U.S. CORONAVIRUS DEATHS TOP 1000 WITH OVER 81000 SICK. UPDATES

U.S. Now Leads the World in Confirmed Cases

Unemployment data set a bleak record and hospitals struggled with an influx of sick patients and lack of equipment. But the White House coronavirus response coordinator dismissed talk of shortages. 

Scientists warned that the United States someday would become the country hardest hit by the coronavirus pandemic. That moment arrived on Thursday.

In the United States, at least 81,321 people are known to have been infected with the coronavirus, including more than 1,000 deaths — more cases than China, Italy or any other country has seen, according to data gathered by The New York Times.

With 330 million residents, the United States is the world’s third most populous nation, meaning it provides a vast pool of people who can potentially get Covid-19, the disease caused by the virus.

And it is a sprawling, cacophonous democracy, where states set their own policies and President Trump has sent mixed messages about the scale of the danger and how to fight it, ensuring there was no coherent, unified response to a grave public health threat.

A series of missteps and lost opportunities dogged the nation’s response.

Among them: a failure to take the pandemic seriously even as it engulfed China, a deeply flawed effort to provide broad testing for the virus that left the country blind to the extent of the crisis, and a dire shortage of masks and protective gear to protect doctors and nurses on the front lines, as well as ventilators to keep the critically ill alive.



WASHINGTON POST

As the highly contagious virus has created clusters of illness, from Seattle to New York City, death has followed in turn. On Wednesday night, the country’s largest city reported 88 new deaths from covid-19, the disease caused by the virus. As of Thursday afternoon, Americans had died in 42 states and territories and the District, with punishing increases in Louisiana and Michigan. Experts fear the worst is still to come, pointing to a rapid acceleration of cases in communities across the country.

The Washington Post is tracking every known U.S. death, analyzing data from health agencies and gathering details from family and friends of the victims. In the first 1,000 fatalities, some patterns have begun to emerge in the outbreak’s epidemiology and its painful human impact. About 65 percent of the dead whose ages are known were older than 70, and nearly 40 percent were over 80, demonstrating that risk rises along with age. About 5 percent whose ages are known were in their 40s or younger, but many more in that age group have been sick enough to be hospitalized. Of those victims whose gender is known, nearly 60 percent were men.

What remains murky is exactly who is dying in America during the pandemic, even as scientists and public health experts race to uncover information that can help save lives.

Overwhelmed state and local authorities have been issuing widely varying reports on those who died, citing medical privacy laws to shield even basic details about age, gender and underlying conditions, the three signal categories that epidemiologists say are key indicators of risk.

The Centers for Disease Control and Prevention, which offers a well-regarded and oft-cited public weekly tracker for the annual influenza season, offers no similar real-time surveillance for the novel coronavirus. The analysis the agency does provide relies on spotty reporting by the states struggling to serve a surge of sick people.

The inconsistency in reporting is particularly stark in New York. State health officials there have been taciturn about death statistics, usually leaving it to Gov. Andrew M. Cuomo (D) to announce the running toll at his daily briefings. In New York City, the health department has started releasing reports every day summarizing deaths by age group, gender, borough and preexisting medical problem.

Coronavirus Disease 2019 (COVID-19)
Daily Data Summary
The data in this report reflect events and activities as of March 26, 2020 at 5:00 PM.
All data in this report are preliminary and subject to change as cases continue to be investigated.
These data include cases in NYC residents and foreign residents treated in NYC facilities.

NYC COVID-19 Deaths
. .
Age Group
- 0 to 17 0 (0%)
- 18 to 44 16 (4%)
- 45 to 64 77 (21%)
- 65 to 74 91 (25%)
- 75 and over 181 (50%)

Sex
- Female 149 (41%)
- Male 216 (59%)

Borough
- Bronx 80 (22%)
- Brooklyn 81 (22%)
- Manhattan 55 (15%)
- Queens 123 (34%)
- Staten Island 26 (7%)

Underlying Illness1
- Yes 295 (97%)
- No 10 (3%)
- Pending Investigation 60
Total 365

1Underlying illnesses include Diabetes, Lung Disease, Cancer, Immunodeficiency, Heart Disease, Hypertension, Asthma, Kidney
Disease, and GI/Liver Disea

Within them are numbers that raise red flags: data that shows that at least 96 percent of those who died as of Thursday had underlying conditions and that 77 New Yorkers who died were under 64.

Still more deaths are not being counted at all, such as those who were misdiagnosed with the flu or another illness and those who died but were never tested, highlighting another key gap in mortality information.

state health departments — including, critically, New York’s — are short-staffed and so deluged by the pandemic that they have not been filling out the forms with the basic information the CDC requires to perform an analysis, CDC officials say.

The New York State Department of Health even recently solicited volunteer help from local public-health graduate students, according to an email shared with The Post.

The first known deaths from the novel coronavirus were an ­86-year-old woman and a 54-year-old man in King County on Feb. 26.

Two weeks later, the toll had reached 50. Four days after that, it topped 100. Then, 48 hours later, it had doubled.

Since March 21, the toll has increased by between 90 and 193 deaths per day, and on Wednesday, agencies reported nearly 250 fatalities, the most so far in the United States in a single day.

“We are at the beginning of the wave in most places in the United States,” said Nahid Bhadelia, an infectious-diseases physician and medical director of the special pathogens unit at Boston University School of Medicine. “The worst is probably yet to come.”

The United States now has the sixth-highest death toll in the world, behind Italy, Spain, China, Iran and France. In Italy, where more than a third of the world’s virus-related deaths have occurred, 21 days passed from the first death to the 1,000th, recorded on March 13. From there, Italy’s toll has climbed faster. Last weekend, it recorded 793 fatalities in a single day, the deadliest day of the outbreak anywhere.

Leaders and health experts in the United States have pointed to Italy as an example of what could happen as the American health-care system becomes overwhelmed and under-resourced.

Most victims had underlying medical conditions, hindering their immune systems’ responses to covid-19’s assault on their cells. In New York City, which had reported 280 deaths as of Wednesday evening, more than anywhere else in the country, 96 percent of people had a preexisting illness, such as asthma, diabetes, lung disease or cancer.

Yet the virus can also strike down those who were otherwise healthy.

Epidemiologists caution against becoming alarmed by the deaths of older people with no known underlying conditions, or by the story of a 35-year-old, seemingly in the prime of life, who succumbs to the disease.

“But the comparable data that you should have is: What about all the 35-year-olds who didn’t die?” Branas said. “Without that, these cases are merely anecdotal.”

The Post’s data on the first 1,000 fatalities reveals trends that have emerged in studies from other countries that have been battling the outbreak far longer. There’s a silver lining to this, Bhadelia said: If the disease were exacting a worse toll in the United States than in countries already ravaged — if it also killed young people at a high rate — that would have been borne out in these numbers. So far, that has not been the case.

Dense urban centers, many of them in coastal states, have been hit hardest in the first two months of the outbreak, but it’s only a matter of time before the coronavirus takes hold in rural areas, too. In some places, such as Albany, Ga., where at least 16 had died as of Thursday, it’s already happening. When it arrives elsewhere, it could have a crippling effect, especially in places where resources and health-care workers are already in short supply.

“It might take longer for covid-19 to make it into the rural communities, and they might not get as many cases there,” Bhadelia said, “but the worrisome thing is, it might not take as many cases to overwhelm the health-care system in these areas.”

Or, as Cuomo put it earlier this week, warning that his state is the canary in the coal mine: “We are your future.”

As hospitalizations rise sharply in New York, doctors scramble.

The outbreak continued to gather pace in New York, where the number of hospitalized patients jumped by 40 percent in one day, Mr. Cuomo said Thursday.

The sharp jump in hospitalizations — to 5,327 patients, of whom 1,290 were in intensive care — called into question optimistic projections that Mr. Cuomo shared the day before, which had suggested that social distancing rules were slowing the rate of hospitalizations.


On Long Island, Peconic Landing, an upscale retirement community on the North Fork, announced six deaths from the virus, sparking fears of an even bigger outbreak among a vulnerable, confined population.

NY TIMES

A N.Y. Nurse Dies. Angry Co-Workers Blame a Lack of Protective Gear.

Kious Kelly, a nurse manager at a Manhattan hospital, texted his sister on March 18 with some devastating news: He had tested positive for the coronavirus and was on a ventilator in the intensive care unit. He told her he could text but not talk.

That was his last message. Ms. Sherron’s subsequent texts to him went unanswered. In less than a week, he was dead.

Mr. Kelly, a 48-year-old assistant nurse manager at Mount Sinai West, may have been the first New York City nurse to die from the virus.

His sister said he had asthma but was otherwise well.

“His death could have been prevented,” Ms. Sherron said on Facebook Wednesday. Later, she added: “I’m angry. He was healthy.”

Colleagues at the hospital were angry, too. Some complained on social media channels that they did not have an adequate supply of protective clothing or masks.

A nurse who worked with Mr. Kelly said the hospital had offered nurses one plastic protective gown for an entire shift, though normal protocol required a change of gowns between interactions with infected patients.

Bevon Bloise, a registered nurse at Mount Sinai West, complained on Facebook that the hospital does not have sufficient personal protective equipment, or P.P.E. “I’m also very angry with the Mount Sinai Health System for not protecting him. We do not have enough PPE, we do not have the correct PPE, and we do not have the appropriate staffing to handle this pandemic. And I do not appreciate representatives of this health system saying otherwise on the news.”


Mr. Kelly’s death was first reported in The New York Post.The Post article included a photo of hospital staff wearing garbage bags over what appeared to be scrubs. Two nurses, who spoke on condition of anonymity for fear of being fired, said they were disposable scrubs made of permeable material, which is why nurses wrapped plastic garbage bags around them.



The photo, they said, was taken on March 17, at a time when there were many coronavirus patients at the hospital and others who had yet to be tested but who presented symptoms of infection.
Another nurse described “issues with supplies for about a year now,” during which it got “to the point where we had to hide our own supplies and go to other units looking for stuff because even the supply room would have nothing most of the time.” The nurse also said various items, including masks, wipes and Purell hand sanitizer, began “disappearing through the night.”

“But when we started getting COVID patients, it became critical,” the nurse said.

The nurse sources said they were using the same PPE between infected and non-infected patients and, because there were no more spare gowns in the hospital, they took to wearing trash bags to stop the spread of infection.


In the emailed statement, Ms. Lee added that “the troubling photo circulating in the media specifically shows the nurses in proper P.P.E. underneath garbage bags.”

She did not respond to a question asking why hospital staff wore garbage bags.
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Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the timeline for the development of a coronavirus vaccine was proceeding faster than usual, but would still take at least a year. He said small Phase 1 trials have already begun, and that he hoped larger Phase 2 or Phase 3 trials could begin by the middle of the summer.
Dr. Fauci stressed the importance of making sure a vaccine is safe and that it did not actually “enhance the infection.”

Coronavirus Updates:

Fauci sees signs of the virus becoming cyclical, like the flu.


Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Wednesday that he was seeing indications that the virus could keep returning as a “seasonal, cyclic thing,” like the flu.

One of the key questions about the virus has been whether its spread would slow or stop in warm weather and return in cold weather, and Dr. Fauci suggested that it may follow that seasonal pattern.

“What we are starting to see now in the southern hemisphere,” he said, referring specifically to southern Africa, “is that we are having cases that are appearing as they go into their winter season. And if, in fact, they have a substantial outbreak, it will be inevitable that we need to be prepared that we will get a cycle around the second time.”

That makes it all the more important that scientists “have a vaccine available for that next cycle,” as well as “a menu of drugs that we have shown to be effective and shown to be safe,” he said.



Cuomo said there were signs that density- control measures were working.

Though the number of confirmed coronavirus cases continues to grow quickly and has now topped 30,000, Gov. Andrew M. Cuomo on Wednesday said that there were early signs that stringent restrictions on social gatherings and other measures could be slowing the virus’s spread.

Mr. Cuomo highlighted data that showed slowing hospitalization rates. On Sunday, the state’s projections showed hospitalizations doubling every two days, while Tuesday’s estimates showed them doubling every 4.7 days.

New York State has 30,811 confirmed cases, up more than 5,000 since Tuesday morning. That is more than 7 percent of the 431,000 cases worldwide tallied by The New York Times. There have been 285 deaths in the state.

Officials reported late Wednesday that New York City had added 3,223 new confirmed cases since the morning, bringing the city’s total to 20,011. The death tally stood at 280, up from 199 in the morning.

State officials project they will need 30,000 ventilators, of which they currently have 4,000. But the state is making headway: Mr. Cuomo said 7,000 more ventilators have been procured, in addition to 4,000 ventilators sent by the federal government.

The governor said about 40,000 health care professionals, including retirees, have volunteered to work when hospitals become strained. Almost half are nurses.

More than 3,800 people are currently hospitalized, or 12 percent of all confirmed cases. Of those, 888 people are currently in intensive care.




Virus rules let construction workers keep building luxury towers.
While life in New York City and the surrounding area has come to a screeching halt, the construction industry, one of the region’s main economic engines and biggest employers, is humming along as if nothing has changed.

Laborers work side by side, cramming 20-people deep into service elevators and sharing the same portable restroom.

While Mr. Cuomo has told New Yorkers to stay indoors in a furious effort to stem the spread of the coronavirus, construction workers have been deemed essential employees, meaning they have to continue working even as most of the work force stays home.

Across the country, governors and mayors have urged roughly half of the United States — at least 179 million people — to stay home. The only people who should go outside, they say, are emergency responders and those considered essential, a wide-ranging term with different meanings in each state.

In New York, New Jersey, Connecticut and most of the country, construction workers have fallen into the essential category. In New York City, which had nearly 158,000 construction jobs in 2018, laborers are hauling hard hats and tools on nearly empty subways and trains every morning on the way to job sites.


“I’m essential to the pocketbooks of rich contractors and essential for spreading the virus, but that’s about it,” said Kirk Gibbs, 57, an electrician at a new parking garage in Syracuse, N.Y. “It’s not essential for us to be here right now.”

$2 Trillion Stimulus Package Passed by Senate

The measure promises a $1,200 payout to millions of Americans and increased jobless aid. It also creates a government bailout fund for distressed businesses.


The Senate voted unanimously on Wednesday to approve a sweeping, $2 trillion fiscal measure to shore up the United States economy as it weathers the devastation of the coronavirus pandemic, advancing the largest fiscal stimulus package in modern American history.

The House was expected to quickly take up the bill on Friday and pass it, sending it to President Trump for his signature.

The legislation would send direct payments of $1,200 to Americans earning up to $75,000 — which would gradually phase out for higher earners and end for those with incomes more than $99,000 — and an additional $500 per child. It would substantially expand jobless aid, providing an additional 13 weeks and a four-month enhancement of benefits, extending them for the first time to freelancers and gig workers and adding $600 per week on top of the usual payment.



The measure would also provide $350 billion in federally guaranteed loans to small businesses and establish a $500 billion government lending program for distressed companies reeling from the impact of the crisis, allowing the administration to take equity stakes in airlines that received aid to help compensate taxpayers. It would also send $100 billion to hospitals on the front lines of the pandemic.

The bill was the product of intense bipartisan negotiations among Republicans, Democrats and the White House. Three senators were absent from the late-night roll call because of the novel coronavirus. Senator Rand Paul, Republican of Kentucky, has contracted Covid-19, while two Utah Republicans, Senators Mitt Romney and Mike Lee, were in self-isolation out of an abundance of caution after spending time with Mr. Paul. Senator John Thune of South Dakota, the second-ranking Republican, also missed the vote because he wasn’t feeling well and had left Washington to return home out of an abundance of caution, a spokesman said.




What the stimulus means to you.
The $2 trillion stimulus package passed by the Senate is not final — it still needs approval from the House and President Trump’s signature. But if it passes, here’s what it will offer ordinary Americans.

How much money will I get?

Americans earning up to $75,000 will receive $1,200, plus an additional $500 per child. The amount received will gradually phase out for Americans making more than $75,000, with support ending at $99,000. Joint filers making less than $150,000 will receive $2,400.

When will I get the money?

Steven Mnuchin, the Treasury secretary, predicted on Wednesday that the money would arrive for most Americans within three weeks.

How will it help the unemployed?

The legislation adds 13 weeks of unemployment payments to the usual duration, which in most states is 26 weeks, and adds an extra weekly $600 on top of the usual payments for four months. It also extends benefits for the first time to freelancers and gig workers.

Will it save my job?


That’s unclear, but it will provide $350 billion in federally guaranteed loans to small businesses and establish a $500 billion government lending program for distressed companies.



The deal is the product of a marathon set of negotiations among Senate Republicans, Democrats and Mr. Trump’s team that nearly fell apart as Democrats insisted on stronger worker protections, more funds for hospitals and state governments, and tougher oversight over new loan programs intended to bail out distressed businesses.

The agreement came together after a furious final round of haggling between administration officials led by Steven Mnuchin, the Treasury secretary, and Mr. Schumer after Democrats twice blocked action on the measure as they insisted on concessions

The perils of the pandemic, which by Wednesday had spread within the marble halls of the Capitol to infect lawmakers themselves, prompted Republicans to put aside their usual antipathy for big government and spearhead an effort to send cash to American families, while agreeing to astonishingly large additions to the social safety net. Democrats, for their part, dropped their routine opposition to showering tax cuts and other benefits on big corporations — all in the interest of getting a deal.



Though the bill is more than double the size of the roughly $800 billion stimulus package that Congress passed in 2009 to ease the Great Recession, analysts and economists warned it may provide only a few months of financial relief given the unknown breadth of the pandemic’s reach. 

Speaker Nancy Pelosi of California endorsed the deal, and planned to push it through the House on Friday by voice vote — meaning that no roll call would be taken — given that the chamber is in recess and its members are scattered across the country, some in places that have imposed travel restrictions and quarantines.

Democrats won a provision to block Trump family businesses — or those of other senior government officials — from receiving loan money under the programs, though the president’s real estate empire could still benefit from other parts of the bill.

Senators also directly targeted those on the front lines of responding to the pandemic, allocating $100 billion to hospitals, more than $1 billion for virus-related research, and $150 billion for state and local governments to help them weather drop-offs in tax revenue and the costs of fighting the pandemic.

Buried in thousands of pages of dense legal text were less visible steps to mitigate the pandemic’s effects on Americans lives and retool large sections of the government to function remotely for the first time.

The bill, for example, would funnel $3.5 billion to states to prop up child care facilities and allows universities to keep paying students in federal work-study jobs even if their academic terms have been cut short.

It would allocate $100 million for additional rural broadband and $150 million for arts and humanities grants to bring cultural programming to Americans stuck at home. It would increase funding for domestic violence shelters and hotlines and set aside $425 million to deal with mental health and substance abuse disorders related to the pandemic. $400 million would become available to protect and expand voting for the 2020 election cycle.

Under other provisions, Americans affected by the virus will soon be able to temporarily withdraw up to $100,000 penalty free from their retirement accounts to use for virus-related expenses. And menstrual products will become eligible for reimbursement under flexible spending accounts.

13 Deaths in a Day: An ‘Apocalyptic’ Coronavirus Surge at an N.Y.C. Hospital

Hospitals in the city are facing the kind of harrowing increases in cases that overwhelmed health care systems in China and Italy.


NY TIMES

By Michael Rothfeld, Somini Sengupta, Joseph Goldstein and Brian M. Rosenthal
March 25, 2020

In several hours on Tuesday, Dr. Ashley Bray performed chest compressions at Elmhurst Hospital Center on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus and had gone into cardiac arrest. All eventually died.

Elmhurst, a 545-bed public hospital in Queens, has begun transferring patients not suffering from coronavirus to other hospitals as it moves toward becoming dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, 27, a general medicine resident at the hospital.

Across the city, which has become the epicenter of the coronavirus outbreak in the United States, hospitals are beginning to confront the kind of harrowing surge in cases that has overwhelmed health care systems in China, Italy and other countries. On Wednesday evening, New York City reported 20,011 confirmed cases and 280 deaths.

More than 3,922 coronavirus patients have been hospitalized in the city. Gov. Andrew M. Cuomo on Wednesday offered a glimmer of hope that social-distancing measures were starting to slow the growth in hospitalizations statewide. This week, the state’s hospitalization estimations were down markedly, from a doubling of cases every two days to every four days.

It is “almost too good to be true,” Mr. Cuomo said.

Still, hospitals are under siege. New York City’s hospitals run the gamut from prestigious teaching institutions catering to the elite to public hospitals providing care for some of the poorest communities in the nation. Regardless of whom they serve, few have been spared the impact of the pandemic: A flood of sick and fearful New Yorkers has besieged emergency rooms across the city.

Working with state and federal officials, hospitals have repeatedly expanded the portions of their buildings equipped to handle patients who had stayed home until worsening fevers and difficulty breathing forced them into emergency rooms. Elmhurst, among the hardest-hit hospitals in the city, is a prime example of the hardships medical centers and their staffs are facing across the country.

“Elmhurst is at the center of this crisis, and it’s the number one priority of our public hospital system right now,” the city’s public hospital system’s statement said. “The front line staff are going above and beyond in this crisis, and we continue surging supplies and personnel to this critical facility to keep pace with the crisis.”

Dr. Mitchell Katz, the head of the Health and Hospitals Corporation, which operates New York City’s public hospitals, said plans were underway to transform many areas of the Elmhurst hospital into intensive care units for extremely sick patients.

But New York’s hospitals may be about to lose their leeway for creativity in finding spaces.

All of the more than 1,800 intensive care beds in the city are expected to be full by Friday, according to a Federal Emergency Management Agency briefing obtained by The New York Times. Patients could stay for weeks, limiting space for newly sickened people.



Mr. Cuomo said on Wednesday that he had not seen the briefing. He said he hoped that officials could quickly add units by dipping into a growing supply of ventilators, the machines that some coronavirus patients need to breathe.

The federal government is sending a 1,000-bed hospital ship to New York, although it is not scheduled to arrive until mid-April. Officials have begun erecting four 250-bed hospitals at the Jacob K. Javits Convention Center in Midtown Manhattan, which could be ready in a week. President Trump said on Wednesday on Twitter that construction was ahead of schedule, but that could not be independently confirmed.

Officials have also discussed converting hotels and arenas into temporary medical centers.

At least two city hospitals have filled up their morgues, and city officials anticipated the rest would reach capacity by the end of this week, according to the briefing. The state requested 85 refrigerated trailers from FEMA for mortuary services, along with staff, the briefing said.

A spokeswoman for the city’s office of the chief medical examiner said the briefing was inaccurate. “We have significant morgue capacity in our five citywide sites, and the ability to expand,” she said.

In interviews, doctors and nurses at hospitals across the city gave accounts of how they were being stretched.

Workers at several hospitals, including the Jacobi Medical Center in the Bronx, said employees such as obstetrician-gynecologists and radiologists have been called to work in emergency wards.

At a branch of the Montefiore Medical Center, also in the Bronx, there have been one or two coronavirus-related deaths a day, or more, said Judy Sheridan-Gonzalez, a nurse. There are not always enough gurneys, so some patients sit in chairs. One patient on Sunday had been without a bed for 36 hours, she said.

At the Mount Sinai Health System, some hospital workers in Manhattan have posted photos on social media showing nurses using trash bags as protective gear. A system spokesman said she was not aware of that happening and noted the nurses had other gear below the bags. “The safety of our staff and patients has never been of greater importance and we are taking every precaution possible to protect everyone,” she said.

With ventilators in short supply, NewYork-Presbyterian Hospital, one of the city’s largest systems, has begun using one machine to help multiple patients at a time, a virtually unheard-of move, a spokeswoman said.

Elmhurst Hospital Center opened in 1832 and moved to its current Queens location in 1957, making it one of the oldest hospitals in New York City.

In the neighborhood it serves, Elmhurst, more than two-thirds of residents were born outside of the United States, the highest such rate in the city. It is a safety-net hospital, serving mainly low-income patients, including many who lack primary care doctors.

Queens accounts for 32 percent of New York City’s confirmed coronavirus cases, more than any other borough and far more than its share of the city’s population. It also has fewer hospitals. Elmhurst is one of three major hospitals serving a large population and is centrally located, which in part explains why it is busy in normal times and even busier now.

Medical workers said they saw the first signs of the virus in early March — an increase in patients coming in with flulike symptoms before the alarm had been fully raised in the city and the country. Tests results were taking longer then, but they eventually confirmed that many of these patients had coronavirus.

In the weeks after, the emergency room began filling up, with more than 200 people at times. Every chair in the waiting room was usually taken. Patients came in faster than the hospital could add beds; earlier this week, 60 coronavirus patients had been admitted but were still in the emergency room. One man waited almost 60 hours for a bed last week, a doctor said.

The patients coming in now are sicker than before because they were advised to try to recover at home, doctors said.

Like other hospitals, Elmhurst has come perilously close to running out of ventilators several times; other hospitals have replenished its supply.

Despite the more optimistic projections by the state about hospitalization rates, the crowds outside of Elmhurst have not thinned out.

The line of people waiting outside of Elmhurst to be tested for the coronavirus forms as early as 6 a.m., and some stay there until 5 p.m. Many are told to go home without being tested.

Julio Jimenez, 35, spent six hours in the emergency room on Sunday night after running a fever while at work in a New Jersey warehouse. He returned on Monday morning to stand in the testing line in the pouring rain. On Tuesday, still coughing, eyes puffy, he stood in line for nearly seven hours and again went home untested.

“I don’t know if I have the virus,” Mr. Jimenez said. “It’s so hard. It’s not just me. It’s for many people. It’s crazy.”

Rikki Lane, a doctor who has worked at Elmhurst for more than 20 years, said the hospital had handled “the first wave of this tsunami.” She compared the scene in the emergency department with an overcrowded parking garage where physicians must move patients in and out of spots to access other patients blocked by stretchers.

Family members are not permitted inside, she said.

Dr. Lane recalled recently treating a man in his 30s whose breathing deteriorated quickly and had to be put on a ventilator. “He was in distress and panicked, I could see the terror in his eyes,” she said. “He was alone.”

Other doctors said they had tried to resuscitate people while drenched in sweat under their protective gear, face masks fogging up. Some patients have been found dead in their rooms while doctors were busy helping others, they said.

Sometimes doctors try to call patients’ families when it is clear they will not recover.

That is what Dr. Bray said she tried to do before the man who reminded her of her fiancé died on Tuesday. As it turned out, his mother, also stricken with the coronavirus, was a patient at another hospital.

“We weren’t able to get in touch with anybody,” Dr. Bray said.

TRANSCRIPT OF VIDEO:
‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus

An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”

[Machine beeping] “The frustrating thing about all of this is it really just feels like it’s too little, too late. Like we knew — we knew it was coming. Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are, right now, scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines, we could free up ventilators for patients who need them. You know, we now have these five vents. We probably — unless people die, I suspect we’ll be back to needing to beg for ventilators again in another day or two. There’s a mythical 100 vents out there which we haven’t seen. Leaders in various offices, from the president to the head of Health and Hospitals, saying things like, ‘We’re going to be fine. Everything’s fine.’ And from our perspective, everything is not fine. I don’t have the support that I need, and even just the materials that I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a first-world country. On a regular day, my emergency department’s volume is pretty high. It’s about 200 people a day. Now we’re seeing 400 or more people a day. At first, we were trying to isolate patients with cough and fever and be more careful around them, but we weren’t necessarily being extra careful around all the other patients. And then we started to realize that patients who were coming in with no fever but abdominal pain actually had findings on their X-rays and chest CTs that were consistent with this coronavirus, Covid-19. So someone in a car accident gets brought in and we get a CT scan of them, and their lungs look like they have coronavirus. We were seeing a lot of patients who probably had Covid, but we didn’t realize. Ten residents and also many, many of our nurses and a few of the attending physicians got sick. The anxiety of this situation is really overwhelming. All of the doctors, it’s hard for us to get tested even if we want to, even if we have symptoms. We’re exposed over and over again. We don’t have the protective equipment that we should have. I put on one N95 mask in the morning. I need to have that N95 mask on for every patient I see. I don’t take it off all day. The N95 mask I wore today is also the N95 mask I wore on Friday. We’re always worried that we’ll be out of N95 masks. What’s a little bit scary now is the patients that we’re getting are much sicker. Many of the young people who are getting sick don’t smoke, they’re healthy, they have no co-morbidities. They’re just young, regular people between the ages of 30 and 50 who you would not expect to get this sick. So many people are saying it’s going to be OK, everything’s fine, we have what we need. And if this goes on for a month or two or three or five like it did in China, and we’re already this strained, we don’t have what we need. I don’t really care if I get in trouble for speaking to the media. I want people to know that this is bad. People are dying. We don’t have the tools that that we need in the emergency department and in the hospital to take care of them, and — and it’s really hard.”

Reporting was contributed by Jesse McKinley, Jesse Drucker, Eileen Sullivan and Michael Schwirtz. Susan C. Beachy contributed research.

Michael Rothfeld is an investigative reporter on the Metro desk and co-author of a book, "The Fixers." He was part of a team at The Wall Street Journal that won the 2019 Pulitzer Prize for national reporting for stories about hush money deals made on behalf of Donald Trump and a federal investigation of the president's personal lawyer. @mrothfeld

Somini Sengupta is an international climate correspondent. She has also covered the Middle East, West Africa and South Asia for The Times and received the 2003 George Polk Award for her work in Congo, Liberia and other conflict zones. @SominiSengupta • Facebook

Joseph Goldstein covers health care in New York. He has been a reporter at The Times since 2011. @JoeKGoldstein

Brian M. Rosenthal is an investigative reporter on the Metro Desk. Previously, he covered state government for The Houston Chronicle and for The Seattle Times. @brianmrosenthal

New York’s virus case count is doubling every three days. UPDATES

Coronavirus is accelerating its spread in New York, with potentially disastrous consequences, Gov. Andrew M. Cuomo said on Tuesday.

The case count is doubling every three days, and the peak of infection in New York could come as soon as two to three weeks, Mr. Cuomo said, outrunning earlier projections and threatening to put even bigger strain on the health care system than officials had feared.

“We haven’t flattened the curve. And the curve is actually increasing,” Mr. Cuomo said from the Javits Center in Manhattan, a convention complex that the Army Corps of Engineers is turning into a 1,000-bed emergency hospital.

“The apex is higher than we thought and the apex is sooner than we thought. That is a bad combination of facts.”

Mr. Cuomo, who last week adopted a friendly tone toward President Trump, got as close as he has to chastising the federal government, which has so far sent 400 ventilators to New York City.

“You want a pat on the back for sending 400 ventilators,” Mr. Cuomo said. “What are we going to do with 400 ventilators when we need 30,000 ventilators? You’re missing the magnitude of the problem, and the problem is defined by the magnitude.”

The governor said the state now projects that it may need as many as 140,000 hospital beds to house virus patients, up from the 110,000 projected a few days ago. As of now, only 53,000 are available.

Up to 40,000 intensive-care beds could be needed.

“Those are troubling and astronomical numbers,” Mr. Cuomo said.
As of Tuesday morning, New York State had 25,665 cases, with at least 157 deaths. The state now accounts for nearly 7 percent of global cases tallied by The New York Times.

Some 13 percent of people who have tested positive were hospitalized as of Tuesday with nearly a quarter of those hospitalized in intensive care.

“That’s the problem,” Mr. Cuomo said. “As the number of cases go up, the number of people in hospital beds goes up, the number of people who need an I.C.U. bed and a ventilator goes up, and we cannot address that increasing curve.”

In New York City alone, there have been around 15,000 cases.

Mr. Cuomo said that New York was a harbinger for the rest of the country.

“Look at us today,” he warned. “Where we are today, you will be in four weeks or five weeks or six weeks. We are your future.”

White House: Anyone who has left New York should self-quarantine.

Experts on the White House Coronavirus Task Force expressed alarm on Tuesday over infection rates in New York City, and advised  people who have passed through or left the city to place themselves into 14-day quarantine.

Dr. Deborah Birx, the coronavirus response coordinator, said new infection hot spots on Long Island indicate that people leaving the city are already spreading the virus.

“Everybody who was in New York should be self-quarantining for the next 14 days to ensure the virus doesn’t spread to others no matter where they have gone, whether it’s Florida, North Carolina or out to far reaches of Long Island,” she said.

New York City is now being treated the way parts of China and Europe have been viewed, as an epidemiological hot zone. On Tuesday, Gov. Ron DeSantis of Florida expanded his efforts to quarantine visitors from New York, saying he would sign an order extending a self-isolation requirement to anyone who had traveled from the New York area in the last three weeks. Dr. Birx said that about 60 percent of all the new cases in the country were coming out of the metro New York area.

Trump expresses outrage at having to ‘close the country’ to curb the spread of the virus.


Even as nations from Britain to India declare nationwide economic lockdowns, President Trump said he “would love to have the country opened up, and just raring to go, by Easter,” less than three weeks away, a goal that top health professionals have called far too quick.

“I think it’s possible, why not?” he said with a shrug.

Participating in a town hall hosted by Fox News on Tuesday, he expressed outrage about having to “close the country” to curb the spread of the coronavirus and indicated that his guidelines on business shutdowns and social distancing would soon be lifted.

“I gave it two weeks,” he said, adding, “We can socially distance ourselves and go to work.”

But at a late afternoon news conference, he softened his tone, saying his priority is the health and safety of the American people.

At the  news conference, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, sought to refine Mr. Trump’s Easter timeline, saying it would not pertain to hot spots like New York. There could be “flexibility in different areas” based on data, he said.

”We need to know what’s going on in those areas in the country where there isn’t an obvious outbreak,” Dr. Fauci said. “It’s a flexible situation.”

Other health experts, however, have warned that a patchwork state-by-state approach alone could not contain a virus that doesn’t respect state borders.

Both Mr. Trump and Vice President Mike Pence said that a lockdown had never been under consideration for the United States. Mr. Pence told Fox News viewers that talk of it was misinformation that has circulated online.

“I can tell you that at no point has the White House coronavirus task force discussed a nationwide lockdown,” he said, answering a question from a viewer on the phone.

Mr. Trump fell back on his comparison of the coronavirus to the flu, saying that despite losing thousands of people to the flu, “We don’t turn the country off.”

States including California, Maryland, Illinois and Washington have declared stay-at-home or shutdown orders, but other states have been looking for directives from the Trump administration. And countries in Asia are beginning to see a resurgence of coronavirus after easing up on restrictions.

Democrats near a deal with the White House on the stimulus package.

Top Democrats and Trump administration officials said they were optimistic about finalizing an agreement on Tuesday on a roughly $2 trillion economic stabilization plan to respond to the pandemic, after striking a tentative deal to add oversight requirements for a $500 billion government bailout fund for distressed companies.

“We’re looking forward to closing a bipartisan deal today,” Steven Mnuchin, the Treasury secretary, told reporters as he arrived on Capitol Hill for a round of meetings on Tuesday morning.

Speaker Nancy Pelosi said there was “real optimism that we could get something done in the next few hours” after Democrats won crucial concessions from the Trump administration.

In an interview on CNBC, she said the emerging deal would include strict oversight over the bailout fund, including installing an inspector general to monitor it, as well as what Ms. Pelosi described as a congressional panel “appointed by us to provide constraint.” The measures are similar to those put in place as part of the Troubled Asset Relief Program, the centerpiece of the Wall Street bailout enacted in 2008 to respond to the financial meltdown.

The New York City police have begun to enforce social distancing rules.

The New York City police have begun a new series of patrols to ensure that  residents are practicing appropriate social distancing.

On Sunday, in the span of three hours, the patrols issued at least 50 warnings to restaurants, bars, supermarkets and salons, as well as people crowding in public spaces, the department said.

“We have to keep people separated,” Mayor Bill de Blasio said on “Fox and Friends” Monday morning. “So our men and women of the N.Y.P.D. will be out there spreading the message, telling people to break it up, move along, no lines tight together in a grocery store, no grocery stores full up,”

A White House official is troubled by the ‘attack rate’ in New York.

NY TIMES

The White House’s coronavirus response coordinator offered a grim assessment of the virus’s assault on the New York metropolitan area Monday evening: She said that nearly one in 1,000 people in the region had contracted the virus, an “attack rate” five times that of other areas of the country.

The coordinator, Dr. Deborah L. Birx, said at a White House briefing that the rate of infection showed that the virus must have been spreading for weeks “to have this level of penetrance into the general community.”

She added that 28 percent of tests for the coronavirus in the region were coming up positive, while the rate was less than 8 percent in the rest of the country.

“To all of my friends and colleagues in New York, this is the group that needs to absolutely social distance and self-isolate at this time,” Dr. Birx said.

In epidemiology, the attack rate is the percentage of a population that has a disease. New York State now has an attack rate similar to Italy’s. In New York City itself, the attack rate works out to about one case for every 650 residents.

Losing sense of smell may be a hidden symptom of coronavirus, doctors warn

WASHINGTON POST

While every case is different, the telltale symptoms of the novel coronavirus have been widely agreed upon — a high fever, persistent cough or shortness of breath. In the most severe instances, those afflicted have reported confusion or difficulty breathing, and sometimes, anxiety is the most prevailing symptom of all.

But a team of British ear, nose and throat doctors on Friday raised the possibility of a new indicator of the coronavirus, one they say has been observed globally, even in patients who are otherwise asymptomatic: anosmia, a condition that causes the loss of sense of smell. In a statement, they warned that adults experiencing recent anosmia could be unknown carriers of covid-19, and urged them to consider self-isolation.

“All of this evidence is accumulating very rapidly, but there’s nothing yet robustly in print,” Claire Hopkins, president of the British Rhinological Society, said in an interview. “Since then, I’ve had colleagues from around the world saying: ‘That’s exactly what we’re seeing.’ They’ve been trying [to raise awareness], but it hasn’t been picked up.”

Experts at the World Health Organization say they have not yet confirmed the loss of smell or taste as a symptom of the coronavirus but haven’t ruled it out.

Hopkins, who published the statement along with Nirmal Kumar, the president of ENT UK, a body that represents ear, nose and throat specialists in Britain, said she was driven by recent discussions on rhinological discussion boards related to the coronavirus pandemic. There, she observed ENTs reporting a surge of reported anosmia across their patients, and even among themselves.

In their statement, Hopkins and Kumar cited reports from South Korea, China, Iran and Italy, where, they wrote, “significant numbers of patients with proven covid-19 infection have developed anosmia/hyposmia,” the latter of which signals a reduced ability to detect smells. In Germany, they wrote, more than two-thirds of confirmed coronavirus cases included anosmia. And in South Korea, a country that has seen ample covid-19 testing, “30 percent of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases.”

India’s prime minister decreed a 21-day lockdown for the country of 1.3 billion.

India, the world’s second-most populous country, will order its 1.3 billion people to stay inside their homes for three weeks to try to curb the spread of the coronavirus, Prime Minister Narendra Modi declared on Tuesday.

The extensive lockdown order was declared a day after the authorities there grounded all domestic flights.

Mr. Modi said the decree would take effect at midnight.

“There will be a total ban of coming out of your homes,” Mr. Modi said.

“Every district, every lane, every village will be under lockdown,” he said. “If you can’t handle these 21 days, this country will go back 21 years.”

“The only option is social distancing, to remain away from each other,” he said. “There is no way out to escape from coronavirus besides this.”

Left unclear was how Indians would be able to get food and other needed supplies. Mr. Modi alluded vaguely to the government and civil society groups stepping in to help, but offered no details.

Though India’s number of reported coronavirus cases remains relatively low, around 500, the fear is that if the virus hits as it has in the United States, Europe or China, it could be a disaster far bigger than anywhere else.

New York City has about a third of the nation’s confirmed coronavirus cases, making it the new epicenter of the outbreak in the United States.. UPDATES

NY TIMES

Density creates alarming virus “attack rate” in New York City, officials say.

Nearly 1 in 1,000 people in the New York metropolitan area have contracted the virus, five times the rate of the rest of the country, Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, said on Monday.

The New York metro area is experiencing a virus “attack rate” of nearly one in a thousand, or five times that of other areas Dr. Birx said. In epidemiology, the attack rate is the percentage of a population that has a disease.

New York’s population density may help explain why the “attack rate” is so high.

New York is far more crowded than any other major city in the United States. It has 28,000 residents per square mile, while San Francisco, the next most jammed city, has 17,000, according to data from the U.S. Census Bureau.

All of those people, in such a small space, appear to have helped the virus spread rapidly through packed subway trains, busy playgrounds and hivelike apartment buildings, forming ever-widening circles of infections. The city now has more coronavirus cases per capita than even Italy.

Gov. Andrew M. Cuomo of New York will issue an order requiring hospitals to increase capacity by at least 50 percent, he said on Monday. New York State saw a one-day increase of nearly 5,000 cases, putting the total at 21,689 as of Monday night.

After days of criticizing the Trump administration for not doing enough to help the city, Mr. de Blasio said he had a “very substantial conversation” with President Trump and Vice President Mike Pence on Sunday night about getting additional supplies, medical personnel and financial support.


Trump hints at a short shutdown: “I’m not looking at months.”

The White House coronavirus task force provided an update as the virus spreads in America.
We are going to save American workers, and we’re going to save them quickly. And we’re going to save our great American companies — both small and large. This was a medical problem. We are not going to let it turn into a long lasting financial problem. We also have a large team working on what the next steps will be once the medical community gives a region the OK, meaning the OK to get going, to get back. Let’s go to work. Our country wasn’t built to be shut down. This is not a country that was built for this. It was not built to be shut down. America will, again and soon, be open for business very soon. A lot sooner than three or four months that somebody was suggesting — a lot sooner. We cannot let the cure be worse than the problem itself. We’re not going to let the cure be worse than the problem.



‘Our Country Wasn’t Built to Be Shut Down,’ Trump Says

President Trump, in a nearly two-hour coronavirus briefing, hinted on Monday that the economic shutdown meant to halt the spread of the virus across the country would not be extended.

“America will again and soon be open for business,” the president said, without providing a timeline for when he believes normal economic activity could resume. He later added, “I’m not looking at months, I can tell you right now.”

“If it were up to the doctors, they’d say let’s shut down the entire world,” Mr. Trump said. “This could create a much bigger problem than the problem that you started out with.”

Mr. Trump also suggested that he would soon re-evaluate the federal guidance urging social distancing. More states moved on Monday to impose their own sweeping stay-at-home orders, which will soon cover more than 158 million Americans in 16 states.

Washington, Indiana, Massachusetts, Michigan, Wisconsin, West Virginia and Oregon became the latest states to announce sweeping directives to keep more people home in an effort to slow the spread of the virus.

Mr. Trump sent mixed signals from the White House podium, agreeing at one point with his surgeon general and saying, “It’s going to be bad,” then suggesting that the response to the virus may have been overblown.

“This is going away,” Mr. Trump said, citing jobs, “anxiety and depression” and suicide as arguments for restoring the U.S. economy.

He compared deaths from the novel coronavirus so far to deaths from other causes — influenza and car accidents — suggesting that the scale of those preventable deaths means economic restrictions may not be appropriate to prevent the spread of the virus.

While it is true that those causes of death outnumber deaths from the virus to date, projections from the Centers for Disease Control and Prevention estimated that deaths from Covid-19 could range from 200,000 to 1.7 million people. Estimates from other scientists place the potential deaths in a range from several hundred thousand to several million deaths, substantially more than annual deaths from car accidents and flu combined.


‘You Must Stay At Home,’ Boris Johnson Tells Britain

Facing a growing storm of criticism about his laissez-faire response to the fast-spreading coronavirus, Prime Minister Boris Johnson announced on Monday that he would place Britain under a virtual lockdown, closing all nonessential shops, banning meetings of more than two people, and requiring people to stay in their homes, except for trips for food or medicine.

People who flout the new restrictions, the prime minister said, will be fined by the police.

The steps, which Mr. Johnson outlined in a televised address to the nation, bring him into alignment with European leaders like President Emmanuel Macron of France and Chancellor Angela Merkel of Germany, who have all but quarantined their countries in a desperate bid to slow the outbreak.


Facebook re-emerges as a news hub.


As of Thursday, more than half the articles being consumed on Facebook in the United States were related to the coronavirus.

Before the coronavirus, Facebook could feel at times like the virtual equivalent of a sleepy bingo parlor — an outmoded gathering place populated mainly by retirees looking for conversation and cheap fun.

Now, stuck inside their homes and isolated from their families and friends, millions of Americans are rediscovering the social network’s virtues. That has lifted usage of Facebook features like messaging and video calls to record levels and powered a surge in traffic for publishers of virus-related news.

As of Thursday, more than half the articles being consumed on Facebook in the United States were related to the coronavirus, according to an internal report obtained by The New York Times. Overall U.S. traffic from Facebook to other websites also increased by more than 50 percent last week from the week before, “almost entirely” owing to intense interest in the virus, the report said.

In Texas and Ohio, abortion is declared “nonessential.”
A new front in the political fight over abortion has been sparked by the coronavirus pandemic.

Texas and Ohio have included abortions among the nonessential surgeries and medical procedures that they are requiring to be delayed, saying they are trying to preserve precious protective equipment for health care workers and to make space for a potential flood of coronavirus patients.

But abortion-rights activists said that abortions should be counted as essential and that people could not wait for the procedure until the pandemic was over.

On Monday, Ken Paxton, the attorney general of Texas, clarified that the postponement of surgeries and medical procedures announced by the governor over the weekend included “any type of abortion that is not medically necessary to preserve the life or health of the mother.”

Failure to do so, he said, could result in penalties of up to $1,000 or 180 days of jail time. It was not immediately clear if that included medication abortion, which involves providers administering pills in the earlier stages of pregnancy.

The move followed a similar action by health authorities in Ohio last week and has prompted a legal scramble by abortion rights groups to preserve access. Activists accused state leaders of using the coronavirus crisis to advance an existing agenda to restrict abortions.

‘Wartime President’? Trump Rewrites History in an Election Year

Trump is brazenly grabbing his only clear option to bolster his re-election hopes, portraying himself as a take-charge leader the country can’t afford to lose.

NY TIMES

Clash between GOP, Democrats over stimulus bill intensifies

1.8 trillion package falls far short of advancing in Senate

Democrats blocked legislation from moving forward, saying that it did not do enough to shore up the health-care system and help ordinary Americans, but talks between the sides continued.
By Erica Werner, Seung Min Kim, Rachael Bade and Jeff Stein



Governors, mayors in growing uproar over Trump’s response

Many officials complain that President Trump does not have a coherent or ready plan to confront a crisis that could soon push the nation’s health-care system to the brink of collapse.
By Robert Costa and Aaron Gregg

After the governors of multiple states and other leaders made urgent pleas on Sunday for masks and other protective equipment to help fight the swelling outbreak, President Trump listed a number of federal actions in a news conference in the evening.

As the number of known cases in the United States crossed 31,700, California officials told hospitals to restrict coronavirus testing, and a hospital in Washington State warned that it could run out of life-preserving ventilators by early next month. ​Washington State’s Department of Health told local leaders that only the highest-priority areas would have access to the government’s reserves of protective equipment, including N95 masks.

Mr. Trump said that major disaster declarations were in process for New York, California and Washington — the three states hardest hit by the virus — and that they would not have to pay for deploying National Guard units.

Mr. Trump also said during the Sunday conference that he had directed FEMA to supply four large federal medical stations with 1,000 beds for New York, eight large federal medical stations with 2,000 beds for California, and three large federal medical stations and four small federal medical stations with 1,000 beds for the State of Washington.

The stations for New York, to be built in Jacob K. Javits Convention Center in Manhattan, were announced earlier in the day by Gov. Andrew M. Cuomo.

As Mr. Trump detailed federal activities, he at times repeated facts and appeared halting as he described a complex list of facts and figures in the millions.

Many state and local officials have pressed Mr. Trump to use his authority under the Defense Production Act to mobilize industry to manufacture scarce goods. On Sunday, Peter T. Gaynor, the FEMA administrator, said the president was not doing so, and instead was using the threat of the act as “leverage to demonstrate that we can.”

At the news conference on Sunday, Mr. Trump defended his decision not to implement the Defense Production Act despite an outcry from state governors and Democrats.

The president’s top trade adviser said that, in fact, the act had spurred the country’s “industrial base” to voluntarily mobilize, allowing for the quick conversion of corporate production facilities to produce medical supplies.

“We’re getting what we need without putting the heavy hand of government down,” Peter Navarro, the president’s top trade adviser, told reporters.

New York State now has roughly 5 percent of the world’s cases.
A sharp increase in confirmed coronavirus cases in New York State on Sunday indicated that the state now accounts for roughly 5 percent of coronavirus cases worldwide.

The jump stemmed from both the rapid growth of the outbreak and a significant increase in testing in the state. Health officials emphasized that testing was revealing how quickly the virus had spread.

There are now 15,168 confirmed cases of the coronavirus in the state, up 4,812 since Saturday, and 114 deaths, Mr. Cuomo said. About 13 percent, or 1,974 people in New York who tested positive for the virus, were hospitalized, he said.

The governor took issue with what he called the “insensitive” and “arrogant” behavior of New York City residents who continued to gather in parks and other public spaces. Mr. Cuomo indicated that he would give the city 24 hours to come up with a plan to reduce density in these spaces, which he would need to approve."I don’t know what I’m saying that people don’t get,” Mr. Cuomo said, suggesting that city officials could close some streets to traffic to give residents more outdoor space.

Appearing on NBC’s “Meet the Press” on Sunday morning, Mayor Bill de Blasio of New York warned that the city’s hospitals were straining under a deluge of cases, and he again called on Mr. Trump to send more help. “April is going to be worse than March,” he said. “And I fear May will be worse than April.”






'I can't jump in front of the microphone and push him down': Fauci says he tells Trump things FOUR times before they sink in, criticizes him for shaking hands with people and using term 'China virus' - and is absent from latest briefing

When asked Sunday by Science magazine’s Jon Cohen about having to stand in front of the nation as “the representative of truth and facts” when “things are being said that aren’t true and aren’t factual,” the 79-year-old said there is only so much he can do.

“I can’t jump in front of the microphone and push him down,” Fauci said, referencing Trump. “OK, he said it. Let’s try and get it corrected for the next time.”
The frank comment was just one part of a remarkable Q&A published Sunday night in which Fauci shed light on his relationship with Trump, how the pair handles their differences and what happens before each coronavirus task force news conference.

Read Fauci's full interview here

On more than one occasion, Fauci, described by The Washington Post’s Ellen McCarthy and Ben Terris as “the grandfatherly captain of the corona­virus crisis,” has found himself in the uncomfortable position of having to publicly contradict the president — a risky action that could conceivably jeopardize the scientist’s job.
Anthony Fauci was ready for this. America was not.
Fauci acknowledged as much on Sunday.
“To my knowledge, I haven’t been fired,” he told Cohen, laughing.

Most recently, Fauci has sought to temper Trump’s comments touting an old anti-malarial drug as a potential treatment for covid-19. At a news conference Friday, one day after Trump called the medicine a possible “game-changer,” Fauci said the only evidence of the drug’s promise so far has been “anecdotal,” adding, “So you really can’t make any definitive statement about it.”

Harvey Weinstein has coronavirus: Rapist, 68, tests positive and is put in isolation just days after he was moved from Rikers Island to an upstate NY prison to start his 23-year sentence

Harvey Weinstein has tested positive for coronavirus. A source told DailyMa 'He tested positive and is quarantined.' Weinstein, 68, is isolated at Wende Correctional Facility in Western New York. The shamed producer is said to have told prison staff he believed he has the virus when he entered the state prison system last Wednesday from Rikers Island.

Italy, Pandemic’s New Epicenter, Has Lessons for the World

The country’s experience shows that steps to isolate the coronavirus and limit people’s movement need to be put in place early, with absolute clarity, then strictly enforced.

NY TIMES

early, with absolute clarity, then strictly enforced.


Paramedics transporting a suspected coronavirus patient to a hospital in Rome on Monday.
Paramedics transporting a suspected coronavirus patient to a hospital in Rome on Monday.Credit...Nadia Shira Cohen for The New York Times
By Jason Horowitz, Emma Bubola and Elisabetta Povoledo
March 21, 2020

525
ROME — As Italy’s coronavirus infections ticked above 400 cases and deaths hit the double digits, the leader of the governing Democratic Party posted a picture of himself clinking glasses for “an aperitivo in Milan,” urging people “not to change our habits.”

That was on Feb. 27. Not 10 days later, as the toll hit 5,883 infections and 233 dead, the party boss, Nicola Zingaretti, posted a new video, this time informing Italy that he, too, had the virus.

Italy now has more than 53,000 recorded infections and more than 4,800 dead, and the rate of increase keeps growing, with more than half the cases and fatalities coming in the past week. On Saturday, officials reported 793 additional deaths, by far the largest single-day increase so far. Italy has surpassed China as the country with the highest death toll, becoming the epicenter of a shifting pandemic.

The government has sent in the army to enforce the lockdown in Lombardy, the northern region at the center of the outbreak, where bodies have piled up in churches. On Friday night, the authorities tightened the nationwide lockdown, closing parks, banning outdoor activities including walking or jogging far from home.

On Saturday night, Prime Minister Giuseppe Conte announced another drastic step in response to what he called the country’s most difficult crisis since the Second World War: Italy will close its factories and all production that is not absolutely essential, an enormous economic sacrifice intended to contain the virus and protect lives.

“The state is here,” he said in an effort to reassure the public.

But the tragedy of Italy now stands as a warning to its European neighbors and the United States, where the virus is coming with equal velocity. If Italy’s experience shows anything, it is that measures to isolate affected areas and limit the movement of the broader population need to be taken early, put in place with absolute clarity, then strictly enforced.

Despite now having some of the toughest measures in the world, Italian authorities fumbled many of those steps early in the contagion — when it most mattered as they sought to preserve basic civil liberties as well as the economy.

Italy’s piecemeal attempts to cut it off — isolating towns first, then regions, then shutting down the country in an intentionally porous lockdown — always lagged behind the virus’s lethal trajectory.


ImageThe usually bustling Navigli area in Milan was almost empty during the lockdown this month.
The usually bustling Navigli area in Milan was almost empty during the lockdown this month.Credit...AAlessandro Grassani for The New York Times
“Now we are running after it,” said Sandra Zampa, the under secretary at the Ministry of Health, who said Italy did the best it could given the information it had. “We closed gradually, as Europe is doing. France, Spain, Germany, the U.S. are doing the same. Every day you close a bit, you give up on a bit of normal life. Because the virus does not allow normal life.”

Some officials gave in to magical thinking, reluctant to make painful decisions sooner. All the while, the virus fed on that complacency.

Governments beyond Italy are now in danger of following the same path, repeating familiar mistakes and inviting similar calamity. And unlike Italy, which navigated uncharted territory for a Western democracy, other governments have less room for excuses.

Italian officials, for their part, have defended their response, emphasizing that the crisis is unprecedented in modern times. They assert that the government responded with speed and competence, immediately acting on the advice of its scientists and moving more swiftly on drastic, economically devastating measures than their European counterparts.

But tracing the record of their actions shows missed opportunities and critical missteps.

In the critical early days of the outbreak, Mr. Conte and other top officials sought to down play the threat, creating confusion and a false sense of security that allowed the virus to spread.

They blamed Italy’s high number of infections on aggressive testing of people without symptoms in the north, which they argued only created hysteria and tarnished the country’s image abroad.


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At Palazzo Marino, headquarters of the municipality of Milan, chairs were placed outdoors and at a safe distance ahead of a meeting.
At Palazzo Marino, headquarters of the municipality of Milan, chairs were placed outdoors and at a safe distance ahead of a meeting.Credit...Alessandro Grassani for The New York Times
Even once the Italian government considered a universal lockdown necessary to defeat the virus, it failed to communicate the threat powerfully enough to persuade Italians to abide by the rules, which seemed riddled with loopholes.

“It is not easy in a liberal democracy,” said Walter Ricciardi, a World Health Organization board member and a top adviser to the health ministry, who argued that the Italian government acted on the scientific evidence made available to it.

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He said the Italian government had moved at a much faster clip, and took the threat much more seriously, than its European neighbors or the United States.

Still, he acknowledged that the health minister had struggled to persuade his government colleagues to move more quickly and that the difficulties of navigating Italy’s division of powers between Rome and the regions resulted in a fragmented chain of command and inconsistent messages.

“In times of war, like an epidemic,” that system presented grave problems, he said, adding that it perhaps delayed the imposing of restrictive measures.

“I would have done them 10 days before, that is the only difference.”

It Could Never Happen Here
For the coronavirus, 10 days can be a lifetime.

On Jan. 21, as top Chinese officials warned that those hiding virus cases “will be nailed on the pillar of shame for eternity,” Italy’s culture and tourism minister hosted a Chinese delegation for a concert at the National Academy of Santa Cecilia to inaugurate the year of Italy-China Culture and Tourism.

Michele Geraci, Italy’s former under secretary in the economic development ministry and a booster of closer relations with China, had a drink with other politicians but looked around uneasily.

“Are we sure we want to do this?” he said he asked them. “Should we be here today?”

With the benefit of hindsight, Italian officials say certainly not.


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In San Fiorano, one of the original ‘red zone’ towns that were locked down, residents watched as Prime Minister Giuseppe Conte of Italy announced travel restrictions on the entire country.
In San Fiorano, one of the original ‘red zone’ towns that were locked down, residents watched as Prime Minister Giuseppe Conte of Italy announced travel restrictions on the entire country.Credit...Marzio Toniolo, via Reuters
Ms. Zampa, the health ministry under secretary, said in retrospect she would have closed everything immediately. But in real time, it wasn’t that clear.

Politicians across the spectrum worried about the economy and feeding the country, and found it difficult to accept their impotence in the face of the virus.

Most importantly, Italy looked at the example of China, Ms. Zampa said, not as a practical warning, but as a “science fiction movie that had nothing to do with us.” And when the virus exploded, Europe, she said, “looked at us the same way we looked at China.”

But already in January, some officials on the right were urging Mr. Conte, their former ally and now political enemy, to quarantine schoolchildren in the northern regions who were returning from holidays in China, a measure aimed at protecting schools. Many of those children were from Chinese immigrant families.

Many liberals criticized the proposal as populist fear-mongering. Mr. Conte declined the proposal and responded that the northern governors should trust the judgment of education and health authorities who, he said, had proposed no such thing.

But Mr. Conte also demonstrated that he was taking the threat of contagion seriously. On Jan. 30, he blocked all flights in and out of China.

“We are the first country in Europe to adopt such a precautionary measure,” he said.

Over the next month, Italy responded swiftly to coronavirus scares. Two sick Chinese tourists and an Italian returning from China received care from a prominent infectious disease hospital in Rome. A false alarm led authorities to briefly confine passengers on a cruise ship docked outside of Rome.

‘Patient One,’ Super-spreader
When a 38-year-old man went to the emergency room at a hospital in Codogno, a small town in the Lodi province of Lombardy, with severe flu symptoms on Feb. 18, the case did not set off alarms.

The patient declined to be hospitalized and went home. He got sicker and returned to the hospital a few hours later and was admitted to a general medicine ward. On Feb. 20, he went into intensive care, where he tested positive for the virus.

The man, who became known as Patient One, had had a busy month. He attended at least three dinners, played soccer and ran with a team, all apparently while contagious and without heavy symptoms.


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New beds arriving last month at a hospital in Codogno, near Lodi in Northern Italy.
New beds arriving last month at a hospital in Codogno, near Lodi in Northern Italy.Credit...Luca Bruno/Associated Press
Mr. Ricciardi said Italy had the bad luck of having a super spreader in a densely populated and dynamic area who went to the hospital not once, but twice, infecting hundreds of people, including doctors and nurses.

“He was incredibly active,” Mr. Ricciardi said.

But he also had not had any direct contacts with China, and experts suspect he contracted the virus from another European, meaning Italy did not have an identifiable patient zero or a traceable source of contagion that could help it contain the virus.

The virus had already been active in Italy for weeks by that time, experts now say, passed by people without symptoms and often mistaken for a flu. It spread around Lombardy, the Italian region that has by far the most trade with China and the home of Milan, the country’s most culturally vibrant and business-centered city.

“Who we call ‘Patient One’ was probably ‘Patient 200,’ ” said Fabrizio Pregliasco, an epidemiologist.

On Sunday, Feb. 23, the number of infections clicked past 130 and Italy sealed off 11 towns with police and military checkpoints. The last days of Venice Carnival were canceled. The Lombardy region closed its schools, museums and movie theaters. The Milanese made a run on the supermarkets.


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Disinfecting around the central train station in Milan last week.
Disinfecting around the central train station in Milan last week.Credit...Alessandro Grassani for The New York Times
But while Mr. Conte again commended Italy for its firm hand, he also sought to downplay the contagion, attributing the high numbers of infected to Lombardy’s overzealous testing.

“We have been the first ones with the most rigorous and accurate controls,” he said in an address to the nation. “We have more people infected because we made more swabs.”

The next day, as infections surpassed 200, seven people died and the stock market plunged, Mr. Conte and his health aides doubled down.

He blamed the Codogno hospital for the spread, saying it had handled things in “a not-completely-proper way” and argued that Lombardy and Veneto, another northern region, were inflating the severity of the problem by diverging from global guidelines and testing people without symptoms.

As Lombardy officials scrambled to free up hospital beds, and the number of infected people rose to 309 with 11 dead, Mr. Conte said on Feb. 25 that “Italy is a safe country and probably safer than many others.”

On Friday, Mr. Conte’s office offered an interview on the condition that he could answer questions in writing. When sent questions, including those about his past statements, he declined to respond.

Mixed Messages Sow Confusion
Reassurances from leaders confused the Italian population.

On Feb. 27, Mr. Zingaretti posted his aperitivo picture. That same day, the country’s foreign minister, Luigi Di Maio, the former leader of one of the governing parties, the Five Star Movement, held a news conference in Rome.

“In Italy, we went from the risk of an epidemic to an infodemic,” Mr. Di Maio said, disparaging media coverage that highlighted the threat of the contagion, and adding that only “0.089 percent” of the Italian population was quarantined.

In Milan, only miles from the center of the outbreak, the mayor, Beppe Sala, publicized a ‘‘Milan Doesn’t Stop’’ campaign, and the Duomo, the city’s landmark cathedral that is a draw for tourists, reopened. People went out.


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A crowded wine bar in Milan at the end of February.
A crowded wine bar in Milan at the end of February.Credit...Andrea Mantovani for The New York Times
But on the sixth floor of the regional government headquarters in Milan, Giacomo Grasselli, who is the coordinator of the intensive care units throughout Lombardy, saw the numbers going up and quickly realized that it would be impossible to treat all the sick if the infections continued unabated.

His task force worked to match the sick to beds in intensive-care units in the nearest possible hospitals and appropriate dwindling resources.

At one of the daily meetings of about 20 health and political officials, he told the regional president, Attilio Fontana, about the growing numbers.

An epidemiologist showed the curves of infection. There was a catastrophe facing the region’s well-respected health system.

“We need to do something more,” Mr. Grasselli told the room.

Mr. Fontana, who had been pressing the central government for tougher action, agreed. He said that the mixed messages from Rome and the easing of restrictions had led Italians to believe “that everything was a joke, and they kept living as they used to.”

He said he appealed for tougher national measures in video conferences with the prime minister and other regional presidents, arguing that climbing numbers of cases threatened to collapse the hospital system in the north, but that his requests were repeatedly turned down.

“They were convinced that the situation was less serious and they did not want to hurt our economy too much,” said Mr. Fontana.

The government started providing some economic assistance, which would later be followed by a 25 billion euro ($28 billion) relief package, but the nation became divided between those who saw the threat and those who didn’t.

Ms. Zampa said that it was around that time that government learned that infections in the town of Vò, the virus epicenter of the Veneto region, had no epidemiological link to the Codogno outbreak.

She said that the health minister, Mr. Speranza, and Mr. Conte deliberated about what to do and within the day, they decided to close down much of the north.

In a surprise 2 a.m. news conference on March 8, when 7,375 people had already tested positive for coronavirus and 366 had died, Mr. Conte announced the extraordinary step of restricting movement for about a quarter of the Italian population in the northern regions that serve as the country’s economic engine.


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A police checkpoint in Viale Porpora in Milan amid a lockdown in Italy this month.
A police checkpoint in Viale Porpora in Milan amid a lockdown in Italy this month.Credit...Alessandro Grassani for The New York Times
“We are facing an emergency,” Mr. Conte said at the time. “A national emergency.”

A draft of the decree, leaked to Italian media on Saturday night, pushed many Milan residents to rush to the train station in crowds and attempt to leave the region, causing what many later considered a dangerous wave of contagion toward the south.

Yet the following day, most Italians were still confused about the severity of the restrictions.

To clarify the issue, the interior ministry issued “auto-certification” forms that would allow people to travel in and out of the locked-down area for work, health or “other” necessities.

In the meantime, some regional governors independently ordered people coming from the newly locked-down area to self quarantine. Others didn’t.

The broader restrictions in Lombardy also effectively lifted the quarantine on Codogno and other “red zone” towns linked to the original outbreak. Checkpoints disappeared. Local mayors complained that their sacrifices had been wasted.

A day later, on March 9, when the positive cases reached 9,172 and the death toll climbed to 463, Mr. Conte toughened the restrictions and extended them nationally.

But by then, some experts say, it was already too late.

Local Experiments
Italy is still paying the price of those early mixed messages by scientists and politicians. The people who have died in staggering numbers recently — more than 2,300 in the last four days — were mostly infected during the confusion of a week or two ago.

Roberto Burioni, a prominent virologist at the San Raffaele University in Milan, said that people had felt safe to go about their usual routines and he attributed the spike in cases last week to “that behavior.”


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Italian military guarding a roadblock leading to the village of Vo’Euganeo.
Italian military guarding a roadblock leading to the village of Vo’Euganeo.Credit...Claudio Furlan/LaPresse, via Associated Press
The government has urged national unity in obeying its restrictive measures. But on Saturday, hundreds of mayors from the hardest-hit areas told the government those measures were fatally insufficient.

Leaders in the north are desperate for the government to crack down harder.

On Friday, Mr. Fontana complained that the 114 troops the government deployed were insignificant, and that at least 1,000 should be sent. On Saturday, he closed public offices, work sites and banned jogging. He said in an interview that the government needed to stop messing around and “apply rigid measures.”

“My idea is that if we had shut everything in the beginning, for two weeks, probably now we would be celebrating victory,” he said.

His political ally, Luca Zaia, the president of the Veneto region, pre-empted the national government with his own crackdown, and said that Rome needed to enforce “a more drastic isolation,” including closing all stores and prohibiting public activities other than commuting to work.

“Walks should be banned,” he said.

Mr. Zaia has some credibility on the issue. As new infections have proliferated around the country, they have significantly dropped in Vò, a town of about 3,000 people that was one of the first quarantined and which had the country’s first coronavirus death.

Some government experts attributed that turnaround to the strict quarantine that had been in place for two weeks. But Mr. Zaia had also ordered blanket tests there, in defiance of international scientific guidelines and the national government. The government has argued that testing people without symptoms is a drain on resources.

“At least this slows down the virus’ speed,’’ Mr. Zaia said, arguing that testing helped identify potentially contagious people without symptoms. ‘‘And slowing down the virus’ speed allows the hospitals to breathe.’’

If not, the overwhelming number of patients would crater health care systems and cause a national catastrophe.

Americans and others, he said, “need to be ready.”


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The Pirellone, an iconic building in Milan, was illuminated with the message “Stay at Home.”
The Pirellone, an iconic building in Milan, was illuminated with the message “Stay at Home.”Credit...Alessandro Grassani for The New York Times