UK Diabetes Clinicians Urged to Embrace ‘Time in Range’

A new ‘best practice guide’ urges UK healthcare professionals to embrace the ‘time in range’ metric for patients with diabetes who use continuous glucose monitoring (CGM), particularly in light of the COVID-19 pandemic.

Time in range: a best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic, was published October 19 2020 in Diabetic Medicine by Dr Emma Wilmot of the diabetes department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, and colleagues. The document is a publication of the Diabetes Technology Network (DTN) UK, part of the Association of British Clinical Diabetologists (ABCD). 

Real-time CGM

In June 2019, an international consensus report established the ‘time in range’ concept – the proportion of time a person’s blood glucose falls within a prescribed range – as a clinical metric for patients with type 1 or type 2 diabetes who use either real-time CGM (rtCGM) or intermittently scanned CGM (isCGM), also called ‘flash glucose monitoring’. The latter, the Abbott FreeStyle Libre, is the one most commonly used in the UK, although the NHS in England has recently authorised the Dexcom G6 rtCGM for use during pregnancy.  

The new guidance aims to clarify the intent and purpose of the international consensus recommendations and provide practical clinical and technical advice for use of time in range in UK diabetes care, particularly in the context of the COVID-19 pandemic, co-author Pratik Choudhary, professor of diabetes at the University of Leicester, told Medscape Medical News.

“Even though FreeStyle Libre has been widely rolled out and people are seeing the reports, we felt that a locally-published paper by local leaders of the DTN was needed to get people to start thinking about time in range. People are still fixated on haemoglobin A1c (HbA1c) and glucose of 5 [mmol/L],” Prof Choudhary said.

International Guidelines

The paper reviews and provides rationale for the international guidelines, which recommend generally that more than 70% of glucose readings should fall within a blood glucose range of 3.9-10.0 mmol/L, with modifications for children, older adults, and pregnant women.  

“It’s a huge mindset [change] from saying your target is 5 [mmol/l] to saying you’ve got a target range. It’s saying you’ve got an allowance of 30%, so if you screw up a little bit it’s not a disaster. It will balance out. That’s the narrative we want to put out there,” Prof Choudhary explained.

A UK-based audit on the use of FreeStyle Libre conducted by ABCD showed significant improvements in HbA1c, reduced hospital admissions, and lower levels of diabetes-related distress in patients with type 1 diabetes. Updated data from that study were published in the September 2020 issue of Diabetes Care.

Remote Monitoring

The new document emphasises that time in range is meant as an adjunct to HbA1c rather than a surrogate, and discusses the correlations between the two values and their respective association with diabetes-related outcomes. However, because the COVID-19 pandemic has reduced the capacity for in-person visits including blood tests,

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Race Against Time for Boy Battling Rare, Alzheimer’s-like Illness | Health News

By Dennis Thompson HealthDay Reporter


MONDAY, Nov. 2, 2020 (HealthDay News) — Connor Dobbyn is an energetic and loving 12-year-old, but he’s fading away every second.

Connor has Sanfilippo syndrome, a genetic brain disorder in children that experts compare to Alzheimer’s disease.

The boy already has lost some of what he’s learned in his short time on Earth, and every day he loses a little more.

“We’re on borrowed time. They don’t live through their teens,” said his mom, Marisa DiChiacchio, who lives with Connor in West Chester, Pa. “We have six years left, at most.”

Here’s the good news: Researchers think they’ve found a cure for Connor’s type of Sanfilippo, a therapy that replaces the bad gene in his body with a healthy working version.

But they need millions of dollars in funding to test this potential cure. Connor’s parents have set up a GoFundMe page with a goal of $3 million for a clinical trial that could save their son’s life.

“The research is done. It’s like right there, but they need the money to fund the clinical trial,” DiChiacchio explained.

Kids with Sanfilippo syndrome suffer from the build-up of a long-chain sugar molecule called heparan sulfate, which is normally used by the body to build cartilage, connective tissues, nerve tissues and skin, according to the Nemours Foundation.

These kids have a defect in one of the genes that make enzymes needed to break down heparan sulfate. Without those enzymes, heparan sulfate “builds up everywhere in the body and the brain,” explained Cara O’Neill, chief science officer and co-founder of the Cure Sanfilippo Foundation.

As the substance clogs the brain and body, kids begin experiencing the sort of mental and physical decline associated with dementia in seniors. Kids lose knowledge and skills they’ve gained, develop seizures, experience hearing and vision loss, find it difficult to walk and move, and even struggle to chew and swallow food, O’Neill said.

“These kids become nonverbal. They lose their ability to walk and talk. They’re in wheelchairs and in strollers. Almost all of them develop seizures and different movement disorders,” DiChiacchio said. “There’s literally no cure at this point. These kids are dying.”

Sanfilippo syndrome is relatively rare, occurring in about 1 out of every 70,000 children, O’Neill said.

“We think it’s underdiagnosed because it’s usually masked as autism,” said Glenn O’Neill, president and co-founder of the Cure Sanfilippo Foundation. “Kids exhibit the typical symptoms of autism early in life while parents are trying to figure out what’s going on. But then things actually begin actually going backwards, in the wrong direction.”

That’s what happened with Connor. He’d been struggling with developmental delays since he was 1 year old, and at age 5 he received a diagnosis of autism, DiChiacchio said.

But during a psychological evaluation in the third grade, educators were stunned to find a drastic decline in Connor’s IQ, his mom said.

“It was like a bomb went off,” DiChiacchio said. “His average IQ in kindergarten was 100, and

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Australia has no local case 1st time in months

CANBERRA, Australia — Australia has recorded no new locally transmitted coronavirus infection for the first time in five months.

In Melbourne, the capital of Victoria state, which had the highest number of cases in the country, residents were enjoying the first weekend of cafes, restaurants and pubs reopening to walk-in customers.

The city only has one mystery case without a known source. There are 61 active cases left across the state, down from 70 on Saturday.

State Deputy Premier James Merlino hailed Sunday’s zero figures as “another great day for Victoria,” but urged caution ahead of Australia’s most-prestigious horse race on Tuesday, the Melbourne Cup, known as the “race that stops a nation.” Australians traditionally gather in bars or in private homes to watch the event, a public holiday.

The race attracts crowds of more than 100,000 at Melbourne’s Flemington race course, but this year it will held without fans because of restrictions on public gatherings.

Chief Health Officer Brett Sutton urged Victorians to enjoy the Cup but to continue obeying guidance on mask-wearing and social distancing.

“The great majority of Melburnians know what do to,” Sutton said. “There will be a few who may be a bit liberal in their behavior.”

Sutton said the new wave of infections in Europe showed how quickly the coronavirus can reassert itself.

“What Europe is going through now is a consequence of not being able to get to this point where you can stay on top of very low numbers,” he said. “What we have created is very precious and we need to hold onto it tightly.”

Western Australia state on Sunday recorded one new case of COVID-19, a woman who returned from overseas and is in hotel quarantine.



— Halloween in the pandemic: Costumes and candy, at a distance

— England to enter new lockdown; UK virus cases pass 1 million

— Minority US contact tracers build trust in diverse cities

— Efraín Valles guided world leaders, pop stars and a princess on exclusive tours through the land of the Incas. He now makes ice cream to survive amid the pandemic.

— The government of the Netherlands will halt its multibillion euro coronavirus bailout to national carrier KLM amid a standoff with a pilot’s union about terms of the rescue package.

— Austria has announced a partial shutdown that will see restaurants and bars closed for four weeks, cultural, sports and leisure activities canceled, and residents asked to stay home after 8 p.m.


Follow AP’s coronavirus pandemic coverage at and



SANTA FE, N.M. — Gov. Michelle Lujan Grisham on Saturday said the spread of coronavirus is out of control in New Mexico as she urged residents to stay home and avoid gathering with others to celebrate Halloween.

“Please — do your part to protect yourself and your fellow New Mexicans by celebrating a COVID-SAFE Halloween,” the Democratic governor’s office said in a

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U.S. records more than 90,000 Covid-19 cases in one day for the first time

The United States set yet another pandemic record with more than 90,000 new Covid-19 cases reported in a single day, the latest NBC News tally showed Friday.

a person wearing a hat

© Provided by NBC News

The new benchmark of 90,456 cases was hit Thursday just hours after the U.S. logged its 9 millionth coronavirus case and shattered the previous daily record of 80,662 infections, set a day earlier.

Also, the 540,035 new Covid-19 cases reported from last Friday, Oct. 23, to Thursday was the most for any seven-day period since July, the figures showed.

And with Election Day now just days away, the grim numbers stood in sharp contrast to President Donald Trump’s oft-repeated campaign claim that “we are rounding the turn” on the pandemic.

a man standing in front of a bus: Firefighters and paramedics with Anne Arundel County Fire Department wear enhanced protective equipment as they load a patient into an ambulance on Oct. 26, 2020 in Glen Burnie, Md. (Alex Edelman / AFP - Getty Images)

© Alex Edelman
Firefighters and paramedics with Anne Arundel County Fire Department wear enhanced protective equipment as they load a patient into an ambulance on Oct. 26, 2020 in Glen Burnie, Md. (Alex Edelman / AFP – Getty Images)

Covid-19 infections have actually been increasing across the United States at the fastest rate since the start of the pandemic, and overnight more than 30 states reported having more than 1,000 new cases.

The U.S. now leads the world in the number of Covid-19 cases and deaths, with nearly 230,000 deaths, according to the John Hopkins University Covid-19 dashboard.

“The virus is a global scourge, but it has been an American fiasco, killing more people in the United States than in any other country,” the House subcommittee on the coronavirus crisis said in a scathing report Friday, which blasted the Trump administration’s response to the pandemic as “among the worst failures of leadership in American history.”

In other coronavirus news:

  • Donald Trump Jr. falsely claimed Thursday that Covid-19 deaths have dwindled to “almost nothing,” despite there being around 1,000 reported in the United States that same day. The president’s son, who is not a physician, also said on Fox News’ “The Ingraham Angle” that the medical experts who have been talking about a surge in cases are “truly morons.”

  • Nursing homes, small physician offices and rural clinics have been struggling to secure N95 masks and other PPE because bigger and wealthier health care facilities have been stockpiling them, NBC News reported.
  • Restaurant owners who made it through the summer by serving patrons outside are worried they might not survive the winter as the weather turns colder and renewed restrictions are being considered as new Covid-19 cases are surging.
  • San Francisco hit the brakes on further reopening the city after a slight-but-worrisome uptick in new coronavirus cases, The San Francisco Chronicle reported. “We are tired of COVID-19 but COVID-19 is not tired of us,” Mayor London Breed said.
  • The temperature was expected to hit the freezing mark in Chicago on Friday night, but if you wanted to have a drink or meal inside a bar or restaurant you’re out of luck. New pandemic restrictions are in effect. And last call for outside drinking or dining is 11 p.m.
  • Ninety-percent of
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Virus Hospitalizations Are Up in N.Y.C. But This Time, It’s Different.

At one New York City hospital, coronavirus patients began arriving a few weeks ago from Brooklyn neighborhoods and nearby suburbs that have seen a resurgence of the virus.

But in contrast to March and April — when so many seriously ill New Yorkers flooded into the hospital, Mount Sinai, that a field hospital was erected nearby in Central Park — patients were showing up in smaller numbers and were often less sick. After treatment, they were going home.

“There is a much lower recent mortality rate,” said Dr. David Reich, the president of the hospital, despite the fact that the number of people being treated for Covid-19 had grown from the single digits in August to 56 on a given day last week.

As virus cases surge nationwide, hospitals around the country, particularly in rural areas of the Midwest, are seeing their largest uptick yet of critically ill patients. Some have begun to fill to capacity — an autumn wave of the pandemic that appears to get worse each day.

In New York City, hospitalizations have been slowly but steadily rising, eliciting painful memories of the surge of infections in the spring that killed more than 20,000 people. But the terrifying inundation of patients that overwhelmed hospitals then has yet to materialize again in New York City, even as cases rise.

Broad acceptance of face masks and social distancing has helped curb the spread of the virus, public health experts said. Fewer cases means fewer patients, allowing hospitals to better care for those who do come through the door.

And while there is no cure for Covid-19, doctors, nurses and other medical personnel in New York City have used their experiences during the spring surge to make significant improvements in hospital care.

Across the city’s public and private hospitals, patients with an illness serious enough to need treatment are given a diagnosis and cared for more quickly, spend less time on average in the hospital and are less likely to end up on mechanical ventilation, doctors and hospital executives said.

Fewer are dying: 139 people in the four weeks ending last Saturday. On the worst day during the spring, New York City recorded over 800 confirmed and probable deaths.

That trend has been mirrored in other parts of the country and world, as studies have begun to show lower death rates.

“You would expect there would be a lot more in the way of hospitalizations and deaths and, happily, there are not,” said Dr. Mitchell Katz, head of New York City’s public hospital system. He noted that at the peak in April the city’s public hospital system had more than 900 critically-ill Covid-19 patients on ventilators. On a recent day there were nine.

“How can I call that a second wave?”

Public health officials and epidemiologists had expected a resurgence of the virus in New York as the weather cooled, but many believed its impact would likely be less devastating than in the spring. Now, about 460 people are hospitalized

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LeAnn Rimes Proudly Shares Nude Photos as Her Psoriasis Returns for the First Time in 16 Years

Photo credit: Instagram
Photo credit: Instagram

From Prevention

  • LeAnn Rimes, 38, opened up about her journey with psoriasis in a new essay for Glamour.

  • The singer said that her skin condition flared for the first time in 16 years due to the “stress” of the pandemic and uncertainty that came with 2020.

  • Rimes is embracing her skin just the way it is.

LeAnn Rimes is not hiding her psoriasis anymore. In a new essay for Glamour, the singer opened up about her psoriasis diagnosis, and how the uncomfortable skin condition is flaring up for the first time 16 years due to the stress of the pandemic.

After attempting to hide her psoriasis for years, Rimes is embracing her skin the way it is. She shared the photos to Instagram in honor of World Psoriasis Day (October 29), writing in the caption that she’s ready to be honest about her experience with psoriasis. “And I want to give a voice to what so many other people are going through,” she said.

“You know when you say something you’ve been holding in for so long, and it’s such a sigh of relief? That’s what these photos are to me,” she said. “I needed this. My whole body—my mind, my spirit—needed this desperately.”

Fans flooded the post with messages of support. “I suddenly feel less ashamed of my psoriasis,” one fan wrote, while another person said, “You are so beautiful inside and out. I am always so amazed by you.”

In her essay with Glamour, Rimes shared that she was diagnosed with psoriasis when she was age two. “By the time I was six, about 80% of my body was covered in painful red spots—everything but my hands, feet, and face.

According to a recent review published in BMJ, nearly 3.4 million U.S. adults have psoriasis, and although the autoimmune disease can occur in children, it generally affects adults. The condition usually results in rashes, dryness, small bumps, and redness, but it can also cause joint stiffness, inflamed tendons, and mental health issues like depression.

“I tried everything I could to treat it: steroid creams, major medications—I even tried being wrapped in coal tar with Saran Wrap,” Rimes said, adding that she would also do everything in her power to hide it. “Onstage I’d often wear two pairs of pantyhose or jeans—even in 95-degree heat. Underneath my shirt, my whole stomach would be covered in thick scales that would hurt and bleed. For so much of my life, I felt like I had to hide.”

In her 20s, the singer discovered a treatment that kept her flare-ups at bay, and it wasn’t until this year that her bumps returned.

“All hell broke loose in the world—and inside of me, as I’m sure it did for so many other people amid this pandemic,” she said. “Stress is a common trigger for psoriasis, and with so much uncertainty happening, my flare-ups came right back.”

Rimes is not alone—many Americans are stressed in 2020.

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Sleep experts: It’s time to ditch daylight saving time

Oct. 30 (UPI) — For most of the United States, the clock goes back one hour on Sunday morning, the “fall back” for daylight saving time. Many of us appreciate the extra hour of sleep.

But for millions, that gain won’t counter the inadequate sleep they get the rest of the year. About 40% of adults — 50 to 70 million Americans — get less than the recommended minimum seven hours per night.

Some researchers are concerned about how the twice-a-year switch impacts our body’s physiology. The American Academy of Sleep Medicine, the largest scientific organization that studies sleep, now wants to replace daylight saving time with a move to a year-round fixed time. That way, our internal circadian clocks would not be misaligned for half the year. And it would eliminate the safety risk from sleep loss when transitioning to daylight saving time.

I am a neurologist at the University of Florida. I’ve studied how a lack of sleep can impair the brain. In the 1940s, most American adults averaged 7.9 hours of sleep a night. Today, it’s only 6.9 hours. To put it another way: In 1942, 84% of us got the recommended seven to nine hours; in 2013, it was 59%. To break it down further, a January 2018 study from Fitbit reported that men got even less sleep per night than women, about 6.5 hours.

The case for sleep

Problems from sleep shortage go beyond simply being tired. Compared to those who got enough sleep, adults who are short sleepers — those getting less than seven hours per day — were more likely to report 10 chronic health conditions, including heart disease, diabetes, obesity, asthma and depression.

Children, who need more sleep than adults, face even more challenges. To promote optimal health, 6- to 12-year-olds should sleep nine to 12 hours a day; teens age 13 to 18, eight to 10 hours. But a Sleep Foundation poll of parents says children are getting at least one hour less than that. And researchers have found that sleep deprivation of even a single hour can harm a child’s developing brain, affecting memory encoding and attentiveness in school.

Sleep impacts every one of our biological systems. Serious consequences can result with poor sleep quality. Here’s a short list: Blood pressure may increase. Risk of coronary heart disease could go up. Our endocrine system releases more cortisol, a stress hormone. We become more aroused by “fight or flight” syndrome. There’s a reduction of growth hormone and muscle maintenance. There’s a higher chance of increased appetite and weight gain. The body has less glucose tolerance and greater insulin resistance; in the long term, that means an increased risk for Type 2 diabetes.

Sleep deprivation is associated with increased inflammation and a decreased number of antibodies to fight infections. It may also cause a decrease in pain tolerance, reaction times and memory. Occupational studies show sleep loss can cause poor work performance, including more days missed and more car accidents.

Recent research

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Daylight Saving Time can make kids ‘cranky and irritable’

Turns out, even in the days of limited travel, people can have all the grogginess and crankiness of jet lag without the fun associated with voyaging to a different time zone.

Daylight Saving Time ends at 2 a.m. Sunday, meaning everyone is supposed to set their clocks back one hour. Though Daylight Saving, which starts in March when people typically push clocks ahead one hour, was originally intended as a way to conserve energy and make better use of daylight, some experts said it often feels like more trouble than it’s worth.

That’s particularly true for the first day or so after the time shift, said Dr. Philip Greenspan, a pulmonologist and sleep specialist with Yale New Haven Health.

“Our bodies are set to a certain rhythm,” he said. “What happens when that (rhythm) changes is like a kind of jet lag. Our bodies have to adjust to that change.”

That can lead to temporary grogginess and sleepiness, Greenspan said. For children, who need sleep to develop properly, shifting that hour can be particularly difficult, said Dr. Taralyn Cronin-Weir, pediatrics specialist with Yale New Haven Health.

During time changes, she said, children can get thrown off their sleep schedule.

“They can be cranky or irritable,” she said.

Some experts have argued that the impact of Daylight Saving is a bit more dire than some sleepiness and a bad attitude. In August, the American Academy of Sleep Medicine released a position statement, arguing for a switch from Daylight Saving to a permanent standard time.

The position paper cited several possible health drawbacks to Daylight Saving Time, including an increased risk of stroke to a rise in traffic fatalities. The sleep medicine academy also referenced a research abstract published in May that found an 18 percent increase in adverse medical events related to human error in the week after switching to Daylight Saving.

“A change to permanent standard time is best aligned with human circadian biology and has the potential to produce beneficial effects for public health and safety,” the statement read.

Until that happens, Greenspan and Cronin-Weir said the best people can do is learn to live with Daylight Saving. Cronin-Weir said parents wishing to keep their kids sleep schedule on track can use the next few days to gradually shift them to an earlier bedtime to prepare their bodies for the change.

And Greenspan said people should keep in mind that any grogginess they feel after the time shift isn’t permanent. “It usually takes about a day for every hour you shift to recover,” he said.

Source Article

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Governments Worldwide Consider Ditching Daylight Saving Time

It’s nearly that time of the year again: the end of daylight saving, when Americans push their clocks back and rejoice at the gained hour of sleep—or mourn the lost hour of sunlight in the afternoon.

This system’s twice-a-year transitions have become increasingly unpopular. Scientists have been calling attention to the damaging effects of the time changes—which include a general reduction in mental and physical well-being, as well as a potential increased risk of serious complications, such as strokes and heart attacks, soon after the shifts. There is also evidence of increases in traffic fatalities and harmful medical errors shortly following when clocks are moved forward in the spring.

In many countries, this might be the one of the last instances in which people make the adjustment. Governments around the world have been in discussions about scrapping the seasonal clock changes and sticking to one time—either permanent standard time or permanent daylight saving. In the U.S., many states are considering, or have already passed, legislation to adopt one of the two. Hawaii and most of Arizona decided to adopt just standard time  more than 50 years ago. Last year the European Parliament voted to abolish the time shifts, but the member states of the European Union have yet to agree on how to implement the decision.

Beth Malow, a professor of neurology and pediatrics at Vanderbilt University, spoke with Scientific American about the health effects of this timekeeping practice and what should replace it.

[An edited transcript of the interview follows.]

The end of daylight saving time is fast approaching. Generally speaking, how disruptive are the transitions to and from daylight saving to physical and mental well-being?

There’s a lot of variability in what people experience. Some people have shared with me that, for example, they might have a child with autism, and for two or three months after the transition, they feel like things are just not right with their child’s sleep. People also tell me they just feel out of sync for a while. Other people may deal with the change more easily. It’s similar to when we travel [from the U.S.] to Europe. Some people are affected by jet lag more than others.

The one thing I will say is that people think, “Well, it’s only an hour, so it’s not a big deal. It’s kind of like traveling from Nashville, [Tenn.], to New York [City]—going from Central to Eastern time.” But [daylight saving] really isn’t that. It’s a misalignment of your biological rhythms, or circadian rhythms, for eight months out of the year.

You wrote a commentary in JAMA Neurology last year that discusses some medical complications—such as cardiovascular problems and stroke—associated with the transitions. Can you talk a bit about how daylight saving changes can increase the risk for these kinds of events?

We don’t know the actual mechanism because these are epidemiological studies, where there are large numbers of people, and [researchers] observe the stroke rate or heart attack rate increase

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Fauci expresses support for national mask mandate for the first time amid record-setting coronavirus infections

Anthony S. Fauci, the nation’s top infectious-disease expert, said for the first time Wednesday that the United States needs a nationwide mask mandate to combat the rising tide of coronavirus infections. In interviews with CNBC and the Journal of the American Medical Association, Fauci expressed regret that masks haven’t been adopted more widely and suggested that doing so would be key to avoiding another round of shutdowns.

Anthony S. Fauci wearing a suit and tie: Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, testifies during a Senate hearing in September.

© Graeme Jennings/AP
Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, testifies during a Senate hearing in September.

Here are some significant developments:

  • With five days to go before Election Day on Nov. 3, President Trump and his Democratic challenger Joe Biden have crystallized opposing messages on a pandemic that has affected most aspects of American life, including voting.
  • Germany and France announced month-long lockdowns on Wednesday, saying that the resurgence of infections had spiraled out of control.
  • Health officials say the White House called off an investigation into its coronavirus outbreak, while failing to notify people who may have been exposed.
  • The United States has seen a steady increase in coronavirus infections and hospitalizations for almost the entire month of October, with record-high numbers of cases reported in the past week, according to data tracked by The Washington Post. More than 80,000 new cases were recorded on Wednesday, pushing the total number of infections past 8.8 million. At least 227,000 fatalities have been linked to the virus since February.
  • A federal government briefing document obtained by The Washington Post suggests that a traveler could theoretically drive all the way from the Canadian border to northern Mississippi without ever leaving a “hot-spot” county.

Sign up for our coronavirus newsletter | Mapping the spread of the coronavirus: Across the U.S. | Worldwide | Vaccine tracker | Where states reopened and cases spiked | Has someone close to you died of covid-19? Share your story with The Washington Post.

1:31 AM: Fauci expresses support for national mandate for the first time, says he hasn’t spoken to Trump in ‘quite a while’

Anthony S. Fauci, the nation’s top infectious-disease expert, appeared to call for a nationwide mask mandate for the first time on Wednesday in a series of interviews with the CNBC and the Journal of the American Medical Association.

The director of the National Institute of Allergy and Infectious Diseases has historically been reluctant to advocate for such a sweeping policy, telling reporters last month that a national mandate “probably would not work.” But in a Friday interview with CNN, he suggested that the federal government should “maybe” consider instituting one.

Questioned about his apparent hesitation on Wednesday by CNBC’s Shepard Smith, Fauci said that he had hoped “we could pull together as a country” and recognize the importance of mask-wearing without the government getting involved. “We haven’t,” Smith interrupted, before going on to ask Fauci if it was time for a national mandate.

“You know, yes,” Fauci replied. “If we don’t

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