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Azerbaijan says civilians killed by Armenia in Ganja: Live

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Armenian defence ministry denies the claim, accuses Baku of shelling areas inside Nagorno-Karabakh.

Twelve civilians have been killed and more than 40 people injured in an early-hours missile attack on Azerbaijan’s second-biggest city, Ganja, the Azerbaijani prosecutor general’s office said.

A missile raid levelIed a row of homes in Azerbaijan’s second city of Ganja, killing and badly injuring people in their sleep in a sharp escalation of the Nagorno-Karabakh conflict.

The Armenian defence ministry denied the claim and accused Baku of continuing to shell populated areas inside Nagorno-Karabakh, including Stepanakert, the region’s biggest city.

Here are the latest updates on the Nagorno-Karabakh conflict:

Saturday, October 17

05:55 GMT: Azerbaijan says 12 civilians killed, 40 wounded in Ganja by Armenia shelling

Azerbaijan said 12 civilians were killed and more than 40 were wounded in the city of Ganja due to shelling by Armenia.

The Azeri Prosecutor General’s office said that two shells hit apartment buildings in the country’s second-largest city.

There has been no official reaction from Armenia as yet.

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States need billions to prepare for Covid-19 vaccines. The federal government isn’t helping.

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Early results from the two leading US Covid-19 vaccine trials are expected in November, in what will likely be a major milestone in the race to end the pandemic.

The final leg of the race, however, will be actually getting people vaccinated.

The US Centers for Disease Control and Prevention (CDC) has offered guidance on jurisdictions’ plans, and has given them a deadline of November 1 to be ready to roll out a potential vaccine (a timeline administration officials assert is unrelated to the November 3 election).

Will health departments be ready to distribute a vaccine by then?

“Probably not, if you mean completely ready,” says William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, who also serves as a consultant to the Tennessee Department of Health. “Are they working hard? Absolutely.”

No matter when it commences, a nationwide vaccine administration effort will require a massive workforce of health professionals (who are already in short supply and are often already working on other Covid-19 responses). It also may require costly medical-grade freezers to keep vaccine doses at supercold temperatures — or lots and lots of dry ice. And it needs a robust new data management system to track who gets which vaccine when and where, particularly if vaccines require multiple doses to be effective, and if there ends up being more than one approved vaccine.

The trouble is, states and local health departments have not received funding from Congress to make any of this happen. This “makes it nearly impossible to do what you need to be doing at this stage of the game if your go date is November 1,” says Adriane Casalotti, head of government affairs for the National Association of City and County Health Officials (NACCHO).

Like many things in the pandemic, it didn’t have to be this way, she says. “This is one of the few areas of Covid-19 where we can plan in advance, where we don’t have to build the plane while flying it.” She adds that although their group has been asking the federal government for support for distribution since early vaccine research began, “now it’s late.”

To be sure, there will not be enough vaccine to immunize 328 million people right away, which simplifies logistics somewhat. And many experts are expecting it will be the end of this year or the beginning of 2021 before the first doses are available. (Health and Human Services Secretary Alex Azar recently said there might be enough doses to vaccinate health care workers, first responders, and seniors by the end of January, with some doses arriving sooner.)

But even with a relatively modest beginning (and we’re still talking about tens of millions of people), public health workers want to make sure they have plans and systems in place, rather than rushing to meet a deadline, Schaffner points out. “The government is antsy about getting things started, but most health departments are saying, ‘Whether I start vaccination this week or next week doesn’t matter so much because this is going to be going on for eight months,’” he says.

Let’s take a closer look at the challenges facing the vaccine rollout and how the government could help things get on track sooner rather than later.

Health experts say they need billions of dollars to be ready; the federal government hasn’t promised any money

State health departments were asked in late September to submit their proposed vaccine rollout plans to the CDC by October 16. For this task, the federal government distributed $200 million, which was split among the states, major metropolitan areas, and US territories.

Not only did this mean relatively little funds for each of the 64 jurisdictions (states, territories, and major cities), Casalotti notes, but it also did not guarantee any funding would reach the thousands of smaller local health departments around the country, which is where much of the on-the-ground work of preparing to get people vaccinated will take place.

More importantly, the government has yet to promise any money to support actually building out these plans and helping the health organizations be ready when the vaccines are.

A well-coordinated, well-supported effort by health departments to vaccinate the US population will likely cost at least $8.4 billion, according to an October 1 letter NACCHO sent to Congress requesting that much be appropriated for the effort. And other public health groups, including the Association of State and Territorial Health Offices (ASTHO), agree.

CDC Director Robert Redfield put the number slightly lower, but still in the billions. In a congressional subcommittee meeting in mid-September, Redfield said the CDC would need $6 billion to help states and localities adequately prepare to distribute a potential vaccine.

But the federal government still has not said if it will fund the effort, or how much it will allocate to vaccine distribution and administration.

“That needs to change soon, or that’s going to be a limiting step,” says Marcus Plescia, chief medical officer for ASTHO. “It’s great that we have an opportunity to plan for some element of the Covid-19 response, because so far we’ve just been reacting.”

Health officials are hoping a new, broad Covid-19 relief package, approved by Congress, will include funds earmarked specifically for vaccine distribution readiness. And soon. “That would mean we could finally be really prepared, and we could finally get a step ahead of things,” Plescia says.

A Covid-19 vaccine clinical trial participant receives an injection at the University of Massachusetts Medical School on September 4.
Craig F. Walker/The Boston Globe/Getty Images

If the federal government doesn’t step up, would states and localities be able to? Experts we spoke with agree that the funds need to come from the top. The first reason for this is logistical. With local and state budgets tapped out from pandemic response and lost revenue — and unable to run deficits — the federal government remains the only level of government that could bankroll this effort.

The second reason has to do with equity. “We’ve seen throughout the pandemic response when we’re not working as a nation, it’s really hard for us to make any ground,” Casalotti says. For a vaccine rollout to be most effective, it needs to be supported at a national level, she notes. “People travel, and what happens across state borders can directly impact your community. The virus doesn’t care about jurisdictional boundaries.”

If states and localities are left to somehow support vaccine deployment, the results are going to be uneven, and likely accentuate disparities the pandemic has already laid bare, she says.

“It really has to come from federal sources,” concludes Plescia.

Major unknowns remain, making preparations even more difficult

Planning a national vaccine rollout is a sizable ask, but it is also happening in the midst of major continued uncertainties — and not just about funding. This has left state and local health departments scrambling to prepare as best they can. “They’re not only planning, but they have to plan for several different contingencies,” Schaffner says.

One big unknown is which vaccine or vaccines will be approved and distributed first. This matters in part because many have different requirements, such as extreme cold chains. If health departments need to keep vaccine doses in storage way below zero, as some front-running candidates require, that will necessitate medical-grade freezers.

“You’re not going to find those freezers in pharmacies and doctors’ offices,” Schaffner says. Nor are they “something you can just run down to the hardware store and buy,” Casalotti adds.

So if thousands of vaccine locations around the country are ordering these freezers at the same time — on an expedited timeline — it is possible there could be a shortage.

Or if there is not a shortage, they could follow the path many other pandemic specialty supplies have: With such a sudden increase in demand, there could also be a drastic price increase. This would throw another wrench in even the best-laid plans. It’s quite possible, Casalotti says, for example, that health departments could already have established how many freezers they will need, and where they will procure them, but then encounter a new price, many times higher due to the surge in demand.

The federal government has the ability to step in and prevent this sort of price gouging. Although “we haven’t seen those tools deployed” in previous instances of this during the pandemic, Casalotti says.

Pfizer’s vaccine candidate, which is among those leading the race to approval, requires temperatures of about -94 degrees Fahrenheit (and even then is only stable there for about 10 days). To address this challenge in distribution, it has devised a freezer alternative, in which the vaccine vials can be stored in specially designed boxes filled with dry ice. Although these boxes will need to have their dry ice replenished during storage, which means that “all of our states have been spending a lot of time sorting out their dry ice supplies,” Plescia says.

A lab technician sorts blood samples for a Covid-19 vaccine study at the Research Centers of America on August 13.
Chandan Khanna/AFP/Getty Images

Even this workaround might not prove to be a solution for everyone. Dry ice isn’t readily available everywhere, such as in some US territories, notes Plescia. And a shortage in the carbon dioxide supply has made it hard for some dry ice makers to keep up with demand. So Plescia hopes that even if a vaccine requiring drastic cold storage is approved first, a less temperamental one will not be far behind.

Another big unknown is precisely who will get the vaccine first and when. The CDC’s Advisory Committee on Immunization Practices, which Schaffner also helps advise, is working on finalizing this rubric for who will get the vaccine first. But they might not be able to complete their work until it’s known what vaccine or vaccines will be approved.

Many expect that health care workers and first responders will be first to receive an approved vaccine, which aligns with an assessment put out by the National Academy of Medicine in September and the CDC’s interim playbook for states. (President Trump, at an October 16 stop in Florida, claimed inaccurately that “seniors will be the first in line for the vaccine.” The CDC has listed those 65 and older — along with others at higher risk for severe Covid-19, and essential workers — in the second half of the first phase for vaccination, although this could change based on the results of the ongoing vaccine trials.)

Vaccinating health workers first would also give those working on vaccine distribution a slightly gentler start. As Plescia notes, this population would generally be easy to reach and follow up with through their employers, and tend to be in favor of vaccinations in general.

If this prioritization group does come first, he is optimistic about the possibility of health departments being equipped to provide these early doses when they become available. “I think being ready for that is not overly ambitious, and as we roll that out, we start to learn more and gives us a little more time to be ready to do it in community settings — those are the things that are going to require more capacity and more planning, and just more people,” he says.

What distribution might look like after that is fuzzier, making it hard for health departments to plan logistics, but also communication.

Local health departments are eager for the federal government to take on the job of clear messaging once these priority groups get established.

If local health departments are in charge of telling their communities who gets priority for the vaccine, “that’s just putting local health departments in a really hard position as people are looking at who is at the front of the line and who is at the back of the line,” Casalotti says. And animosity toward health departments has already been building, resulting in reluctance to participate in contact tracing efforts and even, in some cases, threats of violence, she notes.

So she asks for “clear messages from the top that we’re all in this together, and not everyone is in prioritization group 1 — and that’s okay because we, as a nation, are all going to get through this.”

Health departments will need time to get staff and systems up and running

One clear challenge in being ready to vaccinate millions of people as quickly as possible is having enough well-trained workers to give those shots. Hiring people to give shots in a public health setting is challenging even in the best of times, Casalotti says. The pay tends to not be that great and the hours can be hard. Not only that, but much of this available workforce has already been hired out to other much-needed positions, like those in hospitals, she notes.

There are also procedural considerations. “In most governmental structures, you can’t get a million dollars on Monday and hire people on Friday,” Schaffner says. “You have to go through a laborious administrative process to post openings, make sure they are available to everybody, interview applicants — and this all takes time.” And after they get hired, they still need to be trained before they can get to work.

A nurse administers a flu vaccination shot to a woman at a free clinic held on October 14, in Lakewood, California.
Mario Tama/Getty Images

Public health departments and other locations will also likely need to acquire additional ancillary supplies, such as PPE and other items that are already in high demand in the midst of the pandemic and flu season.

“We can be all ready to go and have planned perfectly and have our people in place and our capacity built, and then we run out of PPE,” Plescia says. He worries about that, he says, because “that supply still doesn’t seem to be secure.” And shortages, as we saw earlier in the pandemic, lead to unequal distribution, in which larger and wealthier states can procure more supplies.

There is also the little-discussed — but critical — issue of data infrastructure. As a country, we have a patchwork method for tracking vaccinations. For most adult vaccines, only the patient and office or clinic receive records about a given dose. (As Schaffner jokes, “When my father-in-law lived in New Hampshire, and spent time in Tennessee, then spent winters in Florida, I was his vaccine registry, I told his doctors. It worked fine for my father-in-law, but I can’t do that for everybody.”) Even pediatric vaccinations are usually logged just on a state-level basis. (And still the CDC encourages parents and caretakers to be in charge of tracking their child’s vaccines themselves.)

So the idea of states and localities tying into a robust national vaccine tracking program — and on short order — is daunting, but crucial. Especially with many leading candidate vaccines requiring multiple doses, and different time spans between doses.

And this information will have to flow easily among vaccine administration sites across the country in close to real-time. “We have to have a good ability to track people and know who got the initial dose, and we need to be able to do that across state lines,” Plescia says. “If someone got the first dose in Florida and moves to South Carolina, we need to see what they got.” Even beyond that sort of rapid record look-up, health workers will also need a way to get in touch with people to remind them to get their second dose in the right time frame, he says. One candidate vaccine has a 21-day space between doses; another is 28 days.

“It would be good to go ahead and have the funding so we can start building those systems,” Plescia says.

And not only that, Casalotti says, “we need time to make sure those systems are interoperable, and to train the users in how to employ them. And, frankly, we don’t have the time.”

“The marathon continues”

For many health departments, support from the federal government can’t come soon enough. Despite asking the federal government for vaccine distribution guidance and funding since this spring, Casalotti says they have still wound up behind the eight-ball. “We have ended up in a position where we no longer have the luxury of time. Now we’re behind.”

Additionally, many local health departments still hadn’t recovered from the budget cuts of the 2008 recession, and now a number of them have faced further budget reductions and have had to furlough staff. “That is certainly not what you want to be doing when you know you’re going to be in the middle of a pandemic,” she says.

In the meantime, the CDC has been directed to transfer $300 million from its budget to the public affairs office at its parent agency, the Department of Health and Human Services, Redfield said in a September 16 Senate subcommittee hearing. At least $250 million of that has been allotted for a massive public relations campaign “to defeat despair and inspire hope,” with the bulk of the funds to be used before January.

Some of this could be used toward general vaccine safety education and information, but experts are dubious that will be the case. “I haven’t seen that this program would be addressing this issue,” Casalotti says.

She asks for support from the federal government in reminding people that even after the first round of vaccine doses is distributed, the pandemic lifestyle will be here to stay for most people for quite a while. “The marathon continues, and we’re all running it whether we want to or not.”

Other public health experts are also looking to the federal government for a unified message and response. “This is a pandemic; it’s a national issue,” Schaffner says. “We have not had a coherent, sustained response to Covid-19 from the beginning. Every public health person I know of thinks we need it. This has to be largely directed and funded from a federal level. This is akin to disaster assistance. Sure, the locals go to work, but you really have to deal with this from a federal level. This is a hurricane that’s hit all 50 states.”

Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.


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US stocks mixed: Investors fret fallout of growing COVID-19 cases

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Wall Street’s main stock indexes were mostly unchanged on Tuesday as surging COVID-19 cases in the United States, intensifying restrictions and Washington’s failure to pass a stimulus bill weighed on investor sentiment with exactly one week until the US elections.

The Dow Jones Industrial Average was hovering near the flat line in late morning trading in New York, down over 75 points or 0.27 percent at 27,609.85.

The S&P 500 – a gauge for the health of US retirement and college savings reports – was unchanged, while the tech-heavy Nasdaq Composite Index was  0.62 to the plus side.

The S&P 500 on Monday had its worst day in a month while the Dow fell by more than 800 points at one juncture in the session as investors faced some tough facts.

For months, Democrats and Republicans have been playing the blame game over stalled talks for a new round of coronavirus relief aid. As the deadlock shows no signs of breaking, millions of out-of-work Americans are facing a tough job market and the possibility of more shutdowns as they struggle to keep food on their tables and roofs over their heads.

Talks are reportedly still ongoing between Treasury Secretary Steven Mnuchin and Democratic Speaker of the House of Representatives Nancy Pelosi. But hopes of a deal being passed before the November 3 election are all but dead.

Meanwhile, the economic recovery could be imperilled by the current spike in COVID-19 infections. Cases in Europe have surged, mounting in Italy, Spain and the United Kingdom and ushering in renewed restrictions, curfews and partial lockdowns.

Protests against the lockdowns have turned violent in Italy.

US President Donald Trump continues to insist that the reason for the surge in documented US cases is because the US is conducting millions of tests.

On Twitter on Tuesday morning, Trump suggested the media was overhyping the surge in cases ahead of the election and said the US is “rounding the turn” on the virus.

Some 60 million Americans have already cast their ballots for the man they think is best suited to lead them out of the gravest economic disaster since the Great Depression of the 1920s and 1930s.

Trump’s Democratic rival Joe Biden is leading in the national polls, but the race has been tightening in key battleground states which, as was the case in 2016, are likely to determine the election’s outcome.

Growing uncertainty over the election’s outcome continues to fuel volatility on Wall Street – and is likely to increase if there is no clear winner next Tuesday and if determining the results is a process that gets dragged on for weeks or even months.

Pedestrians wearing protective masks walk through the Chinatown neighbourhood of New York City in the United States, where businesses are struggling to stay open [File: Nina Westervelt/Bloomberg]

On the economic front, there is some good news as orders for durable goods – items such as washing machines and aircraft that are meant to last three years or more – jumped 1.9 percent in September after rising only 0.4 percent in August. The increase was driven by a 4.1 percent rebound in orders for transportation equipment. Orders for motor vehicles and parts gained 1.5 percent in September after dipping 4.1 percent in August.

Durable goods are seen on sale in a store in Los Angeles, California, the United States [File: Lucy Nicholson/ Reuters]

Among stocks making headlines on Tuesday:

Shares of semiconductor designer Advanced Micro Devices were down 2.57 percent in late morning trading on news that the company has agreed to buy competitor Xilinx in a $35bn all-stock deal that is sure to intensify its battle with Intel Corp in the data centre chip market.

Xilinx shares were up more than 10 percent in late morning trading.

Shares of Microsoft were up more than one percent. The tech giant is set to report earnings after Tuesday’s closing bell.

Tech titans Apple, Amazon, Google-parent Alphabet and Facebook, whose shares gained handsomely in the spring and early summer, also report their results later this week.

Big pharma is moving on earning results. Shares of Merck & Co were up 0.06 percent after it raised its full-year earnings forecast.

Shares of Pfizer were down 0.94 after the company reported a drop in third-quarter sales. Pfizer also said it is not yet ready to release data from the late-stage trial of the COVID-19 vaccine candidate that it is developing with Germany’s BioNTech SE.

Shares of Eli Lilly and Co were down 5.61 percent after the drug giant reported that its quarterly profit took a hit from the spike in costs to develop a coronavirus treatment.

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Thailand royalists show support for king

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More than 1,000 people have demonstrated in Thailand’s capital in support of King Maha Vajiralongkorn, a day after thousands of people marched to call for reforms of the monarchy.

Youth and student-led protests began in Thailand in July to call for the resignation of Prime Minister Prayuth Chan-ocha – a former army ruler – and a new constitution, but have increasingly sought curbs on the monarchy’s powers.

Cheering “Long live the king” and hoisting signs with pro-monarchy slogans, the royalists on Tuesday gathered at Lumphini Park in central Bangkok. Almost all of them wore yellow shirts, symbolising devotion to the monarchy, while some held portraits of the king and his late father, King Bhumibol Adulyadej.

“We want to show support and encouragement to his majesty,” said Thatchapan Boriphet, 57. “I am neutral politically but I cannot stand it when there is a violation of the monarchy.”

Royalists march during an event to support the monarchy in Bangkok [Athit Perawongmetha/Reuters]

So far, royalist demonstrations have been considerably smaller than the tens of thousands of people who have joined the biggest protests against the government.

The demographics have also been very different. Many of the demonstrators on Tuesday in Lumphini Park were in their 50s or 60s, or older.

The pro-democracy protesters include many university students and young professionals, as well as a large contingent of high school students.

For many older Thais, any criticism of the monarchy is practically sacrilege. It is considered the bedrock of their national identity and is protected by a lese majeste law that calls for three to 15 years’ imprisonment for anyone who defames the monarch or members of his immediate family.

The military also considers defending the monarchy to be one of its main duties.

The pro-democracy protesters have accused the king of involvement in the country’s politics. On Monday, they marched to the German embassy to seek an inquiry into whether he exercised his powers during long stays in Germany, something Berlin has said would be unacceptable.

The palace has a policy of not commenting to the media and has made no comment since the start of the protests.

Prayuth, the prime minister, has ignored the demands to quit and said the crisis should be discussed in parliament, where his supporters are in the majority.

Opposition parties told him he should step down for the good of the country and stop using his proclaimed support for the monarchy as an argument to keep power.

Prayuth’s opponents say he only kept power at elections last year thanks to electoral rules and a constitution drawn up by the military government he headed after a 2014 coup. He says that the ballot was fair.

A royalist holds a picture of Thailand’s King Maha Vajiralongkorn during an event to support the monarchy in Bangkok [Athit Perawongmetha/Reuters]

Royalists played a large part in demonstrations in 2006 and 2014 that helped bring down elected governments by leading to army takeovers.

At Tuesday’s gathering, Tul Sittisomwong, a prominent figure in the 2014 protests, called for unity and loyalty to the monarchy.

Many royalists believe the student protesters are being manipulated by older activists with their own political agendas.

They have blamed an opposition political party that expresses support for the young demonstrators.

“Wherever you are, Move Forward Party, if you don’t stop your manipulation, we will come to you. The group will be chased out if they don’t stop defaming the monarchy,” Tul said.

“Who is really behind this?” said businessman Sathit Segal, who also played a leadership role in 2014.

“Problems in our country are caused by politicians who think only about themselves, attacking the monarchy,” Segal said.

“You can protest and demand anything you want. But do not involve the monarchy. That cannot be accepted.”

A fringe group of royalists professes to believe the United States is behind efforts to attack the monarchy and destabilise Thailand. A handful protested outside the US embassy on Tuesday.

Self-proclaimed “defenders of the monarchy” mobilised last week online and in rallies in several cities, in many cases led by local civil servants.

There are concerns that political polarisation could trigger violence. A few attendees at a small royalist rally in Bangkok last week attacked anti-government student activists and had to be restrained by police.

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