Editor’s note: This is a live account of COVID-19 updates from Thursday, April 21, as the day unfolded. It is no longer being updated. Click here to see all the most recent news about the pandemic, and click here to find additional resources.

The Justice Department filed an appeal to overturn a federal district judge’s ruling that ended the federal mask mandate on mass transit. The Centers for Disease Control and Prevention asked for the appeal, noting that masking requirements remain necessary to protect the public’s health.

Meanwhile, officials in Spain moved to end masking requirements for indoor public spaces, except for visitors and staff in medical centers and nursing homes. Masks are still required to use public transportation, officials said, but not required in airports or stations.

We’re updating this page with the latest news about the COVID-19 pandemic and its effects on the Seattle area, the U.S. and the world. Click here to see the rest of our coronavirus coverage and here to see how we track the daily spread across Washington.

More on the COVID-19 pandemic

UK patient had COVID-19 for 505 days straight, study shows

A U.K. patient with a severely weakened immune system had COVID-19 for almost a year and a half, scientists reported, underscoring the importance of protecting vulnerable people from the coronavirus.

There’s no way to know for sure whether it was the longest-lasting COVID-19 infection because not everyone gets tested, especially on a regular basis like this case.

But at 505 days, “it certainly seems to be the longest reported infection,” said Dr. Luke Blagdon Snell, an infectious disease expert at the Guy’s & St. Thomas’ NHS Foundation Trust.

Snell’s team plans to present several “persistent” COVID-19 cases at an infectious diseases meeting in Portugal this weekend.

Read the full story here.

—Laura Ungar, The Associated Press

Australian opposition leader gets COVID while campaigning

Australia’s opposition leader said he tested positive for COVID-19 on Thursday in the second week of a campaign ahead of the May 21 election.

Anthony Albanese, the 59-year-old leader of the center-left Labor Party, said he was feeling fine and would isolate at his Sydney home for a week.

The diagnosis is a setback for his party, which is seeking its first election victory since 2010. Labor has been leading Prime Minister Scott Morrison’s conservative government in opinion polls in recent months.

Morrison, 53, tested positive for COVID-19 on March 1 and his symptoms were mild.

Morrison and Albanese came face to face Wednesday for the first time since the election was called on April 10 when they attended the first televised leaders’ debate in Brisbane. They shook hands and posed together for photographs.

Read the story here.

—Rod McGuirk, The Associated Press

DOJ: 21 people charged nationwide with $150M in COVID fraud

Twenty-one people have been charged in the past nine days as part of a nationwide enforcement push to root out those who exploit the pandemic through health care fraud schemes, the Justice Department announced Wednesday.

The cases resulted in about $150 million in alleged false billings and theft from federal pandemic assistance programs. The DOJ seized over $8 million in cash and other fraud proceeds.

Some defendants are accused of offering COVID-19 testing to get people to provide their personal identifying information and a saliva or blood sample. That information and the samples were then allegedly used to submit fraudulent claims to Medicare for unnecessary, far more expensive tests or services.

In Colorado, federal agents went through a man’s trash to uncover an alleged scheme to produce and sell fake vaccination record cards. In Maryland and New York, owners of medical clinics are accused of using information from people who sought COVID testing at drive-thru sites to submit fraudulent claims for lengthy office visits that never occurred.

“Today’s enforcement action sends a very clear message that we will stop at nothing to root out COVID-19 related health care fraud, wherever it may be found,” said Assistant Attorney General Kenneth Polite. 

Read the story here.

—Jennifer McDermott and Michael Balsamo, The Associated Press

Did you skip going to the doctor during the pandemic? You’re not alone

The shoulder pain and dizziness started before the pandemic, but Shane Hardin, 46, didn’t think much of it.

Aches and pains come with the territory of getting older, and Hardin’s job in residential construction can be draining. The spread of COVID-19 across North Texas dissuaded him further from seeing his general practitioner for a checkup.

For more than two years, patients like Hardin pushed off routine health care visits as offices closed to non-emergency cases and the threat of coronavirus loomed. It could take years before the health care system sees the full effects — both physical and financial — of delayed care, North Texas doctors say.

When Hardin sat in a new doctor’s office in September after more than a year since his last physical, he was shocked at the stern warning: He needed to see a cardiologist, and fast. Six weeks later, Hardin was in an operating room for quintuple bypass surgery.

His story fits an alarming trend of medical problems caught in later, more severe stages because of interrupted preventive care.

One study of more than 358,000 patients in Ontario, Canada, published in the Journal of the National Comprehensive Cancer Network, found an immediate decline in the average cancer rate at the start of the pandemic — but that’s not necessarily a good thing. The researchers estimated 12,601 cancer cases went undetected in the Ontario area from March 15, 2020, to Sept. 26 that year.

For those who haven’t yet seen their physicians and dentists, it isn’t too late to get back on a regular health care schedule, physicians say, and the sooner, the better.

Read the story here.

—Marin Wolf, The Dallas Morning News

Airlines weigh return of passengers banned before mask mandate

Before there was a federal transportation mask mandate, individual U.S. airlines required customers to wear face coverings when flying. Those who refused were placed on airline “no-fly” lists — a tally that ballooned into the thousands amid pandemic-related conflict in the skies.

In the days since the mask mandate has fallen, several airlines have said they will consider allowing some of those passengers to return.

Some of the nation’s largest carriers are developing procedures to restore boarding privileges that were revoked for mask-related conflicts, a move that prompted outcry from the union representing workers who were on the front lines of enforcement. The decision comes after airlines and federal agencies spent more than a year developing deterrence and enforcement measures to battle confrontations often stemming from the mask requirement.

Read the story here.

—Lori Aratani, The Washington Post

Rates for measles and other vaccinations dip for kindergartners

A smaller portion of U.S. children got routine vaccinations required for kindergarten during the pandemic, government researchers said Thursday, raising concerns that measles and other preventable diseases could increase.

Rates were close to 94% for measles, whooping cough and chickenpox vaccinations for the 2020-21 school year. That was down 1% from a year earlier and means 35,000 U.S. children entered kindergarten without evidence that they were vaccinated for extremely contagious diseases, the federal Centers for Disease Control and Prevention said in a report.

In addition, almost 400,000 fewer children than expected entered kindergarten and their vaccination status is uncertain, the CDC said.

Pandemic-related disruptions likely contributed to the decline, the report said, as pediatricians canceled non-emergency appointments, parents skipped checkups for their children and vaccine requirements were eased for students doing remote learning.

Read the story here.

—Lindsey Tanner, The Associated Press

Oregon’s COVID numbers rising steadily, hospitalizations not as fast

COVID-19 case numbers in Oregon are on a steady rise as a new variant spreads and residents toss their masks, but hospitalization rates are still averaging fewer than 100 patients per day statewide — a far cry from previous peak virus surges of up to 1,100 patients, state health officials said Wednesday.

The seven-day average of daily cases as of Tuesday has more than doubled since early April and is now at 600 new cases per day, which is likely a “significant undercount” because of home tests that are not reported, said Tom Jeanne, Oregon’s deputy state health officer.

Studies done elsewhere indicate that the actual number of positive cases nationally could be between five to 10 times higher than those reported to health authorities, but officials remain focused on the hospitalization rate as a gauge of the surge’s severity, he said. There were 740 new cases Monday, the latest data available, and five deaths; officials expect hospitalizations will see a slight increase into May and June.

Read the story here.

—Gillian Flaccus, The Associated Press

The pandemic has been hard on our feet

In March of 2020, Krista Fahs began working from home. As she sidled up to her desk, the 53-year-old sales associate for a computer distributor put aside her usual sneakers. She found herself doing laundry, playing with her cat and even visiting neighbors without putting on shoes. “I was barefoot all the time,” she said.

A few months into working from home, she began to feel a twinge of heel pain but disregarded it until last month, when it got too intense to ignore.

The beginning of the pandemic coincided with a steep decline in foot trauma, said Dr. Robert K. Lee, chief of podiatric foot and ankle surgery at UCLA Santa Monica Medical Center, but his practice quickly repopulated with patients such as Fahs who complained about foot pain. “I was like, ‘Aha, so this is the effect of the pandemic on feet across the country,’ ” he said.

There is no hard data on the increase in foot pain, but Dr. James Christina, executive director of the American Podiatric Medical Association, said it has been a clear trend for many of his 12,000 members.

Members like Dr. Rock Positano, co-director of the Non-surgical Foot and Ankle Service at the Hospital for Special Surgery in New York, who has seen foot pain increase so much — 20% to 30% — that he called the phenomenon “pandemic foot.”

Now that spring is here, mandates are relaxing, and people are eager to get their pre-pandemic bodies and hobbies back, so they are hitting the pavement, said Dr. James Hanna, a podiatrist and president of the New York State Podiatric Medical Association. Many are exacerbating existing foot injuries or creating new ones.

“People thought they could just return to where they left off or try something they hadn’t tried in a couple years,” he said, “but their feet aren’t prepared for what their bodies want to do.”

Read the story here.

—Mara Altman, The New York Times

Surprisingly low Shanghai COVID death count spurs questions

Lu Muying died on April 1 in a government quarantine facility in Shanghai, with her family on the phone as doctors tried to resuscitate her. She had tested positive for COVID-19 in late March and was moved there in line with government policy that all coronavirus cases be centrally isolated.

But the 99-year-old, who was just two weeks shy of her 100th birthday, was not counted as a COVID-19 death in Shanghai’s official tally. In fact, the city of more than 25 million has only reported 25 coronavirus deaths despite an outbreak that has spanned nearly two months and infected hundreds of thousands of people in the world’s third-largest city.

Lu’s death underscores how the true extent of the virus toll in Shanghai has been obscured by Chinese authorities. Doctors told Lu’s relatives she died because COVID-19 exacerbated her underlying heart disease and high blood pressure, yet she still was not counted.

Interviews with family members of patients who have tested positive, a publicly released phone call with a government health official and an internet archive compiled by families of the dead all raise issues with how the city is counting its cases and deaths, almost certainly resulting in a marked undercount.

The result is a blurred portrait of an outbreak that has sweeping ramifications for both the people of Shanghai and the rest of the world, given the city’s place as an economic, manufacturing and shipping hub.

An Associated Press examination of the death toll sheds light on how the numbers have been clouded by the way Chinese health authorities tally COVID-19 statistics, applying a much narrower, less transparent, and at times inconsistent standard than the rest of the world.

Read the story here.

—Dake Kang and Huizhong Wu, The Associated Press

Biden administration to appeal ruling striking down transit mask mandate

The Biden administration will appeal a federal judge’s decision that struck down the mask mandate on public transportation, officials announced Wednesday.

The Justice Department filed notice of its plans to appeal after U.S. District Judge Kathryn Kimball Mizelle of Florida on Monday concluded that the mandate exceeded the statutory authority of the Centers for Disease Control and Prevention. The ruling blindsided the White House and sparked days of debate within the administration about how to proceed.

The Justice Department on Tuesday had said it would proceed with an appeal if the CDC determined the masking order was still needed.

The White House spent two days deferring on questions about its legal strategy as agency officials fretted about the political and policy implications of a court battle to support the mask mandate — particularly in a midterm election year when many Americans say they want to move past the pandemic.

Read the story here.

—Ann E. Marimow and Dan Diamond, The Washington Post

Most people in US want masks for travelers: AP-NORC poll

A majority of people in the United States continue to support a mask requirement for people traveling on airplanes and other shared transportation, a poll finds. A ruling by a federal judge has put the government’s transportation mask mandate on hold.

The poll by The Associated Press-NORC Center for Public Affairs Research finds that despite opposition to that requirement that included verbal abuse and physical violence against flight attendants, 56% of those surveyed favor requiring people on planes, trains and public transportation to wear masks, compared with 24% opposed and 20% who say they are neither in favor nor opposed.

Interviews for the poll were conducted last Thursday to Monday, shortly before a federal judge in Florida struck down the national mask mandate on airplanes and mass transit. Airlines and airports immediately scrapped their requirements that passengers wear face coverings, and the Transportation Security Administration stopped enforcing the mask requirement.

But the Justice Department said Wednesday it was filing an appeal seeking to overturn the judge’s order. That notice came minutes after the Centers for Disease Control and Prevention asked Justice to appeal the decision, saying “an order requiring masking in the indoor transportation corridor remains necessary for the public health.”

Read the story here.

—Dave Kolpack, The Associated Press

WHO says global COVID cases, deaths declined again last week

The World Health Organization says that the number of reported new COVID-19 cases worldwide decreased by nearly a quarter last week, continuing a decline since the end of March.

The Geneva-based U.N. health agency said in a weekly report that nearly 5.59 million cases were reported between April 11 and 17, 24% fewer than in the previous week. The number of newly reported deaths dropped 21% to 18,215.

WHO said new cases declined in every region, though only by 2% in the Americas. The report was dated late Wednesday and sent to journalists on Thursday.

Read the story here.

—The Associated Press