Covid-19 Live Updates: A Bright-Red Map and a Dire Warning as the Coronavirus Task Meets at the White House – The New York Times

Credit…Stefani Reynolds for The New York Times

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.”

General Turner pledged that the government would begin distributing the vaccines within 24 hours after they receive emergency approval from the Federal Drug Administration. He did not mention that the doses will be scarce at first, and that the vaccines do not take effect right away.

One of the vaccine developers, Moderna, has said it will have 20 million doses ready by the end of 2020; the other, Pfizer, said it would have about 50 million by then — half for Americans. Both vaccines require two shots, so 20 million doses would be enough for 10 million people.

Credit…Annie Flanagan for The New York Times

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.”

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With many countries under some version of a less severe lockdown than the ones in the spring, the World Health Organization official said on Thursday that there is hope.CreditCredit…Alessandro Grassani for The New York Times

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.

Why Europe Is Flattening the Curve (and the U.S. Isn’t)

As the coronavirus surged anew, the authorities on either side of the Atlantic took profoundly different approaches.

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Why Europe Is Flattening the Curve (and the U.S. Isn’t)

Hosted by Michael Barbaro; produced by Jessica Cheung, Michael Simon Johnson and Paige Cowett; and edited by Lisa Tobin

As the coronavirus surged anew, the authorities on either side of the Atlantic took profoundly different approaches.

michael barbaro

From The New York Times, I’m Michael Barbaro. This is The Daily.

[music

]

Today, the United States and Europe have approached the second wave of the coronavirus in profoundly different ways. My colleagues, Matina Stevis-Gridneff and Mitch Smith on what those two responses look like. It’s Tuesday, November 17.

Matina, you cover Europe for The Times and are based in Belgium. So tell us about how the governments of Europe are responding to this second wave of the coronavirus.

matina stevis-gridneff

Well, Michael, I think by mid-October the writing was on the wall that the second wave that everyone had feared would eventually arrive was with us. We were seeing exponential increases in cases. Hospitals were getting saturated. And the reason for that is that in Europe, we had a horrible first wave, followed by very strict lockdowns, which led us into the beautiful European summer where people were able to go to the beach and have a break and pretend life is normal. And that was great. But the price that they paid was pretty high. And so on a Wednesday in late October, I believe it was October 28, both the French President, Emmanuel Macron —

archived recording (emmanuel macron)

[SPEAKING FRENCH]

matina stevis-gridneff

— and the German Chancellor, Angela Merkel —

archived recording (angela merkel)

[SPEAKING GERMAN]

matina stevis-gridneff

— in almost simultaneous addresses to their nations announced new lockdowns. [INTERPOSING VOICES] [NON-ENGLISH SPEECH]

— and —

archived recording

Heading into partial lockdown, the Dutch Prime Minister said too many people hadn’t been sticking to existing rules as he announced a list of new tougher restrictions.

matina stevis-gridneff

More or less, over that last week of October —

archived recording

Ireland has become the latest to toughen up anti-Covid-19 measures, moving the country to the highest level of restrictions similar to the lockdown last March.

matina stevis-gridneff

The majority of the continent was imposing restrictions on its citizens to contain what was clearly an out-of-control second wave.

archived recording

The House of Commons has approved the four-week lockdown in England, which starts at midnight tonight.

michael barbaro

And what are the general features of these lockdowns that occurred, as you said, pretty much at the same time? What do they look like?

matina stevis-gridneff

Generally, across the board, European governments made it quite clear that you should stay at home. In some countries, that’s been actually quite strictly enforced. For example, in Greece, you need to text a number and get a sort of automated permission on six different categories of reasons for which you need to leave your home.

michael barbaro

Oh, wow.

matina stevis-gridneff

So you text your name and number 6, and that means you’re going out for a little walk or to walk your pet. And if you bump into a police officer, they would check if you’ve actually sent that text. So while enforcement has ranged in Europe, largely, people were told, stay at home, don’t do anything unless it’s truly essential. Don’t go you know, popping out for a coffee or a croissant or whatever. But one thing that was different to the first wave is that across the board in the vast majority of European countries, governments really tried to keep schools open. And that’s been a distinctive feature of their response to the second wave. There’s been a real effort to get kids to school or childcare and not have them stay at home.

michael barbaro

So the general approach here in these European countries over the past few weeks is close down most businesses, severely limit people’s movements, but keep schools open, prioritize education above all else?

matina stevis-gridneff

Precisely.

michael barbaro

I’m curious how leaders in these countries are explaining these decisions given how disruptive they are.

matina stevis-gridneff

Leaders have started by really appealing to people and saying —

archived recording (emmanuel macron)

[SPEAKING FRENCH]

matina stevis-gridneff

— I understand your frustration. I know you’re exhausted. President Emmanuel Macron of France, for example, told his people —

archived recording (emmanuel macron)

[SPEAKING FRENCH]

matina stevis-gridneff

— I know this feeling of the day that never ends. So they started by saying we know we’re asking a huge sacrifice off you. And here’s why we ask it. Key messages included how saturated European hospitals were.

archived recording

[SPEAKING FRENCH]

matina stevis-gridneff

Here in Belgium, for example, the government made it very clear that it was so stretched that patients had to be sent to Germany for care.

archived recording

[SPEAKING FRENCH]

matina stevis-gridneff

It was so stretched that in some cities in Belgium nurses were asked to go work if they had Covid and didn’t have symptoms. So that honesty and transparency about how dire the situation was, was really fundamental to that message. Beyond that, has been this appeal to unity, to societal cohesion, that we’re in this together, and we have to pull through together. And in some countries, this message has gone out in pretty creative ways. So for example, the German government, which isn’t famous for its sense of humor, released last week a reel or an ad —

archived recording

[SPEAKING GERMAN]

matina stevis-gridneff

— of this very old man being interviewed and talking about the great battle of his generation.

archived recording

[SPEAKING GERMAN]

matina stevis-gridneff

Only —

archived recording

[SPEAKING GERMAN]

matina stevis-gridneff

— to then go on to say that what was required of us was to stay home and order in and watch TV and not go out. And that was the battle of our generation.

archived recording

[SPEAKING GERMAN]

michael barbaro

I’m also struck by what you seem to be describing as a kind of coordinated message across different countries. Is that right?

matina stevis-gridneff

I think that’s definitely true. We’ve largely seen similar messages, and actually similar policies across the European Union. And I think the reason for that is that there is a shared sense of reality. Of course, there are political and even social disagreements about what the best course of action is. That’s the case everywhere. I don’t want to make it out like there this perfect consensus in Europe. But the proximity of these countries means that they are able to look at each other, learn from each other, and ultimately, the situation in one country over one border will affect what happens to its next door neighbor. And there’s a real sense of joint fates in that.

michael barbaro

Right, so what’s good for one country is no doubt good for its neighboring country or two countries over?

matina stevis-gridneff

Precisely. And conversely, if your country is doing so much worse than your neighbor, you’re going to be asking questions about why that is. You’re going to be looking over that border to your neighbor and holding your government to account and saying, well, hey, here in Belgium, we have really bad outcomes. But over the border in the Netherlands, things seem to be so much better. Why? So the ability to compare and exchange notes has sort of created this positive reinforcement mechanism that the hope is, will help all European countries out of the second wave and hopefully, the last wave of the coronavirus.

michael barbaro

Matina, from what you’re describing, this sounds like a continent that is largely accepting this second wave of lockdowns. Do I have that right? And if so, I wonder why you think that is beyond the kind of collective understanding that you’ve described.

matina stevis-gridneff

I think people are definitely tired. They’re definitely angry in some cases. They feel perhaps that lessons should have been learned by their government from their first wave to avert or avoid the second lockdown. But by and large, despite some dissent and certainly despite some groups that see this as either a conspiracy or an assault on their liberties, I think if you take a few steps back, what I see is quite broad societal acceptance of these measures. Remember also, this is Europe. The governments are in people’s business, and there is an expectation that they should be. So an active role from the state in managing the outbreak is expected. And people don’t find those interventions as alien or unusual. It’s just part of the political and civic culture on the continent. And there is another thing, which is perhaps a little more material. European governments, even those that don’t have a lot of financial means, have shown a fairly humane approach to the citizens that are suffering financially from this crisis by extending support through an array of measures that are costing them billions and billions of euros. So let’s start with Germany, which is the biggest, the richest, and the most generous country in Europe in its response to the financial fallout. You know, suspending tax payments, suspending social security payments, paying businesses to keep their people onboard and just put them on furlough by covering most or all of their salaries, instead of letting them go. But they even paid out checks to freelance artists —

michael barbaro

Wow.

matina stevis-gridneff

— which no other government really has done. So if you were a freelance artist in Berlin — and of course, you know, there were no exhibitions. You were not be able to make a living — you registered with the government and within a week, you got a 5,000 Euro check in the post, which isn’t a lot. But it showed the willingness of the government to support people that frankly, in the past, in other crises have not really been seen by governments, such as freelance artists, for example. And even in smaller and poorer European countries that have much less flexibility in their budgets to be doing this sort of thing, efforts have been made to support people struggling. So for example, my parents live in Greece. And Greece doesn’t have the most fantastic finances, as a lot of people know. But still, my parents got effectively a tax rebate, which was a real game changer for their financial planning for the rest of the year. And on top of that, the European Union is rallying to get together a landmark stimulus package that will be distributed across its 27 members over and above national stimulus packages in the new year. And so financial assistance keeps coming in various forms. Of course, it can’t last forever. And it will certainly strain the finances of these governments in the long run. But I do think that this is a key reason why, even in these very strange times for relations between citizens and governments, the rapport has kept going. And people have continued feeling connected to their governments, because it’s a two-way street. They don’t just feel like their governments are telling them what to do and more importantly, what not to do, or that their governments are just putting in place measures that are taking away their livelihoods. They feel that they’re also getting something back.

michael barbaro

So most important question of all, Matina, is this second lockdown working? Is it starting to flatten the curve?

matina stevis-gridneff

Well, Michael, the first thing I’m going to do is tell you what’s happening in Belgium by looking on my Coronalert app, which —

michael barbaro

Of course.

matina stevis-gridneff

— informs me that this week we’ve had 47 percent fewer cases than last week and 24 percent fewer hospitalizations, which means that here in Belgium, we’re turning the corner. Similarly, other countries that implemented lockdowns around the same time as Belgium are doing better. The Czech Republic, once the worst infection rate in Europe, also shows similar promising signs. Finland, Ireland, similar trends. And there is every reason to believe that bigger countries, such as Germany or France are just behind us. They implemented their lockdowns a little later. They have their own conditions to contend with at home. But their rate of infection is already slowing down. And so the feeling is that the measures are working, which means that they are actually being applied as well.

michael barbaro

Right, which means that people are likely to keep following them, because there’s an immediate reward for abiding by these rules.

matina stevis-gridneff

Precisely, you can see that things are getting better. And remember, there’s always the promise of a semi-normal holiday season at the end of the year. And that’s, I think something that’s keeping people going, a hope that perhaps there can be small celebrations of the holidays, although governments are cautioning and trying to convince everyone to stay put and stay away from elderly relatives. But there is a feeling that if we get this under control by mid-December, then we may, we just may be able to have a holiday season of sorts.

michael barbaro

Well, Matina, stay safe. And thank you for your time.

matina stevis-gridneff

Thanks so much, Michael.

michael barbaro

We’ll be right back.

So, Mitch, you’re a national correspondent at The Times based in the Midwest, the region that is now being hit the hardest in the US by the virus. We just spoke to our colleague, Matina, about how Europe is responding to its second wave. And it’s a story of coordination and communication. So let’s talk about how that compares with what the governments in the Midwest are doing right now.

mitch smith

Yeah, well, it looks very, very different here. But you are right. The Midwest is in really rough dire shape. And it has been for some time. Case numbers just continue to explode. 13 of the 14 metro areas in the country with the highest rates of recent cases are in the Midwest. Six of the seven states in the country with the highest rates of recent cases, in the Midwest. It’s rising pretty much everywhere in the region. You have governors talking about hospital capacity concerns and really approaching — using language that we just haven’t seen before.

archived recording

The nation has been swept by a Covid storm that has taken Illinois’ positivity rate from low single digits to the mid-teens. And with nearly no mitigations in the states bordering us and no national strategy to reduce the spread, we’re in for a very difficult next few months.

mitch smith

But — but even still, the restrictions are generally much looser than what you’re seeing overseas. And they vary a lot from state to state, from county to county. It just looks a lot different.

michael barbaro

So tell me about these restrictions.

mitch smith

Sure, let me start with the least amount of restrictions. And that would be South Dakota. That’s a state where there is no mask mandate. There is no stay-at-home order. There has not been. And even though cases are extremely high there, as they are in much of the region, there does not seem to be any movement toward that.

archived recording (kristi noem)

And I want to remind you all of this. Because while we were working together and we were preparing as a state, many other states were taking a very different approach. Some ordered their citizens to shelter in place, ordered their businesses to lockdown, and ordered their churches to close.

mitch smith

Governor Kristi Noem, she’s a Republican, and she’s been really outspoken for months now about letting people make their own choices.

archived recording (kristi noem)

And day after day, night after night, they insisted that every single decision I was making was wrong, that I was foolish to trust my people. And I was even sillier to respect the oaths that I took. They told me I should shut my state down.

mitch smith

And she’s acted accordingly and has not imposed the sorts of things we’ve seen some of her peers go for. She’s even had —

archived recording (kristi noem)

South Dakota, the land of the free.

mitch smith

—commercials on Fox News encouraging people to visit her state at some point.

archived recording (kristi noem)

We’re a place to safely explore.

michael barbaro

Ha, during this pandemic?

mitch smith

That’s when the commercials aired, yep.

archived recording (kristi noem)

We’re open for opportunity and always will be. I’m Governor Kristi Noem. Celebrate what makes America great.

michael barbaro

Are there any restrictions in South Dakota of any kind as the second wave moves in?

mitch smith

Statewide, not really. Sioux Falls, the largest city in the state, last week, considered a mask mandate and that failed. Sioux Falls has the eighth most cases per capita in recent weeks of any metro area in the country.

michael barbaro

So, Mitch, if we’re going from least restrictive to more restrictive, what state is next?

mitch smith

So next, I’d go to Ohio, which is a state where the Republican Governor, Mike DeWine, has been outspoken for many months about just how severe this is. That’s a state that’s had a mask mandate now, that’s had some restrictions in place on businesses, that’s been trying to kind of thread that needle. They’ve pointed to small gatherings as the real center of transmission in that state.

archived recording (mike dewine)

We’ll be issuing a new order in the next few days that will place significant new restrictions on these social activities.

mitch smith

And so for instance, they issued new guidance about wedding receptions. And so guests must be seated all the time—

archived recording (mike dewine)

The order also requires everyone to be seated, everyone to wear a mask, unless they are actively consuming food or drinks.

mitch smith

But you can still have a first dance. So not everybody can dance, but you can still have the first dance. You can toss the bouquet, that’s fine. You can cut the cake, but no buffets. And so trying to find some balance and to — and to not completely closed down, while regulating dancing at wedding receptions. That’s kind of where you are in a place like Ohio.

michael barbaro

But this is news to me. You can still hold an indoor wedding in the state of Ohio?

mitch smith

That is correct.

michael barbaro

OK, so what is the most restrictive Midwestern State at this point in the second wave?

mitch smith

Sure, well, Michigan would be the state that has gone the furthest this time. It’s a state with a Democratic Governor, Gretchen Whitmer, a Republican-controlled state legislature, and if you’ve paid attention at all to the election this year, a very divided citizenry. This is a place where there’s wide differences and schools of thought on how to approach this. And over the weekend, Governor Whitmer came out and told high schools and colleges that they would have to close.

archived recording (gretchen whitmer)

We are at the precipice, and we need to take some action. Because as the weather gets colder and people spend more time indoors, this virus will spread. More people will get sick, and there will be more fatalities.

mitch smith

She said that bars and restaurants can’t be open for indoor dining anymore. Casinos, movie theaters, group exercise classes, all shutting down. It’s not a lockdown, but it’s as close as anywhere in the Midwest has come since spring.

archived recording (gretchen whitmer)

Our response is strongest if we are unified and all in this together.

mitch smith

On the right you have serious criticism of the governor for closing down businesses, for closing down schools. You had the state Republican chairman saying she’s showing contempt for the people’s elected representatives by not going through the Republican-controlled legislature to implement these rules. You have at least one state lawmaker saying she should be impeached.

michael barbaro

Wow.

mitch smith

I mean, that’s how divergent the views are on these issues.

michael barbaro

And, Mitch, we know that there has been an economic health versus public health debate that has defined this divide in the country pretty much since the beginning of the pandemic. But what’s the story of the resistance in the Midwest to these measures right now, given the profound levels of infection there?

mitch smith

Well, I think it’s a real mix of things. And these are states that are not monolithic. But I think some of it’s rooted in that some states that went much further in the spring didn’t ever have that many cases. And so perhaps that’s a sign that things worked. I think in some corners, that’s seen as a sign that they lost their livelihood or lost their business when maybe they didn’t need to. I think you also have, in some parts of the region, genuine skepticism of government, a libertarian streak, an independent tradition in many of these states and not necessarily a lot of trust in the government to look out for people like them, to see it through so that when this is over, they come out OK on the other side. Finally, you’ve got to look too, to see how the federal messaging has been frankly, inconsistent with what some of these governors are saying. You have a president who many people in this region admire, voted for, trust, who has had really mixed messages on how to handle this. And I think you continue to see that playing out. And just on Sunday, for instance, when Governor Whitmer comes out with new restrictions and almost immediately, Dr. Scott Atlas, the president’s coronavirus advisor, goes on Twitter to criticize her. He says the only way this stops is if people rise up. You get what you accept. So there’s the tension, a real dissonance at time between different leaders’ messages, between state and federal. And if you’re a person in Michigan, you’re being told one thing by your state leader and another thing from the White House.

michael barbaro

Right. So if we go back to Europe for a moment, Mitch — and I know that you are quite far away from Europe — what Matina told us was the reason why things seem to be working in Europe, why there’s so much buy in, is because there is a history of the government playing this role in people’s lives — that is not what you are describing in the Midwest — there is a uniform message from government leaders at multiple levels — again, we totally lack that here, as you just explained — and finally, there is substantial federal financial assistance, which of course, we haven’t had in the US, because there hasn’t been a major federal stimulus package for months now.

mitch smith

That’s right. That’s important context to understanding how this is being received. There’s a lot of genuine understandable fear about what the future holds if we have to hunker down again.

michael barbaro

Mitch, is there a version where this patchwork approach can somehow work, that it can flatten the curve?

mitch smith

Well, I think we sure hope so. I think that you’re also seeing some signs that people are taking this more seriously. I talked to the mayor of Sioux City, Iowa not long ago, a place that has among the most cases total per capita in the country over the whole pandemic. He was at an event. He said almost everyone was wearing a mask. And even a few weeks before, that wouldn’t have been the case. And he pointed to the governor of Iowa coming out and saying, you have to wear masks if you’re going to an event. And so I think that one thing that matters here is that some of these leaders that have held off a long time in imposing restrictions that have frustrated, particularly some liberals about how they’ve approached this is that when people in those states see them going on TV with deep concern in their voice saying, listen, the hospitals are filling up and we’ve got to do something, I think there’s a real hope that people, even if it’s not spelled out to the letter in some executive order, take action and try to help themselves and help their community. Because I think this is a region where people care a lot about other people. This is a region where people care a lot about their towns, about their neighbors. And so I think as you see this escalate, as you see the concern grow in the faces and the voices of the people they elect — that the sincere hope is that it starts to have an impact. And at the very least, that we can preserve hospital capacity and that people who do get sick can get the best treatment available and have a fighting shot.

michael barbaro

It sounds like what you’re saying is that the scenario here that leads to the curve being flattened might be that things get so bad that people in the Midwest listen to their government officials, not because they’re required to, but because at a certain point, it’ll just seem like there’s no other choice.

mitch smith

I fear that may be true. You continue to see case numbers rise across the Midwest. I look every day, looking for some glimmer that a state’s peaking, a state’s leveling off, that there’s — that there’s progress coming. But so far, it just looks really bleak. And it’s really tragic.

michael barbaro

Well, Mitch, thank you very much. We appreciate it.

mitch smith

Thanks, Michael.

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michael barbaro

We’ll be right back.

Here’s what else you need to know today. A week after a similar announcement from Pfizer, the drugmaker, Moderna, said that its coronavirus vaccine was 94.5 percent effective in a large clinical trial. Both Moderna and Pfizer plan to quickly apply for emergency authorization from the US government to begin vaccinating the public. But a vaccine that is widely available is still likely months away. And The Times reports that President Trump is expected to order the withdrawal of thousands of American troops from Afghanistan, Iraq, and Somalia by the time he leaves office, using his final weeks to pull back as many troops as possible across the world. But the plan is running into resistance from Trump’s own national security advisors, who are warning him that a rapid drawdown could have catastrophic consequences within each of those countries.

That’s it for The Daily. I’m Michael Barbaro. See you tomorrow.

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.

Credit…Mike Blake/Reuters

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, New Mexico 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 bar, 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.”

Credit…Anna Watts for The New York Times

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.

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‘Just a Matter of Time,’ de Blasio Says of Limiting Indoor Activity

Mayor Bill de Blasio of New York warned of further restrictions on indoor activity as the city approaches the Orange Zone.

I want to say at the outset to all the families, to all the parents, to all the kids, that it’s a tough day. It was a tough decision yesterday. It was not something anyone could possibly be happy about. And I do want to say how much I feel and understand the frustration of parents that they want — so many of them want their kids to be in school. And that’s what I fought for in opening our schools back in September against all odds. We will bring our schools back. This is the most important point, we will bring our schools back, but we’re going have to reset the equation. Just a matter of time before indoor dining will close and other types of things — gyms, other things. Anyone who heard those words Orange Zone yesterday, the Orange Zone rules are clear, and New York City will before long be in that Orange Zone status. So for everyone who honestly might feel somehow a little better if they knew that indoor dining was going to be closed or gyms were going to be closed, I’m sorry to tell you that for the sake of those business owners and everyone who loves those gyms and loves indoor dining, it’s just a matter of time.

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Mayor Bill de Blasio of New York warned of further restrictions on indoor activity as the city approaches the Orange Zone.

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.

Credit…Juan Mabromata/Agence France-Presse — Getty Images

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.

Credit…Taylor Glascock for The New York Times

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.”

Credit…Jim Lo Scalzo/EPA, via Shutterstock

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.

Credit…Ray Thompson/Associated Press

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.

Credit…Mads Claus Rasmussen/Ritzau Scanpix, via Associated Press

The slaughter of minks in Denmark to prevent the spread of a potentially dangerous new strain of the coronavirus has prompted a political crisis in the country, with the minister of agriculture forced to step down and the government in danger of collapse.

The cull has led to a political crisis in Denmark, with right-wing parties accusing the government of using the pandemic to try to end mink farming in the country. Denmark is home to some of the world’s largest mink farms, with an estimated population of more than 15 million.

The opposition is calling for Prime Minister Mette Frederiksen to resign after a hurried decision to cull the animals after a mutated strain of the virus was found to have made the leap from the animals to humans.

The Danish health authorities were alarmed because one set of mutations — which had infected at least 12 people — could make a potential coronavirus vaccine less effective.

The mutation affected the spike protein in the virus — something targeted by many potential vaccines. Lab studies, while not conclusive, suggested that cells with this variant of the virus did not act as strongly to antibodies as other coronavirus variants.

Mink — which are part of the weasel family — are prized for their fur and are kept in crowded conditions ideal for the spread of the virus. Unlike other animals, including cats and dogs, mink can become quite sick and die. Outbreaks in mink populations have been infected in other countries as well, including the United States and the Netherlands.

“The mink farms are a reservoir where the coronavirus is thriving,” Dr. Hans Kluge, the World Health Organization’s regional director for Europe, said on Thursday.

The mutation found in Denmark has not been found in any other mink population in Europe and the 12 human cases reported to the W.H.O. in September remain the only reported cases, officials said. Still, biosecurity around mink farms needed to be stepped up, officials said.

Dr. Kluge also praised Denmark for its work in both tracing the genomic sequencing of the virus in about 14 percent of the Covid-19 patients in the country and making that information public.

Last week, minks on at least two farms in northern Greece were found to have the coronavirus, and the W.H.O. said it was working with local health authorities to assess the situation.

When Ms. Frederiksen ordered the killing of all the animals in Denmark two weeks ago, the military had to step in to assist the country’s approximately 1,100 mink farmers in the slaughter.

Mogens Jensen, the minister of agriculture, condemned the rapid action taken by the government, saying it had no legal basis to kill the animals and destroy the industry.

On Thursday, a Danish newspaper, B.T., reported that Mr. Jensen and five other ministers had warned in September that culling beyond the infected areas was illegal.

The slaughter was halted midway through the effort and the focus shifted to culling minks only in the vicinity of the outbreak tied to the mutated strain of the virus.

But Mr. Jensen had already lost the support of the government and was forced to step down.

The culling of the minks has been met by a broad public backlash, with a study by Aarhus University finding support for the government falling by 20 percent.

Danish authorities said on Wednesday that minks on all farms known to have been infected had been culled.

But they added that another 25 farms are still under suspicion of being infected.

Credit…Fabio Bucciarelli for The New York Times

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.”

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“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.

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Africa Surpasses 2 Million Confirmed Coronavirus Cases

Dr. Matshidiso Moeti, the World Health Organization’s regional director for Africa, said gatherings were fueling a ‘concerning uptick’ in cases in some African countries.

Greater mobility and large gatherings, and even small gatherings at the family level, can lead to new clusters of cases in parts of Africa that might previously have been spared. This comes as African countries are experiencing a concerning uptick in cases that are now more than two million Covid-19 cases in Africa. And sadly, for 48,000 people have lost their lives. In the 47 countries of the W.H.O. African region, mainly sub-Saharan Africa plus Algeria, there are more than 1.4 million reported cases and 31,800 deaths. In the past 28 days, cases have increased compared to the previous month in 19 countries in the region, including countries like Kenya, Algeria, Ghana and Angola. In most of the affected African countries, the rise in new cases is coming from workplaces and family gatherings, and of course, we know that there are several political elections coming up in a number of countries — campaigns going on and gatherings as far as that is concerned. We do know that outbreaks spread socially, and we can stop them with safe social interactions. So I’d like to ask everyone to be mindful of your individual risks, and the risks of your loved ones and friends and neighbors. So we are encouraging meet outdoors where possible, avoid mass gatherings, absolutely, continue physical distancing, and practicing frequent hand hygiene and wearing a mask, particularly around older people and those people who have diabetes, hypertension — those comorbidities that make them vulnerable to severe forms of the illness and even risk their lives.

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Dr. Matshidiso Moeti, the World Health Organization’s regional director for Africa, said gatherings were fueling a ‘concerning uptick’ in cases in some African countries.CreditCredit…Brian Inganga/Associated Press

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.”

Credit…Joel Angel Juarez for The New York Times

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.

Credit…Brenna Norman/Reuters

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.”

Credit…Lam Yik Fei for The New York Times

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.

Credit…Adria Malcolm for The New York Times

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.”

Listen to ‘The Daily’: The Pandemic Economy in 7 Numbers

As several areas in the U.S. start to reimpose coronavirus restrictions, we look at some landmark figures that illuminate the depth of the recession and the prospects for recovery.

Credit…Niall Carson/PA, via Associated Press

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.”

Credit…Francois Lenoir/Reuters

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.

Sorgente articolo:
Covid-19 Live Updates: A Bright-Red Map and a Dire Warning as the Coronavirus Task Meets at the White House – The New York Times

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