The Trump administration’s coronavirus response coordinator, appearing at the White House with other top federal health officials for the first time in months, issued a dire assessment of the pandemic on Thursday, along with an urgent warning for Americans to “increase their vigilance” as they await the approval of a vaccine.
Dr. Deborah L. Birx made the remarks after the White House coronavirus task force met with Vice President Mike Pence — who offered a far rosier assessment as he defended the administration’s handling of a pandemic that has now claimed more than 250,000 lives in the United States, and killed nearly 2,000 Americans on Wednesday alone.
“America has never been more prepared to combat this virus than we are today,” Mr. Pence declared, adding: “We approach this moment with the confidence of experience. We know the American people know what to do.”
The late-afternoon news conference, in the White House briefing room, came after President-elect Joseph R. Biden Jr. denounced President Trump’s “incredible irresponsibility” in contesting the results of the presidential election and delaying the beginning of a transition process. Mr. Biden singled out the administration’s refusal to grant his team access to its planning for vaccine distribution.
Calling the vaccine distribution effort “one of the greatest operational challenges we will have faced as a nation,” Mr. Biden said, “There is no excuse not to share the data and let us begin to plan.”
The White House briefing offered a stark reminder of the toll the pandemic has taken on the nation and of vast disconnect between Mr. Trump and Mr. Pence and the federal health officials who advise them. Even as Dr. Birx implored Americans to wear masks — and stood at the lectern wearing one as she spoke — Mr. Pence greeted reporters with his face uncovered.
Dr. Birx, who has a penchant for data, came armed with sobering statistics. Flipping through a series of charts, she displayed a map of the United States that was a vast expanse of bright red — a signal that the entire country, with the exception of the East and West Coasts, is being crushed by the virus.
The briefing, nine months into the pandemic, amounted to a full-court press by an administration that, despite its success in helping develop two promising vaccine candidates, has been knocked back on its heels by the virus.
A string of top officials appeared, including Dr. Anthony S. Fauci, the government’s top infectious disease specialist; Health Secretary Alex M. Azar II; Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention; Gen. Gustave F. Perna, who is coordinating logistics for the vaccine effort; and Dr. Elinore F. McCance-Katz, the head of the Substance Abuse and Mental Health Administration. (Dr. Scott Atlas, Mr. Trump’s lightning-rod coronavirus adviser, was not, however, in evidence.)
Dr. Fauci sought to reassure Americans about the two vaccines nearing approval, saying that neither scientific integrity nor safety had been compromised. “We need to put to rest any concept that this was rushed in an inappropriate way,” he said. “This is really solid.”
The United States has set yet another record: 183,000 new daily cases.
The record was set as the United States struggles with surging coronavirus cases and hospitalizations, the Centers for Disease Control and Prevention on Thursday urged Americans not to travel during the Thanksgiving holiday and to consider canceling plans to spend time with relatives outside their households.
The new guidance, which contrasted sharply with recent White House efforts to downplay the threat, states clearly that “the safest way to celebrate Thanksgiving is to celebrate at home with the people you live with,” and that gathering with friends and even family members who do not live with you increases the chances of becoming infected with the virus or the flu, or transmitting the virus.
Officials said they were strengthening their recommendations against travel because of a startling surge in infections in just the past week. Recent numbers of hospitalizations — more than 79,000 reported on Wednesday — and new daily cases keep shattering U.S. records. As of Wednesday, the seven-day average of new cases across the country had surpassed more than 162,000, an increase of 77 percent from the average two weeks earlier.
“Amid this critical phase, the C.D.C. is recommending against travel during the Thanksgiving period,” said Dr. Henry Walke, Covid-19 incident manager at the agency, during a news briefing.
“We’re alarmed,” he added, citing an exponential increase in cases, hospitalizations and deaths. “What we’re concerned about is not only the actual mode of travel — whether it’s an airplane or bus or car, but also the transportation hubs.”
“When people are in line” to get on a bus or plane, social distancing becomes far more difficult and viral transmission becomes more likely, he said.
The agency’s overriding concern is that the holidays may accelerate the spread of the virus, C.D.C. officials said. Older family members are at great risk for complications and death should they contract the virus.
The agency’s guidance comes after similar warnings from a wide swath of health experts, governors and other officials. Alex M. Azar II, the secretary of health and human services, recently said he wanted Americans to listen to local and state guidance and “consult C.D.C.’s guidelines about how gatherings can be made as safe as possible.”
And as he has repeatedly in recent weeks, Gov. Andrew M. Cuomo of New York on Thursday implored people to avoid both travel and large gatherings during the holiday. He had already prohibited private gatherings of more than 10 people, a rule that some officials have criticized as unenforceable.
“Please: Love is sometimes doing what’s hard,” Mr. Cuomo said. “This year, if you love someone, it is smarter and better to stay away. As hard as that is to say and hear.”
A different message has come from White House officials. Kayleigh McEnany, the White House press secretary, criticized health guidelines issued by governors as at odds with American notions of freedom in an interview on “Fox & Friends” on Wednesday.
“I think a lot of the guidelines you’re seeing are Orwellian,” she said, pointing to a rule in Oregon that gatherings should be limited to six people.
“The American people, we’re a freedom-loving people, we can make good decisions,” she said.
An adviser to President Trump, Dr. Scott W. Atlas, who is a radiologist, not an infectious disease expert, argued against excluding older people from Thanksgiving gatherings earlier in the week, saying that isolation “is one of the unspoken tragedies” of the pandemic and that “for many people, this is their final Thanksgiving believe it or not.”
“It’s not about just stopping cases of Covid, we have to talk about the damage of the policy itself,” he said on Fox News.
C.D.C. officials made their pleas to avoid travel even as they acknowledged that the prolonged outbreak has taken a toll on families.
Dr. Walke warned that family get-togethers — especially those that bring different households together — could inadvertently lead to tragic outcomes.
“The tragedy that could happen is one of your family members, from coming together in a family gathering, could wind up hospitalized and severely ill and could die. We don’t want to see that happen,” Dr. Walke said. “This year we’re asking people to be as safe as possible.”
College students returning home for the holiday should isolate themselves and limit interactions with friends on campus before their return. Once home, they should try to limit interactions with family members, interact outside rather than indoors, and wear masks indoors if a family member has a chronic condition that places them at risk.
Dr. Walke said he himself is not going to visit his parents, though he has not seen them in many months and they are imploring him to come home, and he has encouraged his own adult and college-aged children to isolate themselves before coming home for the holiday.
New concerns about the virus have been reflected in air travel plans. United Airlines said recently that it expected Thanksgiving week to be its busiest period since the pandemic’s onset, but on Thursday it reported that bookings had slowed and cancellations had risen in recent days. American Airlines has slashed December flights between the United States and Europe as cases rise sharply on both sides of the Atlantic.
AAA Travel said last week that it anticipates at least a 10 percent drop in travel this Thanksgiving, the largest one-year decrease since 2008, when the country was in the throes of the Great Recession. People who decide to travel are likely to drive, going shorter distances for fewer days than they may have otherwise, the organization said. Car trips were projected to fall 4.3 percent, far less than air travel. AAA cited rising cases, quarantine rules, health concerns and increased unemployment as factors.
If Americans choose to travel, they should do so as safely as possible, wearing masks and maintaining social distancing, even during the Thanksgiving meal with others outside the household.
The American Hospital Association joined with the American Nurses Association and the American Medical Association, which represents many of the nation’s doctors, to urge the public to be careful over the Thanksgiving holiday weekend.
In an open letter on Thursday, the groups urged Americans “to celebrate responsibly in a scaled-back fashion.”
“We are all weary and empathize with the desire to celebrate the holidays with family and friends, but given the serious risks, we underscore how important it is to wear masks, maintain physical distancing and wash your hands,” the letter said.
Dr. Anthony S. Fauci, the nation’s top infectious disease expert, has warned for weeks of the risks of Thanksgiving dinners, saying that families must conduct a “risk-benefit assessment for what they want to do.” His family is going to forgo a gathering and share a meal over video chat.
“My daughters, who are adult professional women in different parts of the country, have made a decision,” he said at a DealBook event on Tuesday. “They want to protect their daddy.”
The Trump administration stressed its opposition on Thursday to closing schools as a means to combat the coronavirus, even as some of the nation’s largest districts were closing anew or postponed reopening.
“We do not support closing schools,” Vice President Mike Pence said at a White House news conference, arguing that such measures carried a “real cost” to children, a viewpoint echoed by other members of the White House Coronavirus Task Force.
The vice president’s comments came on the same day that schools across New York City, the country’s largest public school system shut their doors after being open for in-person instruction for a little less than eight weeks.
New York City, having lived through one of the worst outbreaks in the country in the spring, had taken one of the most cautious stances toward school closings. As soon as the city reached a 3 percent test positivity rate over a rolling, seven-day average, the policy called for schools to close. When that mark was hit this week, in-person classes were over for 1.1 million students at 1,800 schools.
Numerous other large districts, including those in Chicago and Los Angeles, remain closed, although Chicago tentatively set a January deadline for its students to return to classrooms. Philadelphia recently delayed reopening schools, and Detroit also suspended in-person instruction.
Some states have taken a multitrack approach.
In Rhode Island, Gov. Gina Raimondo allowed elementary and middle schools to remain open during a two-week shutdown scheduled to begin on Nov. 30, but said high schools must close unless the local administration presented an enforceable risk-mitigation plan.
Elementary schools have not proved to be major spreaders, the governor noted, and younger students benefit especially from being in the classroom. High schools are “more problematic,” Ms. Raimondo said, because teenagers are more mobile, more exposed to the virus through outside jobs or sports, and generally less inclined to wear masks.
Mississippi is taking it on a case-by-case basis. Of the state’s 1,200 schools, more than 65 had to go back to virtual learning because of outbreaks, Dr. Paul Byers, the state epidemiologist, said at a news conference this week. The trigger for a school to move to remote learning is three Covid-19 cases, he said.
As the task force gathered at the White House on Thursday, the discussion of schools echoed a controversial guidance document issued by the federal Centers for Disease Control and Prevention on the importance of schools being open. The guidance was written by political appointees in the Trump administration.
Dr. Robert R. Redfield, the head of the C.D.C., said Thursday that the agency did not recommend that schools close back in the spring — and that it was not doing so now.
“Clearly the data strongly supports that K-12 schools, as well as institutes of higher learning, really are not where we’re having our challenges,” he said. “The infections we identified in schools when they have been evaluated were not acquired in schools. They were acquired in the community and in the household.”
However politicized American health policy decision making has become, and however much President Trump’s real goal may be to shore up the economy, the administration is not alone in it views on the wisdom of keeping schools open.
A new report by UNICEF, based on surveys from 140 countries, found that school closures did little to slow the spread of the virus and did much to cause long-term harm. “Unless the global community urgently changes priorities, the potential of this generation of young people may well be lost,” the agency warned.
“Evidence shows that the net benefits of keeping schools open outweigh the costs of closing them,” the report said. “Data from 191 countries show no consistent association between school reopening status and COVID-19 infection rates.”
“The longer schools are closed, the more children suffer from extensive learning losses with long term negative impacts, including future income and health,” the report said.
Some of the data seemed to contradict his conclusion, with only elementary schools not seeming to seed outbreaks. Plus much of the evidence is observational or a result of random testing, unaccompanied by the sort of careful contact tracing that would support Dr. Redfield’s assertion.
In a rare hopeful sign amid the grinding slog through a pandemic that has claimed more than 1.3 million lives across the globe, Europe’s new restrictions appear to be slowing the spread of the coronavirus in some of the worst-hit countries.
The World Health Organization said Thursday that new case rates were falling for the first time in months across the region. Two weeks ago, the agency reported that there were around two million new infections per week detected across Europe. Last week, that number fell to 1.8 million — a drop of 10 percent.
“It is a small signal, but it is a signal nevertheless,” Dr. Hans Kluge, the W.H.O. regional director for Europe, said at a news conference. Europe, he said, is capable of turning the tide, but he cautioned that the virus remained a serious threat.
The restrictions, many of which were announced at the end of October, are less severe than in the spring — many businesses are closed, and gatherings limited in size. Limits on movement are far less strict than they were. But schools generally remain open.
The approach stands in stark contrast to much of the United States, where responsibility for virus policy has been largely left to the states. Many governors have resisted imposing limits on daily life, but a number of them have changed course in recent days, particularly in the Midwest, where the virus is raging out of control.
But while bars, restaurants and gyms have largely remained open in much of the country, sometimes with shortened hours, some public school systems have been closed to in-person learning. Students in Philadelphia, Detroit and Boston are limited to remote learning, and New York City announced that it would go online starting Thursday.
Research increasingly indicates that children under 10 are at less risk of contracting and transmitting the virus, and that opening schools, at least for younger children, is generally safe. Dr. Kluge called school closures ineffective in stopping the virus, and said the W.H.O. was committed to working with European nations to keep primary schools open.
Experts caution that it can take several weeks for public health measures like mask mandates, restaurant closings and restrictions on gathering to influence people’s behavior and start to flatten the epidemic curve. The effect is delayed because the incubation period for the disease is 14 days, so some proportion of the public is already infected and some who are ill will die after the changes take effect.
Thomas Hale, associate professor of global public policy at the Blavatnik School of Government, leads an Oxford University effort to track virus restrictions. The Oxford data, he said, makes it clear that acting quickly and forcefully is the best shot governments have to combat the virus. And the more swiftly they can act, the shorter any lockdown-style policies need to be.
With new restrictions in France, Spain, Germany and Italy, the rate of daily cases in these countries has dropped. In the United Kingdom, even with new restrictions, cases are still steadily climbing.
France, which announced a second lockdown on Oct. 28, has seen its seven-day average for new daily cases fall from more than 54,000 on Nov. 7 to 28,500 on Wednesday, according to a New York Times database. Spain, Belgium, Switzerland and the Czech Republic are among the countries that have also seen decreases.
Since deaths tend to lag behind new infections by several weeks, hospitals across the continent will remain under great strain, and the number of deaths is still rising, with 4,500 lives lost every day in Europe.
“One person is dying every 17 seconds,” Dr. Kluge said.
The W.H.O. remains opposed to lockdowns except as a last resort, and Dr. Kluge said that better mask compliance could help avoid the most draconian restrictions. He estimated that mask compliance across Europe was at about 60 percent. If it were above 90 percent, he said, lockdowns would be avoidable.
Acknowledging public weariness and anxiety ahead of the holiday season, Dr. Kluge said that while people can take comfort from the promise of better days ahead, “it will be six tough months.”
Pandemic fatigue remains a concern throughout the continent, with many eager to roll back restrictions as soon as possible. The government of Spain’s Catalonia region announced on Thursday that bars and restaurants will be allowed to reopen starting Monday, albeit at 30 percent capacity indoors and with a 9:30 p.m. curfew.
Dr. Kluge emphasized that collective action today — and the promise of vaccines on the horizon — were reasons for optimism.
“There is more hope ahead of us than despair behind us,” he said.
California officials on Thursday announced a curfew aimed at trying to quickly curb a surge of new coronavirus infections. Nearly all of the residents of the nation’s most populous state will be barred from leaving their homes to do nonessential work or to gather from 10 p.m. to 5 a.m.
“We are sounding the alarm,” Gov. Gavin Newsom said in a statement. “It is crucial that we act to decrease transmission and slow hospitalizations before the death count surges. We’ve done it before and we must do it again.”
Mr. Newsom joined governors across the country in putting restrictions on residents in an effort to limit the spread of the virus. Curfews have been installed in Ohio and Puerto Rico. Several governors, including Gov. Chris Sununu of New Hampshire, a Republican, have issued mask mandates while others have ordered early closings of bars, restaurants and night clubs. And Pennsylvania will require anyone who enters the state to be tested before arrival.
Mr. Newsom’s move comes amid what California officials and experts have described as an alarming — but not yet irreversible — wave of new infections, heading into a dangerous Thanksgiving week. According to The Times’s database, the state was reporting a seven-day average of 9,974 new cases per day, more than double the average two weeks ago.
The stay-at-home order will go into effect on Saturday night and remain in place until the morning of Dec. 21. It covers counties where more than 94 percent of the state’s population lives and includes Los Angeles, Orange, Santa Clara and San Diego counties.
As with the state’s spring stay-at-home order, residents can still go outside for walks or go to work in what are deemed essential jobs. But it effectively forces all restaurants to close in-person dining at 10 p.m., even if they are operating outdoors.
Arenas and other sites where the state set up extra health care space earlier in the pandemic were once again being prepared to quickly receive patients, if hospitals become overwhelmed.
The governor on Monday had hinted that more restrictions could be on the way. He announced the curfew in a news release, forgoing his usual lengthy virtual news conference, in the wake of stinging criticism and outrage over his decision to attend a high-dollar dinner celebrating a lobbyist friend’s birthday at the French Laundry, a Napa Valley destination, along with members of several other households. On Monday, he apologized for attending the dinner, calling it a “bad mistake” and citing “Covid fatigue.”
As record numbers of coronavirus cases emerge across the United States, cities and states are implementing tough new restrictions. But in New York State, once the center of the pandemic, the response to a second wave has been far more measured, with officials banking on a variety of less disruptive, targeted actions, often reliant on voluntary compliance.
Ominous signs are everywhere: In New York City, Mayor Bill de Blasio closed in-person classes at the city’s schools starting Thursday when the seven-day average rate of positive test results rose above 3 percent on Wednesday. Thousands of new cases are emerging every day statewide, and hospitalizations have more than quintupled since early September, nearing 2,300 on Thursday.
The numbers are also spiking in some areas that were spared the worst in the spring: Western New York has seen about 3,700 new cases in the past week alone, with positivity rates running above 5 percent.
All told, more than a dozen counties around the state are seeing significant outbreaks, from Niagara County in the state’s northwest to New York City.
Gov. Andrew M. Cuomo says his response to the pandemic continues to be aggressive and highlights his state’s achievements: New York is still seeing much lower positivity rates than most states. And the number of daily deaths and hospitalizations pales in comparison to the spring, when thousands died for several weeks running, and tens of thousands were sickened.
On Thursday, Mr. Cuomo said the state was adding to the zones that are subject to restrictions on schools, businesses and gatherings. Many of the new areas are in the mid-Hudson Valley area that includes suburbs north of New York City.
The new zones include a new “yellow zone,” the lowest level of limits, in Westchester County that includes parts of New Rochelle, which had the state’s earliest detected cluster of the virus in March, and Yonkers, which is directly north of the Bronx.
The state will also add a yellow zone in Orange County and expand an existing yellow zone in Rockland County, where clusters of the virus emerged last month.
Still, some public health experts and officials worry that without a broader shutdown, the state might not be able to limit the virus’s spread, particularly as residents tire of restrictions and the holidays near.
“The odds are against us at this stage in terms of keeping it under control,” said Dr. Isaac Weisfuse, a former New York City deputy health commissioner.
Mr. Cuomo has also said that he would put New York City under new limits if state data showed that the citywide seven-day average positivity rate rose above 3 percent. Those restrictions would include closing gyms and indoor dining, both of which remain open, a decision that has upset parents and frustrated public health experts.
On Thursday, Mr. de Blasio said that he thought it was “just a matter of time” before the city hit the state’s threshold, adding that it was a “matter of when, not if.” The closing of gyms and indoor dining was “very likely to be in the next week or two,” he said.
The mayor also advised the city’s business owners to prepare for another wave of capacity limits and further shutdowns, given Mr. Cuomo’s remarks. “Know that this is a very strong likelihood,” he said.
The city’s health department reported on Thursday a seven-day average positivity rate of 3.01 percent. Dave A. Chokshi, the city’s health commissioner, said cases had been rising citywide.
The state, which uses different data, reported the citywide figure at 2.53 percent.
In the latest sign that the leading coronavirus vaccines may work well for older adults, researchers reported on Thursday that the vaccine being developed by AstraZeneca and the University of Oxford produced a similar immune response when tested in both older and younger adults.
The results, published in the journal The Lancet, come from 650 participants, 400 of them over the age of 56. The participants were enrolled in the Phase 2 component of an ongoing clinical trial in Britain. Results are expected soon from the study’s Phase 3 component, which will reveal how well the vaccine protected against Covid-19.
“We are getting very good immune responses — even in the over 70s, which look very similar to those in younger adults,” Andrew Pollard, the Oxford researcher leading the study, told reporters on Thursday. It is not yet known, however, whether vaccinated older adults will be able to sustain those immune responses over time.
Certain vaccines, including those that protect against some viruses that cause the seasonal flu, can be less effective for older adults. That has raised concerns that Covid-19 vaccines won’t work as well in that age group, which is especially vulnerable to the disease.
But results this week are boosting hopes that older adults will respond strongly to the leading vaccine candidates.
Moderna announced on Monday that a preliminary analysis found its vaccine to be 94.5 percent effective. The vaccine appeared equally safe and effective in all groups assessed.
And Pfizer, which on Wednesday announced the first complete results from a late-stage vaccine trial, said its vaccine was 94 percent effective in older adults, compared to 95 percent in the study overall.
More than 321,000 coronavirus cases have been reported at American colleges over the course of the pandemic, according to a New York Times survey of more than 1,900 colleges and universities.
More than 68,000 of those cases were identified this month, a sharp increase that comes as many students prepare to return home for Thanksgiving. Several governors in the Northeast issued statements urging universities to test students before they travel for the holiday.
See The Times’s campus-level data on coronavirus cases at colleges.
“With the holidays approaching, we are fighting ‘living room spread’ from small gatherings in private homes — and adding college students’ interstate travel will be like pouring gasoline on a fire,” said Gov. Andrew M. Cuomo of New York.
College towns emerged as hot spots this fall when students arrived on campus. Clusters emerged in dormitories and fraternity houses and on sports teams. More than 65 colleges have each reported at least 1,000 cases over the course of the pandemic, and more than 540 colleges have reported at least 100 cases.
Though most universities managed to keep their campuses open, the virus was never contained, and the pandemic continues to reshape the academic year. The Ivy League canceled winter sports. In Michigan, health officials ordered colleges to stop in-person classes. Across the country, many colleges will switch to online classes after Thanksgiving, with plans to resume in-person instruction in 2021.
On the University of Wisconsin’s flagship campus, where more than 3,600 people have tested positive, officials asked that students who leave for Thanksgiving stay away until the new year, and that those who plan to stay on campus avoid holiday travel.
“If you must finish the fall semester in Madison, we strongly recommend against traveling for the Thanksgiving recess,” Jake Baggott, the executive director of University Health Services said in a letter. “Given the very high rates of Covid-19 throughout Wisconsin and many other places, staying here is safest for you and for your family.”
As coronavirus cases increase across the country, the Smithsonian will once again temporarily close eight of its Washington-area institutions on Monday.
“The Institution’s top priority is to protect the health and safety of its visitors and staff,” the Smithsonian said in a statement. “We will use this time to reassess, monitor and explore additional risk-mitigation measures.”
Seven museums and the National Zoo, which had all reopened by Sept. 25, will be shutting again, the statement said.
No reopening date was announced.
Like the rest of the country, the nation’s capital has seen a surge in cases in the past few weeks: 156 new coronavirus cases were reported in Washington on Wednesday, and the average of 155 daily cases was a 73 percent increase from the figure two weeks earlier.
As of Thursday afternoon, at least 19,678 cases of coronavirus had been reported, and at least 667 people had died, in Washington since the beginning of the pandemic, according to a New York Times database.
The decision from the Smithsonian came as a second wave of closures is being announced by museums in a number of states around the nation. In recent days, officials in Oregon, Illinois and several other states announced new virus restrictions that will require museums to close once more, and several prominent institutions in Philadelphia, including the Philadelphia Museum of Art, announced plans this week to close again.
Some governors who have issued new mask mandates and other restrictions are facing public pushback from law enforcement officials who do not want to enforce the measures, testing the limits of the governors’ power to combat the spread of the coronavirus.
In West Virginia, the issue led to a public disagreement between Gov. Jim Justice and Attorney General Patrick Morrisey, who said he would not support criminal charges against people who failed to follow the governor’s statewide mask order.
Governor Justice noted at a news conference that while he could not make it a crime to violate the mask order — the legislature would have to do that — a person who refuses to either wear a mask or leave the premises of a business where masks are required, when told to do so by the police, could be charged with trespassing or obstruction.
But Mr. Morrisey wrote on Facebook on Wednesday that he was against any such prosecutions.
“Let’s be clear: no one is going to send people to jail, and that simply should not be occurring with respect to the governor’s executive orders,” he wrote. “Act responsibly and know we will use our constitutional authority to protect your freedoms and the due process you are afforded to the fullest extent the law allows.”
Mr. Justice responded with a statement saying he was “saddened” to see Mr. Morrisey’s Facebook post, and called it “extremely disheartening.”
Both men are Republicans who won re-election by comfortable margins this month.
State governors have also met with resistance from county sheriffs over pandemic executive orders. At least five sheriffs’ offices in North Dakota said they would not issue citations to enforce the mask mandate issued last week by Gov. Doug Burgum. “This is a health issue, and should not be turned into a criminal issue,” Sheriff Sarah Warner of Hettinger County wrote in a statement.
Sheriffs in Ohio, Michigan, Wisconsin, Texas and Mississippi, among other states, have at times taken similar positions. One sheriff in Florida went as far as ordering his deputies not to wear masks on duty.
Anchored by Milan, Italy’s financial and fashion capital, Lombardy boasts sophisticated industry and world-class medical facilities. Yet it was overwhelmed by the first wave of the pandemic, forcing doctors to ration ventilators and hospital beds, while having to decide who lived and who died.
The catastrophe in Italy’s most affluent region was in part a consequence of having entrusted much of the public health care system to private, profit-making companies while failing to coordinate their services.
Over the previous quarter-century, substantial investment has flowed into lucrative specialties like cardiac surgery and oncology. Areas on the front lines of the pandemic, like family medicine and public health, have been neglected, leaving people excessively reliant on hospitals for care.
As Italy now contends with a brutal second wave, Lombardy is again near the breaking point, with three-fourths of its hospital beds occupied by Covid-19 patients — nearly double the level considered dangerous by the national Health Ministry.
Among those battling the pandemic there is Dr. Chiara Lepora — much to her surprise.
A physician for the international relief agency Doctors Without Borders, Dr. Lepora had never imagined being deployed in her own country. She was accustomed to caring for people in countries like Yemen and South Sudan, amid extreme poverty and war.
But early this year, as the coronavirus spread from Asia to Europe, Dr. Lepora found herself pressed into service in Lombardy, one of the wealthiest places on earth.
“If you consider profit to be the endgame of health care instead of health, some people are going to be left out,” Dr. Lepora said. “The pandemic exposes all of those weaknesses.”
“Our shields are worn. Our resolve is being tested.”
So say the most immediate frontline health care workers in a new advertising campaign, as the coronavirus pandemic rages across the United States, breaking records nearly every day for deaths — and cases — in state after state.
The campaign, in print and video, by about 100 of the nation’s largest and best-known hospital groups began on Thursday, and aims to counter public resistance to mask-wearing.
The message beseeches Americans to protect everyone, including those on the forefront of the battleground in so many states where incoming patients are waiting for beds in overwhelmed hospitals with staff members fatigued from the unrelenting march of death during the pandemic.
Major hospital groups are sponsoring ads in prominent newspapers, including The New York Times, and backing a social media push featuring a powerful video that expresses the frustration felt by some of the nation’s health care workers over the refusal of so many Americans to wear masks, a practice that could potentially prevent tens of thousands of deaths.
The video, with stark black-and-white photographs of doctors and nurses leaning over Covid-19 patients in the midst of this crisis, urges the public to do more, to step up, to prevent the exponential rise of cases in their communities. It’s a call to arms.
“We put our lives on the line daily to keep you safe. So, do something for us. Wear. A. Mask,” the caption reads.
The hospital groups that are participating represent a broad array of organizations and companies with facilities across the country, including major academic medical centers like Johns Hopkins Medicine, Mass General Brigham, NewYork-Presbyterian and U.C.L.A. Health; large for-profit chains like HCA Healthcare; and religious hospital groups like Adventist Health and CommonSpirit Health.
The Food and Drug Administration on Thursday issued an emergency authorization for a combination of drugs — the approved Covid-19 drug remdesivir and a repurposed arthritis drug known as baricitinib — to treat hospitalized patients with Covid-19 severe enough to require breathing support.
The conditional approval — granted to Eli Lilly, which makes baricitinib — offers frontline clinicians a new option in treating some Covid-19 patients. It was based on the results of a clinical trial run by the National Institutes of Health that compared outcomes for patients who took baricitinib and remdesivir with those who took just remdesivir. The group that got the combination recovered a day sooner.
Still, it was not immediately clear in what circumstances physicians who have been relying on steroids to treat such patients should use the new treatment option.
“The question is: If everybody’s using steroids now, and there’s a mortality benefit, then what does that mean?” said Dr. Walid Gellad, who leads the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. “That baricitinib might help with remdesivir? What do we do with the steroids?”
Baricitinib was first approved in 2018. Last month, the F.D.A. issued its first full approval for Covid-19 use to remdesivir, which is manufactured by Gilead Sciences and had had emergency authorization since May. The drug was approved for hospitalized patients over age 12.
Even so, the utility of remdesivir has remained the subject of debate and skepticism for months. And on the same day the F.D.A. issued its new guidance, the World Health Organization released new recommendations against using the drug as a treatment for Covid-19.
An expert panel “concluded that remdesivir has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement,” the W.H.O. announced. The panel published its review in the journal The BMJ. The report did not rule out the use of the drug altogether as a Covid treatment, but said evidence was lacking to recommend its use.
Africa is experiencing a concerning uptick in confirmed coronavirus cases and has now passed the two million mark, said the World Health Organization’s regional director for Africa, Matshidiso Moeti, in a news briefing Thursday, warning that travel during the coming holiday season created more risk of outbreaks.
While the continent largely escaped some of the dire predictions made early in the pandemic — including that up to 190,000 people could die of it in the first year, or that at least 29 million could be infected — officials warned that countries needed to be prepared for a second wave of infection.
Testing data remains low in Africa, and the pandemic might have taken hold to a much larger degree than the figures show.
There are three main factors driving the second surge, according to a global health professor who also took part in the W.H.O.’s briefing, Salim S. Abdool Karim: superspreading events, especially at universities in South Africa; the approaching December vacation period; and complacency.
“Pandemic fatigue is a reality and is quite widespread, and people are just not maintaining social distancing and wearing their masks to the same extent,” he said.
Indeed, masks are being worn under chins, if at all, in many places across the continent. It is possible to cross Africa’s biggest city, Lagos in Nigeria, without seeing a single mask. The W.H.O. in Africa has introduced a social media campaign, Mask Up Not Down, to try to tackle this problem, and is aiming to reach 40 million young people by the end of the year.
Vaccines developed in Europe should be effective in African countries, too, as the virus circulating there originated from people traveling from Europe. But vaccine nationalism, and a $4 billion gap in financing for vaccine procurement in Africa, could mean that countries there do not get the vaccines they need.
“If we all work at prioritizing the most vulnerable, the most critical to health care, to economies, then I believe we could have a fair process of more equitable access,” said Dr. Moeti. “And not the usual African countries at the back of the queue which we have experienced in the past.”
With coronavirus cases on the rise in all but one state and a newly reached American death toll of 250,000, this would not seem the moment for the United States to take a patchwork response to the pandemic.
But that is what it has done, and that was perhaps never clearer than this week as mayors, school boards and governors struggled to fend off the onslaught.
In Ohio, it was a nightly curfew. In Mississippi, it was an expanded mask mandate, and in Iowa a statewide one — the state’s first ever. In Maryland, all bars, restaurants and night clubs were ordered closed by 10 p.m. And in Pennsylvania, the authorities said anyone traveling to the state would need to be tested before arrival.
“The new normal is no longer sustainable,” Minnesota’s governor, Tim Walz, said Wednesday evening as he announced sweeping new restrictions. “The ground is literally shifting under our feet.”
But there is a glaring exception in Walz’s new restrictions: Houses of worship, funeral homes and wedding venues are allowed to host people as long as they meet certain requirements, one of which is making sure there are no more than 250 people in an indoor space.
New York City, just eight weeks after opening its schoolhouse doors, said it was closing them again. Denver, too, said it would move to all-remote teaching, as did the state of Kentucky.
A day after the governor of California said the state was “pulling the emergency brake” on its reopening, Los Angeles County went a step further and announced a curfew for businesses. Illinois, too, imposed new restrictions.
For its part, Rhode Island will enter what Gov. Gina Raimondo called a two-week “pause” starting on Nov. 30. New measures will close all bar areas, fitness centers, recreational venues and many offices, and impose certain restrictions on other gatherings including limiting indoor socializing to members of the same household. The restrictions were necessary because hospitals are at 97 percent capacity due to rising Covid-19 cases, Ms. Raimondo said on Thursday, and a full lockdown might come after three weeks if the numbers did not come down.
Only in Hawaii were cases reported to be staying relatively flat.
Early in the week, Dr. Anthony S. Fauci, the government’s top infectious disease expert, said the nation needed “a uniform approach,” not a “disjointed” state-by-state, city-by-city response. Public health experts say the lack of a coordinated strategy has been a primary reason that the United States leads the world in infections and deaths.
But there has been a notable lack of national direction.
Even before the election, there was squabbling within the Trump administration over how to contain the virus. The disarray has become even more pronounced in the aftermath of the election, with President Trump directing his aides not to cooperate with the transition.
On Wednesday, President-elect Joseph R. Biden Jr. asked that the government give him access now to federal resources to help him plan a coronavirus response. “This is like going to war,” he said. “You need a commander in chief.”
As the day drew to a close, more than 172,000 new cases had been announced in the United States — the second-highest daily total of the pandemic. And more than 1,900 more Americans were dead.
Tyson Foods said on Thursday that it had suspended the employees named in a lawsuit that alleged the manager of a Tyson pork plant in Waterloo, Iowa, organized a betting pool among supervisors to wager on how many workers would get sick.
The lawsuit, filed by the son of Isidro Fernandez, a meatpacking worker who died in late April, said the betting pool was a “cash buy-in, winner take all.” The plant was the site of a deadly coronavirus outbreak this spring.
Those accused of being involved in the betting pool have been suspended without pay, Dean Banks, the president and chief executive of Tyson Foods, said in a statement on Thursday. Tyson also enlisted the law firm Covington & Burling to conduct an independent investigation, which will be led by Eric H. Holder Jr., the former U.S. attorney general.
“If these claims are confirmed, we’ll take all measures necessary to root out and remove this disturbing behavior from our company,” Mr. Banks said.
A spokesman for Tyson said in an email that the company had introduced multiple steps to protect its workers in Waterloo. Those included taking employee temperatures, relaxing attendance policies and erecting barriers on the production floor to create social distance.
At the time of Mr. Fernandez’s death, the Tyson plant was a virus hot spot, though the plant’s leadership initially denied that there was an outbreak and rebuffed efforts by local officials to close the facility, according to the lawsuit filed in federal court in Iowa.
The workers were told to continue working despite showing symptoms of being sick. One worker was told to stay on the production line even after he vomited, the lawsuit said.
In all, about 1,000 workers — about a third of the work force — tested positive for the virus. Some of the issues at the Waterloo plant were detailed in a New York Times article in May. But the allegation about the betting pool among supervisors and managers was revealed this week after lawyers for Mr. Fernandez’s family amended the original lawsuit. The allegation of the betting pool was first reported by The Iowa Capital Dispatch.
“We’re saddened by the loss of any Tyson team member and sympathize with their families,” the company said in a statement. “Our top priority is the health and safety of our workers.”
At Hong Kong’s deserted airport, cleaning crews constantly spray baggage trolleys, elevator buttons and check-in counters with antimicrobial solutions. In New York City, workers continually disinfect surfaces on buses and subways. In London, many pubs spent lots of money on intensive surface cleaning to reopen after lockdown — before closing again in November.
All over the world, workers are soaping, wiping and fumigating surfaces with an urgent sense of purpose: to fight the coronavirus. But scientists increasingly say that there is little to no evidence that contaminated surfaces can spread the virus. In crowded indoor spaces like airports, they say, the virus that is exhaled by infected people and that lingers in the air is a much greater threat.
Hand washing with soap and water for 20 seconds — or sanitizer in the absence of soap — is still encouraged to stop the virus’s spread. But scrubbing surfaces does little to mitigate the virus threat indoors, experts say, and health officials are being urged to focus instead on improving ventilation and filtration of indoor air.
“In my opinion, a lot of time, energy and money is being wasted on surface disinfection and, more importantly, diverting attention and resources away from preventing airborne transmission,” said Dr. Kevin P. Fennelly, a respiratory infection specialist with the National Institutes of Health.
New claims for unemployment insurance in the United States remained elevated last week amid a surge in coronavirus cases, the government reported Thursday.
More than 743,000 workers filed new claims for state benefits last week, before adjusting for seasonal factors, an increase of 18,000 from the week before. With seasonal swings factored in, the latest figure was 742,000, virtually unchanged from the previous week, the Labor Department said.
Claims had drifted lower in recent weeksbut remain far above the levels reached in previous recessions. What’s more, the coronavirus resurgence in much of the country in recent weeks has caused new restrictions on business activity, leading to more job cuts.
“The economy has made significant progress in healing from the Covid shock, but there is still more work to be done, and layoffs are persisting,” said Michelle Meyer, head of U.S. economics at Bank of America.
New claims for Pandemic Unemployment Assistance, a federal program aimed at self-employed workers and independent contractors, totaled 320,000.
News that competing vaccines from two companies had shown strong evidence of efficacy against the virus has led the stock market higher and fueled hopes that the virus could be brought under control next year. That would clear the way for renewed growth, many experts say.
“We’re potentially entering a period of softness, but the medium term is more promising,” Ms. Meyer said.
On Monday, President-elect Joseph R. Biden Jr. called on the two parties to “come together” and enact a stimulus package along the lines of a $3 trillion proposal passed by the Democratic-controlled House.
For all the body blows of the last year, consumer demand remains relatively healthy, according to Ms. Meyer. “We are still seeing incredible strength in housing, and auto sales remain strong,” she said. “Consumers are still spending on bigger-ticket items.”
With a second pandemic lockdown underway in Ireland, many businesses have struggled to stay afloat.
Among them is Dublin Zoo, which issued a fund-raising appeal this week to prevent it from closing permanently. By Wednesday evening, just hours after launching the appeal, the zoo had received more than one million euros (about $1.2 million) in donations from the public, as well as pledges from the government.
“We find ourselves closed for a second time this year and we’re sad to say the future of Dublin Zoo is uncertain,” read a post on the zoo’s Facebook page, accompanied by a video of staff members asking for donations. The zoo has been closed for five months this year.
The closures have had a devastating impact on Dublin Zoo, where the costs for care run upward of €500,000 a month. The 69-acre zoo, inside Dublin’s Phoenix Park, is a major attraction, with more than 1.2 million people visiting last year. Since its opening in 1831, it has become something of a national treasure, staking its claim as the third most-visited attraction in Ireland and a regular destination for families.
The mayor of the city, Hazel Chu, was among the Dubliners who donated, and posted on Twitter about sponsoring a baby elephant. Irish celebrities and politicians also threw their support behind the campaign, alongside thousands of others who posted on social media, many sharing their own memories of childhood visits to the zoo, under the hashtag #SaveDublinZoo.
But the campaign also triggered calls from political parties demanding that the government come up with a long-term funding solution for the zoo.
The government has already begun working toward a sustainable solution. Malcolm Noonan, the minister who oversees heritage in Ireland, said in a tweet that he met with representatives from Dublin Zoo and Fota wildlife park, another zoo in County Cork, to assess the scale of the funding challenges. He was hopeful his ministry could offer short term financial support to “help tide the two main zoos past this immediate challenge,” but said the public donations were “testament to the high regard that these places have in our public consciousness.”
BRUSSELS — European Union leaders made little progress during a teleconference on Thursday in breaking a stalemate over a stimulus bill. Leaders confronted Hungary and Poland, whose vetoes of the package threaten to derail the plan to rescue the bloc’s economies.
The two countries broke ranks with their peers earlier this week and blocked the 750 billion euro (or $886 billion) stimulus bill, as well as the E.U. multi-annual budget, because of a provision linking E.U. funding to adherence to rule-of-law standards, such as maintaining an independent judiciary and providing transparency in spending of bloc funds.
Hungary’s prime minister, Viktor Orban, claimed the bill was a covert attempt by the E.U. to force Hungary to take in migrants, even though there is no connection between the standards and E.U. migration law. The Polish prime minister, Mateusz Morawiecki, endorsed Mr. Orban’s position, calling the E.U. an “oligarchy” and comparing it to a communist regime in comments earlier this week.
The two countries found a single ally among the 25 other E.U. states: Janez Jansa, the prime minister of Slovenia, who defended his Eastern European peers and suggested that the E.U. drop the provision from the bill. But among the other 24 leaders, the ultimatum did not go down well. Mark Rutte, the prime minister of the Netherlands, dismissed the nations’ demands, calling the proposed rule-of-law mechanisms the “bare minimum.”
The leaders agreed that an in-person meeting would be necessary in order to resolve this last-minute hurdle to the crucial stimulus package, which had just been approved by the European Parliament and was on track for deployment in early 2021. Their next meeting is set for Dec. 10, but, as Europe battles a second wave of the pandemic, it isn’t yet clear whether conditions will allow them to gather in person.
If they cannot, the Polish and Hungarian vetoes could delay the distribution of stimulus money to the bloc’s members, many of whom are relying on it to fund programs to rescue their economies from the depths of a catastrophic recession.
Anthony J. Tata, a senior Pentagon official, has tested positive for the coronavirus after meeting with a visiting Lithuanian official who also met with the acting American defense secretary and other high-level U.S. military officials.
In a statement on Thursday night, a Pentagon spokesman, Jonathan Hoffman, said the Defense Department was notified earlier in the day that the Lithuanian defense minister, Raimundas Karoblis, who visited Washington on Nov. 13, had tested positive for the virus.
After tests were performed on the American officials, Mr. Tata was the only one so far found to be infected, the Defense Department said, adding that he would isolate at home for the next 14 days.
While at the Pentagon, Mr. Karoblis also met the acting secretary of defense, Christopher C. Miller, as well as the secretaries of the Army and the Air Force. Three days later, he met with the secretary of the Navy.
All have since tested negative and are not quarantining, despite their exposure, the Pentagon said.
“We have and are continuing to conduct further contact tracing of D.O.D. personnel who have had close contact with the Lithuanian delegation or Mr. Tata, and are taking appropriate precautions in accordance with CDC guidelines,” the statement said.
Although Mr. Tata has been described as “performing the duties of the under secretary of defense for policy,” he does not, in fact, hold that post. His nomination for the job was withdrawn over the summer, in part when it emerged that he had called President Barack Obama a “terrorist leader.”
But in an end run around lawmakers, the Trump administration appointed Mr. Tata, a retired Army one-star general turned Fox News commentator, to a temporary senior position that did not require Senate approval. He is among a group of hard-line Trump loyalists installed into senior jobs at the Pentagon in recent days.