than year-ago levels. Through Friday, 84% of S&P 500 companies reported better results than analysts had forecast, according to FactSet. If that level holds, it would be the best since at least 2008, when FactSet’s records begin.
Meanwhile, the upcoming U.S. elections could mean more short-term uncertainty in the markets and the results could determine the size and timing of any aid from Congress, said Esty Dwek, head of global market strategy at Natixis Investment Managers.
“It’s going to be a little bit volatile in the next week depending on the results, but we’re not expecting weeks of uncertainty,” she said.
European and Asian markets closed lower. The yield on the 10-year Treasury fell to 0.79% from 0.85% late Friday.
———
AP Business Writer Yuri Kageyama contributed.

For decades, America led the world in humanitarian policies by creating a sanctuary for the oppressed, admitting more refugees annually than all other countries combined.That reputation eroded during Donald Trump’s presidency as he cut the number of refugees allowed in by more than 80%, and Canada replaced the U.S. as No. 1 for resettling people fleeing war and persecution.

Trump has arguably changed the immigration system more than any U.S. president, thrilling supporters with an “America first” message and infuriating critics who call his signature domestic issue insular, xenophobic and even racist.
Before November’s election, The Associated Press is examining some of Trump’s biggest immigration policy changes, from halting asylum to stepping back from America’s humanitarian role.
The pain from a dismantling of the 40-year-old refugee program reverberates worldwide, coming as a record 80 million people have been displaced by war and famine.
They include an Iraqi woman who can’t get to America even though her father helped the U.S. military and a woman in Uganda who hasn’t been able to join her husband near Seattle despite a court settlement requiring cases like hers to be expedited.
“My kids here cry every night, my wife cries in Uganda every night,” said Congolese refugee Sophonie Bizimana, a permanent U.S. resident who doesn’t know why his wife isn’t with their family. “I need her, the kids need her.”
Trump has lowered the cap for refugee admissions each year of his presidency, dropping them to a record low of 15,000 for 2021.
The State Department defended the cuts as protecting American jobs during the coronavirus pandemic. Stephen Miller, a senior adviser to Trump, said the administration has sought to have refugees settle closer to their home countries and work on solving the crises that caused them to flee.
“You cannot solve this problem through American domestic resettlement. The solution has to be one of foreign policy,” Miller told the AP.

The administration also narrowed eligibility this year, restricting which refugees are selected for resettlement to certain categories, including people persecuted because of religion and Iraqis whose assistance to the U.S. put them in danger.
Democratic lawmakers denounced the lower cap and said the categories are shutting out many of the most needy. Democrat Joe Biden promises to raise the annual refugee cap to 125,000 if he wins Nov. 3.
As many as 1,000 refugees who were ready to travel now may not be eligible because they don’t fit into one of the categories, said Mark Hetfield, president of HIAS, a refugee resettlement group. For example, many Syrians may no longer qualify because no category is for those fleeing war, he said.
Even those who qualify are seeing their cases stalled because already-extensive vetting measures have become extreme. For instance, refugees now must provide addresses dating back 10 years, a near impossible task for people living in exile, according to the International Refugee Assistance Project.
The Trump administration also has rolled back other humanitarian protections, like Temporary Protected Status for 400,000 immigrants fleeing natural disasters or violence.
Those from countries like Honduras, Nicaragua, Haiti, Nepal and Syria now face deportation under a plan to end the program in January. Among them is Lili Montalvan, who arrived from El Salvador alone at 16 a quarter-century ago.
Living in Miami, she has a 6-year-old daughter and 18-year-old son who are American citizens. She can’t fathom raising her youngest in El Salvador. Their father was deported back to Peru last year.
“We have children, we have homes, we are part of this country,” said Montalvan, who cleans houses and sells baked goods.
The administration’s efforts to drastically reduce both illegal and legal immigration has triggered a slew of lawsuits.
Bizimana, the Congolese refugee, was a plaintiff in one settled Feb. 10 by a federal court in Seattle, which required the government to expedite the cases of some 300 families. But more than eight months after the legal victory, he’s still waiting for his wife to join him, and no one can tell him why.
Since arriving in 2014, Bizimana has hit hurdles every step of the way in his quest to reunite his family.
After one son arrived in 2016, the door slammed shut for everyone else in October 2017, when the Trump administration suspended refugee admissions for four months and then required more vetting of spouses and children on the verge of joining their families in the U.S.
After a federal judge limited those restrictions in December 2017, seven of his children were admitted, but not their mother. The International Rescue Committee, the resettlement agency that helped Bizimana, said the reasons for the delay are unclear.
He’s not the only one without answers.
Across the globe, an Iraqi woman whose father helped the U.S. military does not know why her case stalled. She spoke on the condition of anonymity for fear her family could still be in danger.
Her father worked closely with the U.S. Army as an Iraqi government official. Because of the relationship, American military doctors agreed to treat her two rare disorders, including one causing her immune system to attack her organs.
But her frequent visits to U.S. bases led to death threats from militias in her Baghdad neighborhood, and she and her family fled to Jordan in 2016.
The 51-year-old mother has waited ever since to get to the United States, where she has a brother in Syracuse, New York. Her family has been interviewed by U.S. officials and finished their background checks.
The New York-based International Refugee Assistance Project was helping her but closed the case in 2019 because there was nothing more it could do, caseworker Ra’ed Almasri said.
“I’ve been working for three years with these people, and they still have not gotten a decision, and yet this is a case with someone who has medical issues, her family helped the U.S. military and has been through so much,” he said. “I don’t see why it hasn’t moved forward.”
The woman still texts Almasri every few weeks asking for news.
Her family first lived off savings, then help from her parents until that dried up when her father died. She sold some of her gold jewelry to pay rent on their modest apartment.
So much time has passed that her identification document from the U.N. High Commission on Refugees has expired, which means she can no longer prove a legal right to be in Jordan. She fears deportation to Iraq.
“This is our fifth year in Jordan, we are running out of money, we hope to receive the good news very soon,” the woman said.
Life has grown tougher for the more than 750,000 refugees in Jordan amid the coronavirus pandemic. Many cannot work or even leave their neighborhoods in Amman, where official checkpoints sealed off areas to slow the spread.
Almasri, the caseworker, said the desperation has become so acute some have attempted suicide.
“People feel stuck,” Almasri said. “They already are in a tough situation, and now they only see things getting worse.”
———
Snow reported from Phoenix, and Watson from San Diego. Associated Press reporters Omar Akour in Amman, Jordan, Elliot Spagat in San Diego and Matthew Lee in Washington contributed to this report.

Presidential adviser Jared Kushner says President Donald Trump wants to help Black Americans, but they have to “want to be successful” for his policies to work

ByThe Associated Press

October 26, 2020, 7:16 PM
• 2 min read

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WASHINGTON — Presidential adviser Jared Kushner said Monday that President Donald Trump wants to help Black people in America, but they have to “want to be successful” for his policies to work.
“President Trump’s policies are the policies that can help people break out of the problems that they’re complaining about, but he can’t want them to be successful more than they want to be successful,” Kushner said on “Fox & Friends.”

Kushner, who is also Trump’s son-in-law, also criticized prominent people who raised their voices after the killing of George Floyd, a Black man who died in police custody, but then didn’t follow through and work to find ways to improve the lives of Black people in America.
“You saw a lot of people who were just virtue signaling — they go on Instagram and cry, or they would, you know, put a slogan on their jersey or write something on a basketball court,” Kushner said. “Quite frankly, that was doing more to polarize the country than it was to bring people forward. You solve problems with solutions.”
Rep. Don Beyer, D-Va., accused Kushner of “casual racism.” Former Democratic National Committee Chair Donna Brazile wrote on Twitter: “He’s talking to folks who have suffered and endured systemic racism and historic tokenism.”
White House press secretary Kayleigh McEnany defended Kushner, saying that “internet trolls” took Kushner’s words out of context. She said they were trying to distract from Trump’s “undeniable record of accomplishment” for Black people.
Trump, who has been trying to appeal to the Black community, has been promoting his attempts to set up economic opportunity zones, provide steady funding for historically Black colleges and universities, and institute criminal justice reforms.