In the absence of a gold standard, researchers are finding a high frequency of false negatives among SARS-CoV-2 RT-PCR tests
Serology tests designed to detect antibodies to the SARS-CoV-2 coronavirus that causes the COVID-19 illness have been dogged by well-publicized questions about accuracy. However, researchers also are raising concerns about the accuracy of molecular diagnostics which claim to detect the actual presence of the coronavirus itself.
Diagnostic tests, typically involving a nasopharyngeal swab, can be inaccurate in two ways, said Steven Woloshin, MD, MS, in a news release announcing a new report that examines challenges and implications of false-negative COVID-19 tests. Woloshin is an internist, a professor at Dartmouth Institute, and co-director of the Geisel School of Medicine at Dartmouth.
A false-positive result mistakenly labels a person infected, with consequences including unnecessary quarantine and contact tracing, he stated in the news release. False-negative results are far more consequential, because infected persons who might be asymptomatic may not be isolated and can infect others.
Woloshin led a team of Dartmouth researchers who analyzed two studies from Wuhan, China, and a literature review by researchers in Europe and South America that indicated diagnostic tests for COVID-19 are frequently generating false negatives. The team published their results in the June 5 New England Journal of Medicine (NEJM).
For example, one research team in Wuhan collected samples from 213 hospitalized COVID-19 patients and found that an approved RT-PCR test produced false negatives in 11% of sputum samples, 27% of nasal samples, and 40% of throat samples. Their research was published on the medRxiv preprint server and has not been peer-reviewed.
The literature review Woloshins team studied was also published on medRxiv, titled, False-Negative Results of Initial Rt-PCR Assays for COVID-19: A Systematic Review. It indicated that the rate of false negatives could be as high as 29%. The authors of the review looked at five studies that had enrolled a total of 957 patients. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability, they wrote. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection.
Another literature review, published in the Annals of Internal Medicine, titled, Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain ReactionBased SARS-CoV-2 Tests by Time Since Exposure, estimated the probability of false negatives in RT-PCR tests at varying intervals from the time of exposure and symptom onset. For example, the authors found that the median false-negative rate was 38% if a test was performed on the day of symptom onset, versus 20% three days after onset. Their analysis was based on seven studies, five of which were peer-reviewed, with a total of 1330 test samples.
Doctors also are seeing anecdotal evidence of false negatives. For example, clinicians at UC San Diego Health medical center treated a patient with obvious symptoms of COVID-19, but two tests performed on throat samples were negative. However, a third test, using a sample from a bronchial wash, identified the virus, reported Medscape.
The lesson for clinicians is that they cant rely solely on test results but must also consider their own observations of the patient, Joshua Metlay, MD, PhD, of Massachusetts General Hospital told Medscape.
Sensitivity and Specificity of COVID-19 Clinical Laboratory Tests
The key measures of test accuracy are sensitivity, which refers to the ability to detect the presence of the virus, and specificity, the ability to determine that the targeted pathogen is not present. So, a sensitive test is less likely to provide a false-negative result and a specific test is less likely to provide a false-positive result, wrote Kirsten Meek, PhD, medical writer and editor, in an article for ARUP Laboratories.
Analytic sensitivity and specificity represent the accuracy of a test under ideal conditions in which specimens have been collected from patients with either high viral loads or a complete absence of exposure, she wrote. However, sensitivity and specificity under real-world conditions, in which patients are more variable and specimen collection may not be ideal, can often be lower than reported numbers.
In a statement defending its ID Now molecular point-of-care test, which came under scrutiny during a study of COVID-19 molecular tests by NYU Langone Health, Northwell Health, and Cleveland Clinic, according to MedTech Dive, Abbott Laboratories blamed improper sample collection and handling for highly-publicized false negatives produced by its rapid test. An FDA issued alert about the test on May 14 noted that Abbott had agreed to conduct post-market studies to identify the cause of the false negatives and suggest remedial actions.
Issues with Emergency Use Authorizations
In their NEJM analysis, Woloshin et al point to issues with the FDAs process for issuing Emergency Use Authorizations (EUAs). For example, they noted variations in how manufacturers are conducting clinical evaluations to determine test performance. The FDA prefers the use of natural clinical specimens but has permitted the use of contrived specimens produced by adding viral RNA or inactivated virus to leftover clinical material, they wrote.
When evaluating clinical performance, manufacturers ordinarily conduct an index test of patients and compare the results with reference-standard test, according to the Dartmouth researchers. For people showing symptoms, the reference standard should be a clinical diagnosis performed by an independent adjudication panel. However, they wrote, it is unclear whether the sensitivity of any FDA-authorized commercial test has been assessed in this way. Additionally, a reference standard for determining sensitivity in asymptomatic people is an unsolved problem that needs urgent attention to increase confidence in test results for contact-tracing or screening purposes.

In a perspective for Mayo Clinic Proceedings, Colin P. West, MD, PhD; Victor M. Montori, MD, MSc; and Priya Sampathkumar, MD, offered four recommendations for addressing concerns about testing accuracy:

• Continued adherence to current measures, such as physical distancing and surface disinfection.
• Development of highly sensitive and specific tests or combinations of tests to minimize the risk of false-negative results and ongoing transmission based on a false sense of security.
• Improved RT-PCR tests and serological assays.
• Development and communication of clear risk-stratified protocols for management of negative COVID-19 test results.

These protocols must evolve as diagnostic test, transmission, and outcome statistics become more available, they wrote.
Meanwhile, clinical laboratories remain somewhat on their own at selecting which COVID-19 molecular and serology tests they want to purchase and run in their labs. Complicating such decisions is the fact that many of the nations most reputable in vitro diagnostics manufacturers cannot produce enough of their COVID-19 tests to meet demand.
Consequently, when looking to purchase tests for SARS-CoV-2, smaller medical laboratory organizations find themselves evaluating COVID-19 kits developed by little-known or even brand-new companies.
Stephen Beale
Related Information:
New Report Examines Challenges and Implications of False-Negative COVID-19 Tests
Questions about COVID-19 Test Accuracy Raised Across the Testing Spectrum
COVID-19 Test Results: Dont Discount Clinical Intuition
FDA Provides New Tool to Aid Development and Evaluation of Diagnostic Tests That Detect SARS-CoV-2 Infection
EUA Authorized Serology Test Performance
Emergency Use Authorization (EUA) Information and List of All Current EUAs
Coronavirus (COVID-19) Update: FDA Provides Promised Transparency for Antibody Tests
Understanding Medical Tests: Sensitivity, Specificity, and Positive Predictive Value
Webinar Part 1: Quality Issues Your Clinical Laboratory Should Know Before You Buy or Select COVID-19 Serology Tests
Webinar Part 2: Achieving High Confidence Levels in the Quality and Accuracy of Your Clinical Labs Chosen COVID-19 Serology Tests, featuring James Westgard, PhD

12:11 PM 6/28/2020

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Gilead Sciences Inc. said it will charge the U.S. government and other developed countries $390 per vial for its coronavirus-fighting drug remdesivir, or about $2,340 for a typical five-day course of treatment.
Deaths from the virus surpassed 500,000 worldwide and confirmed cases exceeded 10 million as the World Health Organization reported the most infections for a single day. New clusters around the world indicate that the pandemic is far from over.

Tokyo reported more incidences of the disease, daily deaths in Iran reached a record and cases in Austria rose to the highest level since mid-May. Texas is fast becoming the new center of the pandemic in the U.S. while Vice President Mike Pence encouraged people to wear masks, two days after declining to give that specific guidance.

Key Developments:

Subscribe to a daily update on the virus from Bloombergs Prognosis team here. Click VRUS on the terminal for news and data on the coronavirus.

Gileads Remdesivir to Cost $2,340 for 5-Day Treatment (7:01 a.m. NY)

Gilead Sciences Inc. said it will charge developed nations $390 per vial for its coronavirus-fighting drug remdesivir, or about $2,340 for a typical five-day course of treatment.

The company said that once supplies of the drug are less constrained, the government will no longer manage allocation.
Remdesivir is one of the first widely used drugs for Covid-19. It received an emergency use authorization from U.S. regulators in May, after a trial found the medicine hastened recovery by about four days in hospitalized patients.

Iran Fatalities Increase to Record (6:03 a.m. NY)

Iran recorded the highest daily number of fatalities since the start of the outbreak, with 162 deaths in the past 24 hours. The death toll reached 10,670 from a total of 225,205 cases.

The level of infections is high or alarming in 11 of 31 Iranian provinces, Health Ministry spokeswoman Sima Sadat Lari said on state television.

Thailand Business-Travel Bubbles to Start Soon (5:34 p.m. HK)

Thailand plans to allow foreign business travelers into the country for the first time since closing its borders to most international flights in March.
Passport holders from Hong Kong, Singapore, South Korea and Japan, and people from some Chinese provinces, may be allowed to travel to Thailand as part of proposed business-travel bubbles from July.
Thailands Cabinet will consider approving the proposal Tuesday after Prime Minister Prayuth Chan-Ocha endorsed it. The Cabinet will also review extending a state of emergency by a month through July, which Prayuth sees as vital as lockdowns are eased for schools and high-risk businesses, including nightclubs and bars.

Czechs Tighten Measures to Tackle Local Outbreaks (4:35 p.m. HK)

The Czech government is tightening quarantine measures in two northeastern counties to contain local outbreaks of coronavirus after the number of cases jumped in the past few days, Health Minister Adam Vojtech said.

Starting Tuesday, events of more than 100 people will once again be banned in the two counties, with restrictions on the opening hours of restaurants and bars; foreign workers crossing borders to the counties will be tested. Employees are being tested at the OKD mines, one of the current virus hotspots. Elsewhere in the Czech Republic, measures are being eased.
The number of new cases jumped to 305 on Sunday, the biggest daily increase since April 3.

Luxembourg Infections Accelerate (4:30 p.m. HK)

Luxembourgs new cases increased more than usual in the last four days, and the government is seeking clarity on the causes, Health Minister Paulette Lenert said.

A party held earlier this month is one reason why numbers rapidly rose to between 22 and 44 in the past three days, Lenert told RTL radio Monday. There have also been several new, more spread-out infections that are more worrying, she said. The increase coincides with the governments decision to ease lockdown measures, allowing bigger private gatherings.

China Seals Off County Linked to Beijing Cluster (4:20 p.m. HK)

China put 400,000 residents of a northern county under lockdown at the weekend after at least a dozen coronavirus cases associated with the Beijing outbreak were reported there.
In a sign that the resurgence of cases in the capital is proving difficult to stamp out even as officials say theyve been largely contained, Hebei provinces Anxin county has been sealed off and each household can assign only one person to go out for necessities daily, state media reported. Vehicles cannot enter the county and only those with special passes can leave.
The containment measures in Anxin, 140 kilometers (87 miles) from Beijing, are more severe than in the capital itself, where the cluster has grown to 311 people since it was first detected June 12.

Russia Reports 1.1% Increase in Cases (3:35 p.m. HK)

Russia recorded 6,719 new coronavirus infections in the past 24 hours, bringing the total to 641,156, according to the governments virus response center.

The tally was the lowest since April 29, and 31.6% of the new cases were asymptomatic, the center said. The death toll for the day was 93, bringing the total to 9,166. The center said 4,343 people recovered, taking the total to 403,430.

Tokyo Finds Around 60 New Cases: TBS (2:59 p.m. HK)

Tokyo found around 60 new cases of coronavirus on Monday, TBS reported, citing Governor Yuriko Koike.
The increase matched Sundays tally, which was the highest since the state of emergency was lifted in May.

Austrian Infections Rise Amid Clusters (2:17 p.m. HK)

Austrian daily new infections rose to 74 on Sunday, bringing the seven-day average to 45, the highest level since May 22, according to the interior ministry.

Infections were driven by a cluster in Linz, an industrial city two hours west of Vienna, where the virus spread in services of the Pentecostal church community, according to health agency AGES. A Rotary club meeting in Salzburg contributed to new cases in that region last week. Austria has 551 live virus cases, 48% more than two weeks ago.

Thailand to Allow Schools, Bars to Reopen (1:47 p.m. HK)

Thailand will allow all schools, nightclubs and bars to reopen in the countrys fifth stage of reopening, Taweesilp Witsanuyotin, a spokesman for the Covid-19 center, said at a briefing. The nightclubs and bars will be subject to restrictions on the numbers of patrons and closing hours.
Thailand plans to extend its state of emergency to manage risks as the country prepares for the latest reopening, Prime Minister Prayuth Chan-Ocha said on Monday.

German Infection Rate Stays Below Key Threshold (1:35 p.m. HK)

Germanys coronavirus infection rate stayed below the key threshold of 1.0 for a fifth day. The reproduction factor rose to 0.71 on Sunday, from 0.62 the previous day, according to the latest estimate by the countrys health body, the Robert Koch Institute.

There were 235 new cases in the 24 hours through Monday morning, down from 422 the previous day, according to data from Johns Hopkins University. There were no new fatalities recorded.
A jump in the infection rate from around June 20 was driven by local outbreaks, including in two municipalities in the western state of North Rhine-Westphalia.

China Halts Meat Imports From More Plants (1:14 p.m. HK)

China suspended meat imports from more plants, including chickens from a JBS unit, beef from a Cargill factory in Canada and pork from a Danish Crown plant, taking the total to 15 by June 28, according to the countrys customs department.
Customs will not accept any import application for delivery from the date when the halt started, it said, without providing any reason for the suspension. Earlier, the department stopped meat imports from plants reporting coronavirus infections among their employees.

Ardern Says More Work to Be Done on Travel Bubble (1:01 p.m. HK)

New Zealand Prime Minister Jacinda Ardern said more work needs to be done for an agreement on a trans-Tasman bubble for safe travel to Australia. She said in a news conference the cabinet will not move to open the border with Australia until it has reassurances that New Zealanders will be safe. More broadly, she said it is untenable to be opening up the border to Covid-19.

Cases Surge in Australias Hot Spot (10:01 a.m. HK)

The Australian state of Victoria has recorded 75 more cases in the past 24 hours, health authorities announced, leading to increased concern the nation may be on the cusp of a second wave of cases as it removes lockdown restrictions that have crippled the economy.

The surge in cases in Melbourne, the capital of Australias second-most-populous state, have been centered around suburbs in the citys northern and western fringes. Victoria Premier Daniel Andrews, who has indicated that some of those areas may need to return to stricter lockdown measures, has blamed some clusters on large family gatherings that have broken social-distancing restrictions.

Beijing Reports Seven New Coronavirus Cases (9:04 a.m. HK)

Beijing reported seven new coronavirus infections June 28, bringing total cases linked to a recent outbreak to 318, Beijing Municipal Health Commission said in a statement. The number of infections was down from 14 reported a day earlier. Overall, China reported a total of 12 new cases for June 28.

Houston Official Leading Virus Fight Is in Self-Quarantine (9:01 a.m. HK)

The top county executive in the Houston area is in self-quarantine after a staffer tested positive for Covid-19. Harris County Judge Lina Hidalgo plans to self-isolate at home for 14 days after an employee in her office tested positive, according to a statement.

Hidalgo has been one of the most-prominent critics of Texas Governor Greg Abbotts aggressive reopening of the second-largest U.S. economy. Covid-19 cases and hospitalizations have spiked since the state reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads.

Texass Positive-Test Rate Soars to Record (8:09 a.m. HK)

Texass Covid-19 positive-test rate surged to 14.31%, the highest for the second-most populous U.S. state since the pandemic emerged, underscoring the magnitude of the growing crisis facing Americas Sunbelt.
The positivity rate on Saturday surpassed the previous record of 13.86% set on April 13, state health department figures released on Sunday showed. The number has almost tripled since May 31, when Texas posted a 5.44% positive-test rate.

Pence Encourages Mask Wearing (7:46 a.m. HK)

U.S. Vice President Mike Pence encouraged people to wear masks to prevent the spread of the virus, two days after declining to give that specific guidance.
Wear a mask, wherever its indicated or wherever youre not able to practice the kind of social distancing that would prevent the spread of the coronavirus, Pence said at a press briefing with Texas Governor Abbott and federal and state health officials, who are grappling with a surge in coronavirus cases. Wearing a mask is just a good idea.

During a White House coronavirus task force briefing on Friday, Pence avoided saying whether Americans should wear one. Asked on CBS Face the Nation, about President Donald Trumps refusal to say everyone should wear a mask Pence said that every state has a unique situation and that the principle of federalism has guided their decision making.

California Shuts Bars in L.A., Other Counties (7:22 a.m. HK)

Some California residents hoping to celebrate Independence Day in a bar will now have to change their plans. Bars are required to shut in seven counties — including Los Angeles — and theyre recommended to close in eight others, including Sacramento and Santa Barbara, following a surge in coronavirus cases, according to an order by Governor Gavin Newsom on Sunday.

Most in Poll Say Trump Unprepared (6:30 a.m. HK)

Almost three-quarters of Americans said that, as they look back a few months, the Trump administration wasnt ready to deal with the outbreak when it started this year, according to a CBS News poll.

Some 72% judged the administration unprepared against 28% who said it was prepared, according to the June 23-26 survey. Almost half, 49%, said the outbreak would get worse this summer. The remainder split between those who think it will get better and those who expect it to stay about the same.
The CBS poll said assessments of how President Donald Trump has handled the outbreak continue to slip, to 41% now from 47% in mid-April and 53% in late March.

Brazil Cases Rise 2.3% (6:20 a.m. HK)

Brazil had 30,476 new cases in the past 24 hours, a 2.3% rise from the previous day, bringing the national total to 1.34 million, the Health Ministry reported on Sunday. The government registered 522 deaths, raising the toll to 57,622.

San Quentin Prison Cases Surge (5:30 p.m. NY)

Californias San Quentin State Prison is seeing an explosion of cases after a botched transfer from another facility, impacting hundreds of incarcerated residents and scores of officers in a potential public health threat to the San Francisco Bay Area.
About 816 people in the prison tested positive on Sunday, according to data from the Department of Corrections and Rehabilitation. That means more than 1 in 5 of the prisons population of 3,507 is infected, and its not clear if everyone has been tested. State data show 89 staff members have Covid-19. A spokeswoman didnt respond to an e-mail seeking comment on the rise in cases Sunday.

San Quentin had zero known cases through May, but infections jumped after officials transferred 121 people from the California Institution for Men in Chino on May 30. The practice of transferring inmates has been widely criticized for spreading the virus.

WHO Reports Another High for Cases (4:45 p.m. NY)

The World Health Organization reported almost 190,000 new cases for the 24-hour period through early Sunday, a week after the previous one-day high.
Cases from the Americas accounted for 62% of the 189,077 new infections, followed by 13% from Southeast Asia and 8.8% from Europe, according to the report from the United Nations agency based in Geneva.

The U.S. and Brazil, together, represented 49% of all new infections. The WHO report showed 9.84 million cases, a total that lags behind tallies from John Hopkins University, which showed more than 10 million cases on Sunday.

U.S. Cases Up 1.7%, Above 7-Day Average (4 p.m. NY)

Coronavirus cases in the U.S. increased by 42,735 from the same time Saturday to 2.53 million, according to data collected by Johns Hopkins University and Bloomberg News. The 1.7% increase was above the average daily rise of 1.5% over the past week. The total was less than the 45,450 reported on Saturday but above 40,000 for a third straight day. Fatalities rose 0.3% to 125,709.

DeSantis Cites Socializing for Cases (3:15 p.m. NY)

Florida Governor Ron DeSantis said people in the 18-to-44 age group account for most of the rise in positive Covid-19 tests, with the 24-to-34 year old by far the leading group for new infections.
Its basically socializing, DeSantis said at a Pensacola news conference as he dismissed suggestions the rise reflected opening the economy too soon. Most of this is not because of people going to work, its because theyre being social.
DeSantis said young people, who are at lower risk from the disease, should avoid gathering in large groups and then visiting restaurants or other venues where the infection can spread.

Arizona Cases Rise 5.5% (12:42 p.m. NY)

Arizonas new cases increased by 3,858 to 73,908, a 5.5% increase that exceeded the prior weeks average of 4.4%, the state reported Sunday. Daily infections have exceeded the weekly average for four straight days. The number of deaths rose by 9 to 1,588.

Cuomo Fears Imported Infections (12:05 p.m. NY)

New York had the fewest daily deaths since the pandemic began in March, five on Saturday, as Governor Andrew Cuomo said he is now afraid of the spread from other states.

We are one country and people travel and Im afraid the infection rate in the other states will come back to New York and raise that rate again, Cuomo said on NBCs Meet the Press.

The governor said New York has plans to reopen schools, and the state will assess the infection rate and what the disease is doing before making a decision on a date. If this continues across the country, Cuomo said, kids are going to be home for a long time.
With assistance by Paul Sillitoe

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Gilead Sciences Inc. said it will charge the U.S. government and other developed countries $390 per vial for its coronavirus-fighting drug remdesivir, or about $2,340 for a typical five-day course of treatment.
Deaths from the virus surpassed 500,000 worldwide and confirmed cases exceeded 10 million as the World Health Organization reported the most infections for a single day. New clusters around the world indicate that the pandemic is far from over.

Tokyo reported more incidences of the disease, daily deaths in Iran reached a record and cases in Austria rose to the highest level since mid-May. Texas is fast becoming the new center of the pandemic in the U.S. while Vice President Mike Pence encouraged people to wear masks, two days after declining to give that specific guidance.

Key Developments:

Subscribe to a daily update on the virus from Bloombergs Prognosis team here. Click VRUS on the terminal for news and data on the coronavirus.

Gileads Remdesivir to Cost $2,340 for 5-Day Treatment (7:01 a.m. NY)

Gilead Sciences Inc. said it will charge developed nations $390 per vial for its coronavirus-fighting drug remdesivir, or about $2,340 for a typical five-day course of treatment.

The company said that once supplies of the drug are less constrained, the government will no longer manage allocation.
Remdesivir is one of the first widely used drugs for Covid-19. It received an emergency use authorization from U.S. regulators in May, after a trial found the medicine hastened recovery by about four days in hospitalized patients.

Iran Fatalities Increase to Record (6:03 a.m. NY)

Iran recorded the highest daily number of fatalities since the start of the outbreak, with 162 deaths in the past 24 hours. The death toll reached 10,670 from a total of 225,205 cases.

The level of infections is high or alarming in 11 of 31 Iranian provinces, Health Ministry spokeswoman Sima Sadat Lari said on state television.

Thailand Business-Travel Bubbles to Start Soon (5:34 p.m. HK)

Thailand plans to allow foreign business travelers into the country for the first time since closing its borders to most international flights in March.
Passport holders from Hong Kong, Singapore, South Korea and Japan, and people from some Chinese provinces, may be allowed to travel to Thailand as part of proposed business-travel bubbles from July.
Thailands Cabinet will consider approving the proposal Tuesday after Prime Minister Prayuth Chan-Ocha endorsed it. The Cabinet will also review extending a state of emergency by a month through July, which Prayuth sees as vital as lockdowns are eased for schools and high-risk businesses, including nightclubs and bars.

Czechs Tighten Measures to Tackle Local Outbreaks (4:35 p.m. HK)

The Czech government is tightening quarantine measures in two northeastern counties to contain local outbreaks of coronavirus after the number of cases jumped in the past few days, Health Minister Adam Vojtech said.

Starting Tuesday, events of more than 100 people will once again be banned in the two counties, with restrictions on the opening hours of restaurants and bars; foreign workers crossing borders to the counties will be tested. Employees are being tested at the OKD mines, one of the current virus hotspots. Elsewhere in the Czech Republic, measures are being eased.
The number of new cases jumped to 305 on Sunday, the biggest daily increase since April 3.

Luxembourg Infections Accelerate (4:30 p.m. HK)

Luxembourgs new cases increased more than usual in the last four days, and the government is seeking clarity on the causes, Health Minister Paulette Lenert said.

A party held earlier this month is one reason why numbers rapidly rose to between 22 and 44 in the past three days, Lenert told RTL radio Monday. There have also been several new, more spread-out infections that are more worrying, she said. The increase coincides with the governments decision to ease lockdown measures, allowing bigger private gatherings.

China Seals Off County Linked to Beijing Cluster (4:20 p.m. HK)

China put 400,000 residents of a northern county under lockdown at the weekend after at least a dozen coronavirus cases associated with the Beijing outbreak were reported there.
In a sign that the resurgence of cases in the capital is proving difficult to stamp out even as officials say theyve been largely contained, Hebei provinces Anxin county has been sealed off and each household can assign only one person to go out for necessities daily, state media reported. Vehicles cannot enter the county and only those with special passes can leave.
The containment measures in Anxin, 140 kilometers (87 miles) from Beijing, are more severe than in the capital itself, where the cluster has grown to 311 people since it was first detected June 12.

Russia Reports 1.1% Increase in Cases (3:35 p.m. HK)

Russia recorded 6,719 new coronavirus infections in the past 24 hours, bringing the total to 641,156, according to the governments virus response center.

The tally was the lowest since April 29, and 31.6% of the new cases were asymptomatic, the center said. The death toll for the day was 93, bringing the total to 9,166. The center said 4,343 people recovered, taking the total to 403,430.

Tokyo Finds Around 60 New Cases: TBS (2:59 p.m. HK)

Tokyo found around 60 new cases of coronavirus on Monday, TBS reported, citing Governor Yuriko Koike.
The increase matched Sundays tally, which was the highest since the state of emergency was lifted in May.

Austrian Infections Rise Amid Clusters (2:17 p.m. HK)

Austrian daily new infections rose to 74 on Sunday, bringing the seven-day average to 45, the highest level since May 22, according to the interior ministry.

Infections were driven by a cluster in Linz, an industrial city two hours west of Vienna, where the virus spread in services of the Pentecostal church community, according to health agency AGES. A Rotary club meeting in Salzburg contributed to new cases in that region last week. Austria has 551 live virus cases, 48% more than two weeks ago.

Thailand to Allow Schools, Bars to Reopen (1:47 p.m. HK)

Thailand will allow all schools, nightclubs and bars to reopen in the countrys fifth stage of reopening, Taweesilp Witsanuyotin, a spokesman for the Covid-19 center, said at a briefing. The nightclubs and bars will be subject to restrictions on the numbers of patrons and closing hours.
Thailand plans to extend its state of emergency to manage risks as the country prepares for the latest reopening, Prime Minister Prayuth Chan-Ocha said on Monday.

German Infection Rate Stays Below Key Threshold (1:35 p.m. HK)

Germanys coronavirus infection rate stayed below the key threshold of 1.0 for a fifth day. The reproduction factor rose to 0.71 on Sunday, from 0.62 the previous day, according to the latest estimate by the countrys health body, the Robert Koch Institute.

There were 235 new cases in the 24 hours through Monday morning, down from 422 the previous day, according to data from Johns Hopkins University. There were no new fatalities recorded.
A jump in the infection rate from around June 20 was driven by local outbreaks, including in two municipalities in the western state of North Rhine-Westphalia.

China Halts Meat Imports From More Plants (1:14 p.m. HK)

China suspended meat imports from more plants, including chickens from a JBS unit, beef from a Cargill factory in Canada and pork from a Danish Crown plant, taking the total to 15 by June 28, according to the countrys customs department.
Customs will not accept any import application for delivery from the date when the halt started, it said, without providing any reason for the suspension. Earlier, the department stopped meat imports from plants reporting coronavirus infections among their employees.

Ardern Says More Work to Be Done on Travel Bubble (1:01 p.m. HK)

New Zealand Prime Minister Jacinda Ardern said more work needs to be done for an agreement on a trans-Tasman bubble for safe travel to Australia. She said in a news conference the cabinet will not move to open the border with Australia until it has reassurances that New Zealanders will be safe. More broadly, she said it is untenable to be opening up the border to Covid-19.

Cases Surge in Australias Hot Spot (10:01 a.m. HK)

The Australian state of Victoria has recorded 75 more cases in the past 24 hours, health authorities announced, leading to increased concern the nation may be on the cusp of a second wave of cases as it removes lockdown restrictions that have crippled the economy.

The surge in cases in Melbourne, the capital of Australias second-most-populous state, have been centered around suburbs in the citys northern and western fringes. Victoria Premier Daniel Andrews, who has indicated that some of those areas may need to return to stricter lockdown measures, has blamed some clusters on large family gatherings that have broken social-distancing restrictions.

Beijing Reports Seven New Coronavirus Cases (9:04 a.m. HK)

Beijing reported seven new coronavirus infections June 28, bringing total cases linked to a recent outbreak to 318, Beijing Municipal Health Commission said in a statement. The number of infections was down from 14 reported a day earlier. Overall, China reported a total of 12 new cases for June 28.

Houston Official Leading Virus Fight Is in Self-Quarantine (9:01 a.m. HK)

The top county executive in the Houston area is in self-quarantine after a staffer tested positive for Covid-19. Harris County Judge Lina Hidalgo plans to self-isolate at home for 14 days after an employee in her office tested positive, according to a statement.

Hidalgo has been one of the most-prominent critics of Texas Governor Greg Abbotts aggressive reopening of the second-largest U.S. economy. Covid-19 cases and hospitalizations have spiked since the state reopened eight weeks ago, pushing intensive-care wards to full capacity and sparking concerns about a surge in fatalities as the contagion spreads.

Texass Positive-Test Rate Soars to Record (8:09 a.m. HK)

Texass Covid-19 positive-test rate surged to 14.31%, the highest for the second-most populous U.S. state since the pandemic emerged, underscoring the magnitude of the growing crisis facing Americas Sunbelt.
The positivity rate on Saturday surpassed the previous record of 13.86% set on April 13, state health department figures released on Sunday showed. The number has almost tripled since May 31, when Texas posted a 5.44% positive-test rate.

Pence Encourages Mask Wearing (7:46 a.m. HK)

U.S. Vice President Mike Pence encouraged people to wear masks to prevent the spread of the virus, two days after declining to give that specific guidance.
Wear a mask, wherever its indicated or wherever youre not able to practice the kind of social distancing that would prevent the spread of the coronavirus, Pence said at a press briefing with Texas Governor Abbott and federal and state health officials, who are grappling with a surge in coronavirus cases. Wearing a mask is just a good idea.

During a White House coronavirus task force briefing on Friday, Pence avoided saying whether Americans should wear one. Asked on CBS Face the Nation, about President Donald Trumps refusal to say everyone should wear a mask Pence said that every state has a unique situation and that the principle of federalism has guided their decision making.

California Shuts Bars in L.A., Other Counties (7:22 a.m. HK)

Some California residents hoping to celebrate Independence Day in a bar will now have to change their plans. Bars are required to shut in seven counties — including Los Angeles — and theyre recommended to close in eight others, including Sacramento and Santa Barbara, following a surge in coronavirus cases, according to an order by Governor Gavin Newsom on Sunday.

Most in Poll Say Trump Unprepared (6:30 a.m. HK)

Almost three-quarters of Americans said that, as they look back a few months, the Trump administration wasnt ready to deal with the outbreak when it started this year, according to a CBS News poll.

Some 72% judged the administration unprepared against 28% who said it was prepared, according to the June 23-26 survey. Almost half, 49%, said the outbreak would get worse this summer. The remainder split between those who think it will get better and those who expect it to stay about the same.
The CBS poll said assessments of how President Donald Trump has handled the outbreak continue to slip, to 41% now from 47% in mid-April and 53% in late March.

Brazil Cases Rise 2.3% (6:20 a.m. HK)

Brazil had 30,476 new cases in the past 24 hours, a 2.3% rise from the previous day, bringing the national total to 1.34 million, the Health Ministry reported on Sunday. The government registered 522 deaths, raising the toll to 57,622.

San Quentin Prison Cases Surge (5:30 p.m. NY)

Californias San Quentin State Prison is seeing an explosion of cases after a botched transfer from another facility, impacting hundreds of incarcerated residents and scores of officers in a potential public health threat to the San Francisco Bay Area.
About 816 people in the prison tested positive on Sunday, according to data from the Department of Corrections and Rehabilitation. That means more than 1 in 5 of the prisons population of 3,507 is infected, and its not clear if everyone has been tested. State data show 89 staff members have Covid-19. A spokeswoman didnt respond to an e-mail seeking comment on the rise in cases Sunday.

San Quentin had zero known cases through May, but infections jumped after officials transferred 121 people from the California Institution for Men in Chino on May 30. The practice of transferring inmates has been widely criticized for spreading the virus.

WHO Reports Another High for Cases (4:45 p.m. NY)

The World Health Organization reported almost 190,000 new cases for the 24-hour period through early Sunday, a week after the previous one-day high.
Cases from the Americas accounted for 62% of the 189,077 new infections, followed by 13% from Southeast Asia and 8.8% from Europe, according to the report from the United Nations agency based in Geneva.

The U.S. and Brazil, together, represented 49% of all new infections. The WHO report showed 9.84 million cases, a total that lags behind tallies from John Hopkins University, which showed more than 10 million cases on Sunday.

U.S. Cases Up 1.7%, Above 7-Day Average (4 p.m. NY)

Coronavirus cases in the U.S. increased by 42,735 from the same time Saturday to 2.53 million, according to data collected by Johns Hopkins University and Bloomberg News. The 1.7% increase was above the average daily rise of 1.5% over the past week. The total was less than the 45,450 reported on Saturday but above 40,000 for a third straight day. Fatalities rose 0.3% to 125,709.

DeSantis Cites Socializing for Cases (3:15 p.m. NY)

Florida Governor Ron DeSantis said people in the 18-to-44 age group account for most of the rise in positive Covid-19 tests, with the 24-to-34 year old by far the leading group for new infections.
Its basically socializing, DeSantis said at a Pensacola news conference as he dismissed suggestions the rise reflected opening the economy too soon. Most of this is not because of people going to work, its because theyre being social.
DeSantis said young people, who are at lower risk from the disease, should avoid gathering in large groups and then visiting restaurants or other venues where the infection can spread.

Arizona Cases Rise 5.5% (12:42 p.m. NY)

Arizonas new cases increased by 3,858 to 73,908, a 5.5% increase that exceeded the prior weeks average of 4.4%, the state reported Sunday. Daily infections have exceeded the weekly average for four straight days. The number of deaths rose by 9 to 1,588.

Cuomo Fears Imported Infections (12:05 p.m. NY)

New York had the fewest daily deaths since the pandemic began in March, five on Saturday, as Governor Andrew Cuomo said he is now afraid of the spread from other states.

We are one country and people travel and Im afraid the infection rate in the other states will come back to New York and raise that rate again, Cuomo said on NBCs Meet the Press.

The governor said New York has plans to reopen schools, and the state will assess the infection rate and what the disease is doing before making a decision on a date. If this continues across the country, Cuomo said, kids are going to be home for a long time.
With assistance by Paul Sillitoe

Key PointsQuestion  What is the association between acute acral lesions and coronavirus disease 2019 (COVID-19) in children and adolescents?
Findings  In this case series of 20 patients aged 1 to 18 years with new-onset acral inflammatory lesions, all lacked systemic manifestations of COVID-19. Both reverse transcriptasepolymerase chain reaction and serologic test results were negative for severe acute respiratory syndrome coronavirus 2.
Meaning  An association between acral skin disease and COVID-19 has yet to be proved.
Importance  A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently been identified as the cause of a pandemic called coronavirus disease 2019 (COVID-19). In this context, some associated skin diseases have been described. Cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of COVID-19 in adolescents and children.
Objective  To evaluate the pathogenesis of these newly described acute acral lesions.
Design, Setting, and Participants  This prospective case series was conducted at La Fe University Hospital, a tertiary referral hospital in Valencia, Spain, between April 9 and April 15, 2020. Among 32 referred patients, 20 children and adolescents with new-onset inflammatory lesions did not have a diagnosis.
Exposures  Patients were not exposed to any drug or other intervention.
Main Outcomes and Measures  We performed reverse transcriptasepolymerase chain reaction for SARS-CoV-2 and a range of blood tests for possible origins of the lesions. Skin biopsies were performed in 6 patients.
Results  Of the 20 patients enrolled, 7 were female and 13 were male, with an age range of 1 to 18 years. Clinical findings fit into the following patterns: acral erythema (6 patients), dactylitis (4 patients), purpuric maculopapules (7 patients), and a mixed pattern (3 patients). None of the patients had remarkable hematologic or serologic abnormalities, including negative antibodies to SARS-CoV-2. Biopsies performed in 6 patients showed histologic findings characteristic of perniosis.
Conclusions and Relevance  The clinical, histologic, and laboratory test results were compatible with a diagnosis of perniosis, and no evidence was found to support the implication of SARS-CoV-2 infection.

At the end of 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of an outbreak of pneumonia and severe acute respiratory syndrome in Wuhan, China.¹ On January 30, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a public health emergency of international concern.² Although SARS-CoV-2 infection can affect individuals of any age, severe illness is uncommon in children.
Recently, possible COVID-19related skin changes have been described: mostly urticaria, drug-related eruptions, and chickenpox-like vesicles.³ In addition, cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of SARS-CoV-2 infection in adolescents and children.⁴ In this article, we report an outbreak of acral skin lesions observed between April 9 and April 15, 2020.
A prospective case series was performed at La Fe University Hospital, Valencia, Spain, to assess the clinical and etiologic features of children and adolescents with acute acro-ischemia. Among 32 patients referred for acral lesions between April 9 and April 15, 2020, we included 20 who presented with new-onset acral inflammatory lesions without an obvious diagnosis of recognizable cause.
Each patient underwent a complete blood cell count; biochemistry tests for liver and kidney function, erythrocyte sedimentation rate, and levels of ferritin, lactate dehydrogenase, and C-reactive protein; coagulation tests, including levels of D-dimer, cryoglobulins, and proteins C and S; urine sediment examination; autoimmunity tests for antinuclear antibodies (enzyme-linked immunosorbent assay [ELISA] and indirect immunofluorescence assay), antineutrophil cytoplasmic antibodies, antiphospholipid antibodies (lupus anticoagulant, antiβ₂-glycoprotein, anticardiolipin antibody), C3, C4, and interleukin 6; serologic tests for enterovirus, Epstein-Barr virus, human herpesvirus 6, parvovirus B19, mycoplasma, rubella, and measles; tests for immunoglobulin (Ig) G, IgM, and IgA (COVID-19 ELISA Kit, Vircell; sensitivity and specificity for IgG and IgM+IgA joint detection of 70% and 98%); and reverse transcriptasepolymerase chain reaction (RT-PCR) by nasopharyngeal swab for SARS-CoV-2 (Viasure SARS-CoV-2 Real Time PCR Detection Kit, CerTest Biotec; detection limit 10 RNA copies per reaction for the ORF1ab and N genes).
This study was approved by the institutional review board of La Fe University Hospital, and written informed consent for each procedure and for publication was obtained from all patients or their families.
Twenty patients were included in this study, 13 of whom were male. Main characteristics of the patients are depicted in the Table.
No patient had any clinical symptoms (fever, fatigue, dry cough, anorexia, myalgia, dyspnea, sputum, headache, sore throat, smell or taste disorders, or rhinorrhea) suspected to be COVID-19related.^1,2,5 Similarly, no co-inhabitant showed any symptoms. Ten of 20 patients lived with relatives older than 50 years (6 of whom were older than 80 years). The mean (SD) age of the patients was 12.3 (4.3) years, and no patient was older than 18 years. Nine of them (45%) had a history of vascular reactive disease of the hands (Raynaud phenomenon or perniosis). Only patient 8 had a history of connective tissue disease (systemic lupus erythematosus). None of them reported previous drug intake except for patient 18, who had taken a single dose of 500 mg of acetaminophen 2 weeks before, and patient 10, who had started treatment for anemia with ferric sulfate 1 month before. Fifteen (75%) reported walking barefoot around the house during the quarantine. Of all patients, only 2 lived in a home equipped with a heating system. No abnormal test results were found in any patient except for patient 3 and patient 8, who had positive results for antinuclear antibodies (titers of 1/160 and 1/1280, respectively).
Dermatologic findings were classified into the following groups based on skin pattern: periungual erythema; inflammation of 1 or more fingers with occasional whitish areas, which we have called dactylitis; and purpuric maculopapules with occasional blisters. In some patients, we observed a mix of lesions. Acral erythema was found in 6 (30%) of the cases (Figure 1A), dactylitis in 4 (20%) (Figure 1B), purpuric maculopapules in 7 (35%) (Figure 1C), and a mixed pattern in 3 (15%) (Figure 1D).
We obtained 6 skin biopsy specimens from 6 different patients. Results are presented in the Table and Figure 2. In all patients, results of serologic and viral testing were negative for SARS-CoV-2 as well as other viruses.
On March 14, 2020, a state of emergency was declared in Spain, and strict stay-at-home rules were imposed. Citizens were alerted to a series of signs and symptoms to detect early SARS-CoV-2 infection. Reports of diverse cutaneous lesions as possible symptoms of COVID-19 have led to an increase in visits to our hospital for any of these manifestations.⁴ However, apart from temporal coexistence, the involvement of COVID-19 in the development of these lesions has not been proved so far.
In this article, we report a series of 20 cases of cutaneous lesions classifiable on the clinical spectrum of perniosis. Regarding histologic features, it is worth noting that there is bias because 5 of 6 biopsies were performed in patients with more severe lesions. Nevertheless, the histologic findings in all of them were characteristic of chilblains, confirming the clinical impression.⁶
When evaluating the pathogenesis of these lesions, several possibilities emerge. Both our cases and others reported in the literature have developed in a short space of time, generally with an onset in the second to third week of the pandemic.^7–12 Some of the cases that have been described occurred in patients with SARS-CoV-2 infection demonstrated by RT-PCR or in symptomatic patients, but there are also a large number of patients, similar to ours, in whom the presence of the virus could not be demonstrated by RT-PCR, the serologic test results were negative, or the patients were asymptomatic.^7–11
At least 3 different scenarios may be considered to explain the abrupt appearance, during the peak of the pandemic, of these characteristic lesions in a group of SARS-CoV-2negative patients. One possibility is that the patients were in a very early stage of the disease, which would explain the negativity of PCR and serologic test results.⁸ This seems to us the least probable explanation, given that the mean (SD) duration of the disease before consultation in our series was 13.25 (8.11) days and we conducted follow-up in all patients for 4 additional weeks.
The second alternative is that acrocyanosis and perniosis were a subacute manifestation of the infection, in which patients no longer had detectable viral particles.^8–12 Additionally, in situations in which the viral inoculum was small, it is conceivable that the RT-PCR results were negative, patients did not develop other symptoms, and the serologic response was of low intensity and not detectable with the tests currently available. Serologic responses have been shown to be lower in young individuals than in older ones.¹³ In this scenario, the only manifestations of COVID-19 could be endotheliitis and a facility for thrombosis in the distal small vessels of the extremities.^8,9,14 Entotheliitis and thrombosis have been described in patients with severe COVID-19 with previous endothelial damage and cardiovascular comorbidity (eg, diabetes, hypertension, obesity).^14,15 However, the absence of those risk factors and the unaltered results of the coagulation tests performed in our patients do not support this explanation.
Finally, a third possibility, which is not supported by the results of all of the complementary examinations carried out in our patients, is that these skin lesions are not induced by the virus but by the quarantine state itself. Accordingly, this quarantine perniosis appeared mainly in children isolated in houses that were not well suited for individuals who spent long periods barefoot or only wearing socks and with very little physical activity.
This study was carried out in a short period and with patients from a single center. Furthermore, there is still limited knowledge regarding the clinical manifestations of and detection methods for SARS-CoV-2.
In this case series of 20 children and adolescents, a relationship between acute acral skin changes and COVID-19 could not be demonstrated. Other studies with improved microbiologic tests or molecular techniques aimed at demonstrating the presence of SARS-CoV-2 in the skin may help to clarify this problem.
Accepted for Publication: May 15, 2020.
Published Online: June 25, 2020. doi:10.1001/jamadermatol.2020.2340
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Roca-Ginés J et al. JAMA Dermatology.
Corresponding Author: Ignacio Torres-Navarro, Department of Dermatology, Hospital Universitario y Politécnico la Fe, 106 Fernando Abril Martorell Ave, Valencia 46026, Spain (nacho.torres.navarro@gmail.com).
Author Contributions:Drs Torres-Navarro and Botella-Estrada had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Botella-Estrada and Évole-Buselli contributed equally.
Concept and design: Roca-Ginés, Torres-Navarro, Sánchez-Arráez, Abril-Pérez, Botella-Estrada, Évole-Buselli.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Roca-Ginés, Torres-Navarro, Sánchez-Arráez, Abril-Pérez, Martínez i Cózar, Botella-Estrada, Évole-Buselli.
Critical revision of the manuscript for important intellectual content: Roca-Ginés, Torres-Navarro, Sánchez-Arráez, Abril-Pérez, Sabalza-Baztán, Pardo-Granell, Botella-Estrada, Évole-Buselli.
Statistical analysis: Roca-Ginés, Torres-Navarro.
Obtained funding: Torres-Navarro.
Administrative, technical, or material support: Roca-Ginés, Torres-Navarro, Abril-Pérez, Sabalza-Baztán, Pardo-Granell.
Supervision: Roca-Ginés, Torres-Navarro, Botella-Estrada, Évole-Buselli.
Other (diagnosis pathology):Martínez i Cózar.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was funded by the Department of Dermatology of La Fe University Hospital.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the patients and their families for granting permission to publish this information. We also thank María Dolores Gómez-Ruiz, PhD, and Carmina Sos-Lloret, MD, from the Department of Microbiology, Hospital Universitario y Politécnico La Fe, for their support. They did not receive compensation for this work.

Are the Covid Toes, Fingers and body rash the symptoms of the African Swine Fever in Humans? – GS

Scammers have found yet another way to take advantage of the COVID-19 pandemic, by selling fake antibody tests.

A real antibody test will screen your blood for antibodies made when your body fights off an infection.

The presence of antibodies can determine if you have had COVID-19.

The FBI says fake tests potentially provide false results, which is bad enough, but the people selling the fraudulent kits are really after your personal information.

SEE ALSO: Answers to questions about new coronavirus antibody studies

Scammers are interested in things like your name, birth date and social security number.

They may even steal your Medicare or health insurance information.

Information like that can be used in future insurance fraud cases.

Here is what the FBI says to look out for:

• People calling you saying the government is requiring you to take an antibody test

• Tests advertised on social media

• Claims that you can get money for taking the tests

You can also look up approved antibody test kits by checking them out at

FDA.gov.

If you think you have already been the victim of a COVID-19 fraud, you can report it to the

National Center for Disaster Fraud Hotline, online

 or at (866) 720-5721.

Follow Jeff Ehling on Facebook, Twitter and Instagram.
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WASHINGTON – Russian bounties offered to Taliban-linked militants to kill coalition forces in Afghanistan are believed to have resulted in the deaths of several U.S. service members, according to intelligence gleaned from U.S. military interrogations of captured militants in recent months.
Several people familiar with the matter said it was unclear exactly how many Americans or coalition troops from other countries may have been killed or targeted under the program. U.S. forces in Afghanistan suffered a total of 10 deaths from hostile gunfire or improvised bombs in 2018, and 16 in 2019. Two have been killed this year. In each of those years, several service members were also killed by what are known as “green on blue” hostile incidents by Afghan security forces who are sometimes believed to have been infiltrated by the Taliban.

The intelligence was passed up from the U.S. Special Operations forces based in Afghanistan and led to a restricted high-level White House meeting in late March, the people said.
The meeting led to broader discussions about possible responses to the Russian action, ranging from diplomatic expressions of disapproval and warnings, to sanctions, according to two of the people. These people and others who discussed the matter spoke on the condition of anonymity because of its sensitivity.

The intelligence – which the CIA was tasked with reviewing, and later confirmed – generated disagreement about the appropriate path forward, a senior U.S. official said. The administration’s special envoy for Afghanistan, Zalmay Khalilzad, preferred confronting the Russians directly about the matter, while some National Security Council officials in charge of Russia were more dismissive of taking immediate action, the official said.

It remained unclear where those discussions have led. Verifying such intelligence is a process that can take weeks, typically involving the CIA and the National Security Agency, which captures foreign cellphone and radio communications. Final drafting of any policy options in response would be the responsibility of national security adviser Robert O’Brien.
The CIA assessment took time and coincided with the scaling back and slowing down of a number of government functions as the coronavirus pandemic began to take hold, two people said.
A National Security Council spokesman said “the veracity of the underlying allegations continue to be evaluated.” The CIA and the Defense and State departments declined to comment.
Russia and the Taliban have denied the existence of the program.
Among the coalition of NATO forces in Afghanistan, the British were briefed late last week on the intelligence assessment, though other alliance governments were not formally informed. The New York Times first reported the existence of the bounty program Friday evening.
As more details have unfolded, the primary controversy in Washington over the weekend revolved around denials by President Donald Trump and his aides that the president was briefed on the intelligence.
Trump on Sunday confirmed statements by Director of National Intelligence John Ratcliffe and the White House press secretary that he received no briefing on the subject, and he referred in tweets to “what are known as reports” by “Fake News.”
“Nobody briefed or told me, [Vice President Mike] Pence or Chief of Staff [Mark Meadows] about the what are known as attacks on our troops in Afghanistan by Russians, as reported through an ‘anonymous source’ by the Fake News . . . Everybody is denying it & there have not been many attacks on us,” Trump said on Twitter, insisting that “nobody’s been tougher on Russia than the Trump administration.”
But his Twitter remarks did little to clarify whether the administration was denying that the assessment existed, or simply denying that Trump knew anything about it. Richard Grenell, who served as acting director of national intelligence until last month, tweeted that “I never heard this. And it’s disgusting how you continue to politicize intelligence.”
House Speaker Nancy Pelosi, D-Calif., on Sunday joined other lawmakers – including leading Republicans – in expressing concern and calling for the administration to provide Congress with an explanation.
“This is as bad as it gets, and yet the president will not confront the Russians on this score, denies being briefed,” Pelosi said on ABC News’s “This Week.”
“But he wants to ignore,” she said, “he wants to bring them back to the G-8 despite the annexation of Crimea and invasion of Ukraine, despite what they yielded to [Putin] in Syria, despite [Russian President Vladimir Putin’s] intervention into our election, which is well-documented by our intelligence community and despite now possibly this allegation, which we should have been briefed on.”
Senate Judiciary Committee Chairman Lindsey Graham, R-S.C., a Trump ally who golfed with the president Sunday, tweeted earlier in the day that “I expect the Trump Administration to take such allegations seriously and inform Congress immediately as to the reliability of these news reports.”
In a second tweet, Graham said it was “Imperative Congress get to the bottom” of the Russian offer “to pay the Taliban to kill American soldiers with the goal of pushing America out of the region.”
Rep. Liz Cheney, R-Wyo., the third-highest-ranking member of the House GOP leadership, also took to Twitter on Sunday to say that if the report of Russian bounties “is true, the White House must explain” why the president wasn’t briefed, who did know and when, and “what has been done in response to protect our forces & hold Putin responsible.”
A third person familiar with the issue said, “I don’t think that anybody withheld anything and screwed up by not getting to the president on time.” By the end of the process, the person said, the intelligence community was confident in its assessment.
The issue is not when the president was briefed, the person said, because the process worked as it should have, given the coronavirus delay and the need to draw up policy options.
“The issue now that you are aware of it, what are you going to do about it? That’s where the focus should be,” the person said.
In years past, there were persistent reports that Russia was supplying small arms to the Taliban. Carter Malkasian, who served as a senior adviser to the previous chairman of the Joint Chiefs of Staff, Gen. Joseph Dunford, said Russia had cultivated a relationship with Taliban elements, largely in northern Afghanistan, beginning about 2015. The outreach was partly as a response to Moscow’s concerns about the threat posed by Islamic State militants in the region, and also a desire to see U.S. troops leave the region.
But more recently, U.S. officials said that Russia – which tried and failed to start its own Afghan peace process – has been cooperative and helpful since the Taliban signed a peace deal, including a plan for U.S. withdrawal, with the administration early this year.
Malkasian, now a scholar at the Center for Naval Analysis, said the bounty operation, if true, could be a “random” initiative, rather than one that reflected a well-coordinated program ordered by the highest levels of the government.
He said a primary Russian goal in Afghanistan continues to be the exit of American forces, but not at any cost.
“They may want us out, and they may be happy to see a few Americans die,” he said, “but I don’t think they want to see the Taliban take over.”

A mutated version of the coronavirus that has gripped Europe and the West is more infectious because it doesn’t break as often while inside the body, a study has found.
Researchers at The Scripps Research Institute in Florida say the ‘spike protein’ that the virus uses to attach to cells in the airways has adapted since January.
It used to break off regularly while trying to bind to receptors in people’s airways, which it would use to gain entry to the body, but is now more resilient, they say.
A genetic mutation which scientists around the world have been picking up on for months appears to have caused this spike to be less likely to snap, and also to force the coronaviruses to produce more of them to make itself more infectious.
As a result the virus appears to be approximately 10 times more infectious than it was when it first jumped to humans in China at the end of the year, scientists say.
The mutated version of the virus, dubbed G614 – a change from D614 – is a tiny change in its genetic make-up that scientists weren’t sure what to make of when they found it.
But by May research had found it had become the dominant strain being found in Covid-19 patients across the UK, US, Canada and Italy.

Lead researcher on the Scripps institute’s study, Dr Hyeryun Choe, told the Washington Post the mutation seemed to have happened to ‘compensate’ for the weakness of the spike protein in the past.
The Post reported it appeared to have become approximately 10 times more infectious as a result of this change.
The way the virus enters the body is by using its spike to latch onto a receptor – called an ACE-2 receptor – inside someone’s airways.
ACE-2 receptors are essentially tiny gateways that the virus uses to get into the blood and then multiply rapidly, destroying cells around them in the process and triggering illness.
Dr Choe and her colleagues examined the differences between the spike proteins, dubbed S, on the outside of both versions of the coronavirus.
They found: ‘These results show SG614 is more stable than SD614, consistent with epidemiological data suggesting that viruses with SG614 transmit more efficiently.’
The spike was stronger, they said, and as a result the virus was better able to bash through the gateway of the ACE-2 receptors.
Dr Choe told the Washington Post: ‘The epidemiological study and our data together really explain why the [G variant’s] spread in Europe and the US was really fast… This is not just accidental.’
However, this improved spike strength did not seem to be making people any sicker – or any less sick.
This, they suggested, could be because the spike had nothing to do with the virus’s ability to reproduce – to replicate – once it was inside the body.

The process of reproduction, and using the body’s resources to achieve this, is how the coronavirus causes illness.
Dr Choe’s study added: ‘An interesting question is why viruses carrying the more stable SG614 appear to be more transmissible without resulting in a major observable difference in disease severity.
‘It is possible that higher levels of functional S protein observed with SG614 increase the chance of host-to-host transmission, but that other factors limit the rate and efficiency of intra-host replication.’
The paper was published online on bioRxiv without being reviewed by independent scientists.
Researchers in the UK and US had in May noted that the G614 version of the virus had become ‘the dominant pandemic form in many countries’.
They said it was first found in Germany in February and had since become the most common form of the virus in patients worldwide – it appears to force out the older version whenever they clash.
Viruses mutate naturally all the time and it is not usually cause for alarm but should be studied in case they change so much they become unrecognisable to the body and immunity from a first infection cannot protect against them, as is the case with flu.
A study done by scientists at the University of Sheffield and Los Alamos National Laboratory, New Mexico, found that D614 appeared to have been the virus’s original state in humans, and the one found in Wuhan.
It made up the vast majority of all Covid-19 infections in China, and Asia as a whole, and also seemed to be the first version of the virus to appear in the countries they studied.
However, the mutated version – G614 – started to appear soon after in Europe and North America in particular, before going on to take over as the dominant virus.
‘A clear and consistent pattern was observed in almost every place where adequate sampling was available,’ the researchers said.
‘In most countries and states where the COVID-19 epidemic was initiated and where sequences were sampled prior to March 1, the D614 form was the dominant local form early in the epidemic.
‘Wherever G614 entered a population, a rapid rise in its frequency followed, and in many cases G614 became the dominant local form in a matter of only a few weeks.’