The Coronavirus Outbreak


President Trump lashed out at Congressional Democrats for announcing an oversight committee to monitor the virus response. Nearly 10 million Americans have lost their jobs. Critical medicines are running low.

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Dr. Deborah Birx, the coordinator of the coronavirus response, emphasized that social distancing, not masks, was still the most important step Americans could take to slow the spread of the virus.

ImagePeople waited in line outside of a pharmacy in New York City on Wednesday.
People waited in line outside of a pharmacy in New York City on Wednesday.Credit...Andrew Seng for The New York Times

The Trump administration appeared to be conflicted Thursday about whether to recommend that all Americans wear cloth masks if they go out in public, even as federal health officials were revising guidance to reflect new concerns that the coronavirus is being spread by infected people who have no symptoms.

Until now, the federal Centers for Disease Control and Prevention, like the World Health Organization, has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks, including N95 respirator masks, for health care workers who desperately need them at a time when they are in continuously short supply.

At a White House briefing Thursday evening, President Trump said his administration was “coming out with regulations” on mask wearing but stressed that the guidance would be entirely voluntary. “If people want to wear them, they can,” he said.

According to a federal official, the C.D.C. has been preparing to recommend that everyone wear face coverings in public settings, like pharmacies and grocery stores, to avoid unwittingly spreading the virus. Public health officials have continued to stress, however, that N95 masks and surgical masks should be saved for front-line doctors and nurses, who have been in dire need of protective gear.

For weeks, the administration has sent conflicting messages on masks. At first, officials clearly stated that masks should only be worn by sick people. For some time, Mr. Trump has been saying masks might be useful, but scarves would be fine as well. Chinese officials have expressed alarm at how few ordinary Americans are covering their noses and mouths.

Earlier this week, Dr. Robert Redfield, the director of the C.D.C., confirmed in a radio interview that the agency was reviewing its guidelines on who should wear masks. Citing new data that shows high rates of transmission from people who are infected but show no symptoms, he said the guidance on mask wearing was “being critically re-reviewed, to see if there’s potential additional value for individuals that are infected or individuals that may be asymptomatically infected.”

Dr. Deborah Birx, the coordinator of the virus response, pleaded with Americans on Thursday to follow the federal guidelines on social distancing “to a tee,” emphasizing that it was still the most important step Americans could take to slow the spread. Masks, she said, weren’t enough.

Failing to follow the guidelines would keep the United States on a steep trajectory of new cases and deaths.

“We have to change that slope; we have to change the logarithmic curve that we’re on,” she said of the steep increases in cases in many parts of the country. “We see country after country having done that, what it means in the United States is not everyone is doing it.”

Under prodding by Mr. Trump, Dr. Birx noted that some communities in the United States are doing a better job lowering the steep curve of cases by keeping people inside with social distancing.

She added: “We see Spain, we see Italy, we see France, we see Germany, when we see others beginning to bend their curves. We can bend ours, but it means everybody has to take that same responsibility as Americans.”

Dr. Birx said that recommendations against gatherings of more than 10 do not mean people should be having dinner parties or cocktail parties of less than 10 people.

“We’re only as strong as every community, every county, every state, every American following the guidelines to a tee,” she said. “And I can tell by the curve, and as it is today that not every American is following it. And so this is really a call to action.”

When the first cases of the coronavirus were reported in the United States in January, President Trump mostly dismissed the looming threat, Wall Street chugged ever upward and people set about their business with scant recognition of the calamity that lay ahead.

On Thursday, the scope of the economic disaster became clearer as the Labor Department reported the loss of 10 million jobs in only two weeks. Wall Street has seemingly imploded, and the global economy has shuddered as the fallout of the pandemic reaches into every country.

Hopes for a dramatic but brief downturn followed by a quick recovery have faded, and in their place are fears that the world may be on the cusp of an economic shock unseen since the Great Depression.

The speed and scale of the job losses is without precedent. Until last month, the worst week for unemployment filings was 695,000 in 1982.

At his evening coronavirus briefing, President Trump again said he would not reopen the Affordable Care Act’s federal insurance exchange to make it easier for the newly unemployed or the already uninsured to buy deeply subsidized health insurance. But Vice President Mike Pence said on Friday that the administration will unveil a plan to directly pay hospitals to treat uninsured coronavirus patients.

Despite the news that 6.6 million people had filed for unemployment benefits last week, the S&P 500 rose more than 2 percent after Mr. Trump said he expected Russia and Saudi Arabia to announce oil production cuts. Oil prices had been hammered as the pandemic all but eliminated travel and demand for energy, and a price war between Saudi and Russia had intensified the decline.

Mr. Trump’s statement led crude oil futures, which had already been climbing on Thursday, to surge, and shares of oil and gas companies also rallied. But by Thursday afternoon the agreement Mr. Trump said he expected had yet to materialize, and neither Russia nor Saudi Arabia publicly committed to such a cut. A Saudi statement issued on Thursday called only for a meeting of oil producing nations to reach a “fair agreement.” The Kremlin cast further doubt on the possibility, denying a claim that Mr. Trump made on Twitter that Mr. Putin had discussed the matter with the crown prince.

With or without a deal, Mr. Trump’s unusual oil diplomacy and his eagerness to claim a victory reflects his growing anxiety about the United States’ coronavirus-gripped economy. It also underscores his sudden reliance, after years of upbeat talk about growing American energy independence, on foreign oil industries. But if Russia and Saudi Arabia fail to strike an agreement that bolsters global oil prices, Mr. Trump will find himself left twisting in the wind by two repressive leaders whose good will he has spent years cultivating at significant political cost.

Across the country, as hospitals confront a harrowing surge in coronavirus cases, they are also beginning to report shortages of critical medications — especially those desperately needed to ease the disease’s assault on patients’ respiratory systems.

The most commonly reported shortages include drugs that are used to keep patients’ airways open, antibiotics, antivirals and sedatives. They are all part of a standard cocktail of medications that help patients on mechanical ventilators, control secondary lung infections, reduce fevers, manage pain and resuscitate those who go into cardiac arrest.

Demand for these drugs significantly increased in March as the pandemic took hold. Orders for antibiotics like azithromycin and antiviral medicines like ribavirin nearly tripled. Requests for medicines used for sedation and pain management, including fentanyl, midazolam and propofol, increased by 100 percent, 70 percent and 60 percent respectively.

Demand for albuterol, a common asthma inhaler medication, also has risen significantly, given its importance in easing the breathing of patients with severe infection.

“Just like we’re seeing shortages of other materials, like masks and ventilators, medications are right there in the mix of things that we don’t always have enough of on hand,” said Erin Fox, a drug shortage expert at the University of Utah. “So we were not prepared for this kind of surge.”

Such were the expectations for the Navy hospital ship U.S.N.S. Comfort that when it chugged into New York Harbor this week, throngs of people, momentarily forgetting the strictures of social distancing, crammed together along Manhattan’s west side to catch a glimpse.

On Thursday, though, the huge white vessel, which officials had promised would bring succor to a city on the brink, sat mostly empty, infuriating local hospital executives.

Only three patients had been transferred to the ship, officials said, even as New York hospitals struggled to find space for the thousands infected with the coronavirus.

The Comfort was sent to New York to relieve pressure on city hospitals by treating people with ailments other than Covid-19.

But the reality has been different.

A tangle of military protocols and bureaucratic hurdles has prevented the Comfort from accepting many patients at all. On top of its strict rules preventing people infected with the virus from coming on board, the Navy is also refusing to treat a host of other conditions. Guidelines disseminated to hospitals included a list of 49 medical conditions that would exclude a patient from admittance to the ship.

“If I’m blunt about it, it’s a joke,” said Michael Dowling, the head of Northwell Health, New York’s largest hospital system. “Everyone can say, ‘Thank you for putting up these wonderful places and opening up these cavernous halls.’ But we’re in a crisis here, we’re in a battlefield.”

President Trump lashed out at Democrats in Congress on Thursday for announcing the start of oversight investigations into the Trump administration’s response to the coronavirus, accusing them of “conducting these partisan investigations in the middle of a pandemic.”

Speaker Nancy Pelosi said earlier on Thursday that she had created a special select bipartisan committee to oversee all aspects of the government response to the virus, including its distribution of more than $2 trillion in emergency aid. Without citing Ms. Pelosi’s move specifically, the president made clear he objects.

“I want to remind everyone here in our nation’s capital, especially in Congress, that this is not the time for politics, endless partisan investigations,” he said. “Here we go again.”

Mr. Trump repeated the language he often used to describe the investigations into his administration: “You see what happens. It’s a witch hunt after witch hunt after witch hunt. And in the end, the people doing the witch hunt they’ve been losing, and they’ve been losing by a lot.”

The White House then released a letter that Mr. Trump sent to Senator Chuck Schumer of New York, the Democratic leader, pressing his attack as the nightly coronavirus task force briefing continued.

“I’ve known you for many years but I never knew how bad a Senator you are for New York until I became president,” Mr. Trump wrote, after complaining about “your ridiculous impeachment hoax.”

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Former Vice President Joseph R. Biden Jr. addressed the Trump administration’s handling of the coronavirus pandemic, and the safety of upcoming elections.CreditCredit...Carlos Barria/Reuters

Corpses are strewn in the streets of Ecuador or spend days waiting to be picked up from private homes as the number of coronavirus deaths surges. There is no more wood for coffins, leading one cardboard manufacturer to begin producing cardboard caskets.

“We are so beaten down,” a city councilman, Andrés Guschmer, said on Thursday.

He described a collective grief in the normally lively city of fewer than three million people.

Latin America has started to see a rapid rise in cases, and many leaders are preparing for an explosion.

Officially, Ecuador has had 98 deaths because of coronavirus, most of them in Guayaquil, a city where many families have members who work or study in Spain and Italy. But that number is a dramatic undercount, Guayaquil was seeing three or four times the number of deaths it typically sees in a day, he said, adding that the day before they had about 320 deaths.

In Guayaquil, part of the reason for the backlog is that federal regulation requires each death to be assessed by criminal investigators before the body’s removal, but there are not enough investigators, said Mr. Guschmer, who is in charge of coordinating corpse removal with federal officials.

He has urged the national government to change the protocol.

Jorge Wated, an official working on the national government’s response to the crisis, said on Wednesday that deaths in the city could reach 3,500 in coming months.

Among the dead in Guayaquil are four journalists, several of whom were covering the crisis before they died, said César Ricaurte, the director of a media defense group called Fundamedios.

U.N. is “missing in action” during pandemic, foreign policy experts say.

The leader of the United Nations has called the coronavirus pandemic the most challenging crisis since World War II and pleaded for a unified global response and a halt to all armed conflicts. But the Security Council — the U.N.’s most powerful arm and the only one empowered to use military force and sanctions — has been conspicuously silent, allowing the secretary general’s calls to be widely disregarded.

Fighting continues unabated in Syria, Yemen, Libya, Afghanistan, Mali and Colombia, among other hot spots. North Korea, which claims to have no coronavirus infections, launched two short-range missiles in recent days, its fourth weapons test in a month.

And there are few immediate indications that the situation will change, causing alarm and frustration among rights groups and foreign policy experts who say the United Nations is failing to fulfill its outsize role as the pandemic rages on across the globe.

Diplomats, former U.N. officials and civil rights groups say the Council’s inaction reflected a bitter standoff between two of its five veto-wielding permanent members — China and the United States — over the origin of the pandemic.

Louis Charbonneau, the United Nations director at Human Rights Watch, said “the Security Council has been entirely missing in action” on the pandemic.

“We’re in a situation widely recognized as our most urgent security issue, with a large portion of the global population on lockdown, and the Security Council is incapable of doing anything,” he said.

The Navy removed the captain of the stricken aircraft carrier Theodore Roosevelt on Thursday, only days after he implored his superior officers for more help as a coronavirus outbreak spread aboard the ship, Defense Department officials said.

About 100 sailors have been infected so far.

In a letter that leaked to the news media on Tuesday, Capt. Brett E. Crozier laid out the dire situation unfolding aboard the warship, with almost 5,000 crew members, and described what he said were the Navy’s failures to provide him with the proper resources to combat the virus by moving sailors off the vessel and disinfecting areas on board.

Senior Defense Department officials were angry that the letter found its way first to The San Francisco Chronicle, and then to other news outlets, where it was widely reported.

The decision to remove Captain Crozier came on Thursday, officials said.

The carrier is currently docked in Guam.

The C.I.A. has been warning White House officials since at least February that China is understating its coronavirus numbers — an obfuscation that could have profound impact on health experts’ ability to predict how the virus will spread.

American officials have long viewed many figures and reports out of China with suspicion. But the intelligence about China’s undercount of its coronavirus death toll played a role in President Trump’s negotiation last week of an apparent détente with President Xi Jinping of China after weeks of rising tensions over the virus.

The C.I.A. has its own health experts and epidemiologists who work on classified models of the pandemic’s spread, and intelligence officers seek new information to contribute to those models and improve them. But American intelligence agencies have not obtained better numbers about the death toll in China in large measure because the Chinese government itself does not know how damaging the virus has been.

Midlevel bureaucrats in the city of Wuhan, where the virus originated, and elsewhere in China have been lying about infection rates, testing and death counts, fearful that if they report numbers that are too high they will be punished, lose their position or worse, current and former intelligence officials said.

White House officials believe that China is a month or so ahead of the United States in how the pandemic will play out. And obtaining a more accurate view of the coronavirus toll in China could be critical to heading off a second wave of the pandemic.

New York State, whose 2,468 coronavirus deaths have made it the center of America’s outbreak, is in danger of depleting its stockpile of critically needed ventilators in just six days, Gov. Andrew M. Cuomo said Thursday.

“If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies,” Mr. Cuomo said. “That’s the blunt equation here.”

The lack of ventilators, which are needed for patients who are incapable of breathing on their own, is emerging as one of the biggest looming dangers of the pandemic. Mr. Cuomo said that the state had sent 400 ventilators from its stockpile on Wednesday night to hard-hit hospitals in New York City and another 200 to hospitals in Long Island and Westchester.

That left just 2,200 ventilators in the state’s stockpile, he said — leading state officials to fear that if their projections hold, they will run through them in six days.

Mr. Cuomo said that buying more ventilators was proving difficult with so much competition from around the nation and the world. So he said that hospitals were taking extraordinary measures to get the most out of their existing ventilators, including splitting ventilators by connecting two patients to machines that are intended for one.

The U.S. government has nearly emptied its emergency stockpile of protective medical supplies like masks, gowns and gloves, a senior official said. Some states receiving desperately needed ventilators from the federal government discovered that the machines did not work.

Mr. Cuomo made a plea, and an offer, to businesses. He said that the state would pay to help manufacturers switch over to the production of needed hospital gowns, gloves and other equipment.

“If you have the capacity to make these products, we will purchase them, and we will pay a premium,” he said. “But we need it, like, now.”

Mr. Trump, under fire for his administration’s failure to respond quickly to the pandemic, lashed out at New York again on Thursday, saying the state’s doctors and hospitals are “never satisfied” with the medical supplies provided by the federal government because of politics.

Mr. Trump said he had ordered his health secretary to use the Defense Production Act to help a half-dozen American companies secure the materials they need to produce more ventilators. The companies listed in the order include General Electric, Hill-Rom, Medtronic, ResMed, Royal Philips, and Vyaire Medical.

It was not immediately clear how the new order would affect the production of ventilators or how quickly the companies would be able to provide the devices to hospitals in hot spots like New York City or New Orleans.

The Food and Drug Administration on Thursday approved the first test for coronavirus antibodies for use in the United States.

Currently available tests are designed to find fragments of viral DNA indicating an ongoing infection. An antibody test, on the other hand, tells doctors whether a patient has ever been exposed to the virus — and, having recovered, now may have at least some immunity.

That is important for several reasons. People with immunity might be able to venture safely from their homes and help shore up the work force. It may be particularly important for doctors and nurses to know whether they have antibodies.

Antibody testing eventually should give scientists a better sense of how widespread the infection is in the population and help researchers calculate more precisely the fatality rate and the frequency of asymptomatic infections.

Separately, an unproven stem cell therapy derived from human placentas will begin testing in patients with coronavirus, the New Jersey biotech company Celularity said Thursday.

The treatment has not yet been used on any patients with symptoms of Covid-19, but it has caught the attention of Rudy Giuliani, President Trump’s personal lawyer. Mr. Giuliani recently featured an interview with the company founder on his website and said on Twitter that the product has “real potential,” while also criticizing the Food and Drug Administration for not moving more quickly to approve potential remedies.

There is no proven treatment for the respiratory disease, but several experimental approaches, including old malaria drugs and H.I.V. antivirals, are being tested in patients around the world.

Amid the pandemic, the United States is now facing a drastic drop in the national blood supply. On Thursday, the F.D.A. that it was reducing the amount of time men who have had sex with men should wait before they give blood from one year to three months.

Nearly 5,400 people have died because of the epidemic in France. Nearly 60,000 people in France have tested positive for the virus, and over 26,000 of them are hospitalized. Over 6,000 of those are in intensive care, and hospitals in areas that are hardest hit, especially the Paris region, are nearing their maximum capacity.

The police cited “persistent tensions” between hospitals and funeral homes as deaths accelerated. They said coffins would be placed temporarily in the refrigerated hall, which is “offset and isolated” from the rest of the food market, a sprawling 573-acre complex in Rungis.

“This location will make it possible to preserve, in conditions that are the most dignified and acceptable from a sanitary standpoint, the caskets of the deceased awaiting burial or cremation, in France or abroad,” the police said.

The morgue is expected to start operating on Friday.

It was not the first time that the French authorities have used Rungis for a dire health crisis. In 2003, when a brutal heat wave killed thousands of elderly people, 700 bodies were kept in a refrigerated warehouse at the same site.

Trump’s company spoke with a bank and a Florida county about delaying payments on loans, and other obligations.

All over the United States, businesses large and small are seeking breathing room from their lenders, landlords and business partners as they face the financial fallout from the coronavirus crisis.

The president’s family company is among those looking for help.

With some of its golf courses and hotels closed amid the economic lockdown, the Trump Organization has been exploring whether it can delay payments on some of its loans and other financial obligations, according to people familiar with the matter and documents reviewed by The New York Times.

Representatives of Mr. Trump’s company have recently spoken with Deutsche Bank, the president’s largest creditor, about the possibility of postponing payments on at least some of its loans from the bank.

And in Florida, the Trump Organization sought guidance last week from Palm Beach County about whether it expected the company to continue making monthly payments on county land that it leases for a 27-hole golf club.

The discussions with Deutsche Bank and Palm Beach County are preliminary, and it isn’t clear whether Mr. Trump’s company will be able to delay or reduce its payments, according to people briefed on the discussions.

“These days everybody is working together,” said Eric Trump, the president’s son, who helps manage the family business. “Tenants are working with landlords, landlords are working with banks. The whole world is working together as we fight through this pandemic.”

The Trump Organization’s requests put lenders and landlords in the awkward position of having to accede or risk alienating the president.

Dr. Anthony S. Fauci, the nation’s leading expert on infectious diseases, said on the Times podcast “The Daily” on Thursday that the threat of the virus resurging will continue until a vaccine is approved.

“I believe that in a few months, hopefully, that we’ll get it under control enough that it won’t be as frightening as it is now, but it will not be an absent threat,” he said. “And the threat of resurgence will be something that we need to make sure that we are prepared for.”

Addressing the delays in testing for the virus across the United States, which left Americans largely blind to the scale of the looming catastrophe until early March, Dr. Fauci said that the government was working to increase capacity.

The government “is right now, today, ramping up to essentially make the private sector the major driving force of the testing,” he said. “Early on, that was not in place. And that’s unfortunate.”

Dr. Fauci, who has advised presidents from both parties on pandemic responses, has become the explainer-in-chief of the pandemic. Since joining the White House coronavirus task force in late January, he has taken on a public role translating the science behind the crisis for the general public — and clarifying President Trump’s false or misleading claims in press briefings.

“The president has his own style,” Dr. Fauci said. “That’s obvious to the American public.” He added, “I don’t think it would be possible for me to influence another person’s style. I mean, that just doesn’t happen.”

Dr. Fauci also looked ahead, to how he believes the crisis will be seen years from now.

“I think it will be remembered as really showing what a great country we are. We have been through, as I’ve said, if you look at the history of our country, some extraordinary ordeals. I mean, world wars and diseases and depressions,” he said. “And we’ve gotten through it. I have a great deal of faith in the spirit of the American people. We’re resilient. We’re going to get over this. And this is going to end.”

There are still a dozen states where governors have resisted issuing stay-at-home orders to try to slow the spread of the virus, though localities in some of them have put their own bans in place. An analysis of cellphone location data by The New York Times found that people in the Southeast and other places that waited to enact such orders have continued to travel widely, potentially exposing more people as the outbreak accelerates.

A half-dozen of the most populous counties where residents were still traveling widely last week are in Florida, where Gov. Ron DeSantis did not call for a statewide lockdown until Wednesday. See where America did not stay at home:

Your home is currently serving as a work space, living space and possibly a school and playground. It wasn’t designed for all these disparate tasks, but there are things you can do to make your home more comfortable for you and your family in these times.

Reporting was contributed by Abby Goodnough, Michael Schwirtz, Margot Sanger-Katz, Knvul Sheikh, Michael Cooper, Alan Blinder, Karen Zraick, Reid J. Epstein, Jonah Engel Bromwich, Emily Cochrane, Andy Newman, Mike Baker, Elian Peltier, Aurelien Breeden, Julie Turkewitz, David Enrich, Ben Protess, Eric Lipton, Megan Specia, Marc Santora, Damien Cave, Austin Ramzy, Michael Wilson, Edward Wong, Ana Swanson, Katie Thomas, Helene Cooper, Thomas Gibbons-Neff, Eric Schmitt, Jan Hoffman, Keith Collins, David Yaffe-Bellany, Neil Vigdor, Andrew Das, Maya Salam, Mihir Zaveri, Julian E. Barnes, Ana Swenson, Raphael Minder, Iliana Magra, Kevin Armstrong, Ben Casselman, Ben Shpigel, Isabel Kershner, Anton Troianovski and Niki Kitsantonis.

  • Updated March 24, 2020

    • It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Experts are divided on how much protection a regular surgical mask, or even a scarf, can provide for people who aren’t yet sick. The W.H.O. and C.D.C. say that unless you’re already sick, or caring for someone who is, wearing a face mask isn’t necessary. The New York Times and other news outlets have been reporting that the wearing of face masks may not help healthy people, noting that while masks can help prevent the spread of a virus if you are infected, most surgical masks are too loose to prevent inhalation of the virus and the more effective N95 masks, because of shortages at health centers worldwide, should be used only by medical personnel. But researchers are also finding that there are more cases of asymptomatic transmission than were known early on in the pandemic. And a few experts say that masks could offer some protection in crowded places where it is not possible to stay 6 feet away from other people. Masks don’t replace hand-washing and social distancing.

    • Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.