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Coronavirus Live Updates: Social Distancing Will Last for Months, Birx Says


Businesses reopen in some states, but conflicting messages stoke confusion.

As several states moved ahead with plans to restart their economies, many Americans faced yet another new calculation on Monday. After weeks of being told to simply stay home, they would now have to decide how to make sense of conflicting messages from local politicians and public health officials.

Dr. Deborah L. Birx, the White House coronavirus response coordinator, cautioned that Americans should expect some form of social-distancing guidelines to continue for months.

“Social distancing will be with us through the summer,” she said Sunday on NBC’s “Meet the Press.” Her comments came after Vice President Mike Pence suggested that the epidemic would be under control by the end of May.

“I think by Memorial Day Weekend we will largely have this coronavirus epidemic behind us,” he said late last week.

While states and localities face different challenges across the country, the pressure to ease restrictions will only grow as the economic pain deepens, restlessness increases and spring turns to summer.

In Southern California this weekend, tens of thousands of people flocked to the beaches in Orange County.

“We won’t let one weekend undo a month of progress,” Mayor Eric Garcetti of Los Angeles wrote on Twitter on Sunday. “The places we love — our beaches, hiking trails — will still be there when this is over. And by staying home, we’re making sure our loved ones will be too.”

He did not speculate when restrictions would be eased in New York City and surrounding suburbs. But he noted that they could not persist indefinitely.

“You can’t tell people in a dense urban environment all through the summer months: ‘We don’t have anything for you to do. Stay in your apartment with the three kids.’ That doesn’t work,” he said. “There’s a sanity equation here also that we have to take into consideration.”

The coronavirus pandemic has now killed more than 200,000 people and sickened more than 2.9 million worldwide, according to data collected by The New York Times. At least 177 countries have reported cases of Covid-19, the disease caused by the virus.

The actual toll is higher by an unknown degree, and will remain so for some time. A Times review of mortality data in 12 countries showed that official tallies have undercounted deaths during the outbreak, largely because of limited testing. Several thousand people in New York City who died without testing positive for Covid-19, and thousands more across the world, are considered probable cases.

Still, even the official numbers offer a sense of the scale and speed of the pandemic. The known global death count surpassed 100,000 on April 10, just a little more than two weeks ago.

Only two other countries have confirmed more than 20,000 deaths: France, with more than 22,800; and Britain, which crossed into that range on Saturday. Germany and Turkey both have outbreaks of more than 100,000 cases, but their official death tolls are lower.

Deaths per capita offer another measure of the pandemic. Belgium, with about 12 million people, has a relatively high figure of 62 deaths per 100,000 people, according to the Times database. But Belgium’s toll may reflect its more complete counting of deaths. Unlike many other countries, Belgium includes in its count deaths at nursing homes, where clustered populations of older adults are especially vulnerable. Spain’s reported toll is 50 deaths per 100,000 people, and Italy’s is 44. The figure in the United States is 15 per 100,000 people.

Most countries do not report deaths that occur outside of hospitals. Deaths that occurred before the virus was known to be circulating — like two in Santa Clara County, Calif., in February — are only starting to be re-examined. Further, some countries may be deliberately undercounting their tolls.

The economic rescue package that President Trump signed into law last month included $349 billion in low-interest loans for small businesses. The so-called Paycheck Protection Program was supposed to help prevent small companies — generally those with fewer than 500 employees in the United States — from capsizing, as the economy sinks into what looks like a severe recession.

The loan program was meant for companies that could no longer finance themselves through traditional means, like raising money in the markets or borrowing from banks under existing credit lines. The law required that the federal money — which comes at a low 1 percent interest rate and in some cases will not need to be paid back — has to be spent on things like payroll or rent.

A New York Times investigation found that dozens of large but lower-profile companies with financial or legal problems had received large payouts under the program, according to an analysis of the more than 200 publicly traded companies that have disclosed receiving a total of more than $750 million in bailout loans.

As a handful of states relaxed social-distancing guidelines over the weekend, they have struggled to navigate the competing demands of protecting residents’ safety and keeping the economy open. Here’s a look at how some of those states have approached that balancing act:

  • Although Alaska allowed businesses and restaurants in most parts of the state to reopen with some restrictions in place on April 24, the city of Anchorage has delayed its reopening to Monday.

  • Arkansas will allow simple elective surgeries to take place.

  • With Colorado’s stay-at-home order expiring over the weekend, Gov. Jared Polis introduced rules allowing curbside retail deliveries and phasing in elective surgery and store openings. Large workplaces can open at 50 percent capacity on May 4.

  • In Georgia, gyms, barbershops, tattoo parlors and spas in the state reopened last Friday. Houses of worship were allowed to resume in-person services, and restaurants and theaters can reopen on Monday.

  • Hawaii’s stay-at-home order was set to end April 30 but was extended on Sunday until the end of May. Gov. David Ige said he planned to ease restrictions on beaches, reopening them to allow for exercise, and would permit elective surgeries to resume under the extended order.

  • Kentucky will permit nonurgent health care services, such as radiology and outpatient care, to resume on Monday.

  • Gov. Larry Hogan of Maryland said his state would not start to reopen until the number of deaths there declined for 14 straight days. “I’m going to be very cautious,” he said on the ABC program “This Week.” “We’re going to make decisions on science.”

  • Gov. Gretchen Whitmer of Michigan, whose coronavirus policies have been the target of protests, said on “This Week” that her approach had saved lives. The governor has extended her stay-at-home order until May 15, but she relaxed a number of social-distancing policies on Friday, allowing in-state travel and some recreational activities.

  • On Monday, Minnesota will see the partial reopening of businesses.

  • Mississippi’s statewide stay-at-home order is set to expire on Monday. It will be replaced with a “safer at home” order, which will allow several retail businesses to reopen, but at limited capacity.

  • Montana’s plans to reopen began on Sunday with places of worship becoming operational at reduced capacity and with encouragement to follow social-distancing guidelines. Some businesses will reopen on Monday, with restaurants and bars expected to reopen May 4.

  • Gov. Andrew M. Cuomo of New York said that after May 15, when his executive order shutting down the state is set to expire, construction and manufacturing businesses may be able to reopen in the least hard-hit regions. But the state’s populous southern section, including New York City and its suburbs, were not likely to reopen any time soon.

Even as states begin to loosen their social-distancing restrictions, businesses are confronting deep uncertainty, and many corporate executives say it is simply too soon to come back. Businesses large and small are sticking with having employees work from home or have decided to wait to reopen.

Residents of poorer areas of Los Angeles County are more than three times more likely to die because of the coronavirus than people in wealthier communities in Southern California, public health officials said.

In a statement on Sunday, the Los Angeles County Department of Public Health said it had recorded 16.5 deaths per 100,000 people in areas where at least 30 percent of residents lived in poverty. The death rate in communities with less poverty was 5.3 per 100,000 people.

“As we have more information about who is dying, we are reminded that the work ahead requires that we address issues of disproportionality that result in higher rates of death among African Americans, Latinx and Asians as well as residents living in poverty,” said Dr. Barbara Ferrer, the county’s public health director.

“Ensuring access to testing, early treatment and care, and economic support among those communities at higher risk of devastating outcomes associated with Covid-19, is essential.”

The number of cases in Los Angeles County, the nation’s most populous, has swelled in recent weeks, and more than 900 deaths in Los Angeles County have been blamed on the virus. Health officials nationwide have been warning that disparate rates of sickness and death have emerged in some places, especially among black people.

The new statistics from Los Angeles County show similar trends, with the mortality rate for African Americans at 13 per 100,000 people. Among white people, the death rate is 5.5.

The data also reinforced warnings that the virus can be more perilous for people with other health conditions. According to the county, 93 percent of people who died already had underlying health problems.

On the same day that the price for U.S. crude oil fell to about $30 below zero — a mind-bending concept that marked the first time oil prices had ever turned negative — Mayor Sylvester Turner of Houston, the self-proclaimed energy capital of the world, stood before reporters. His words were grim and muffled by the black mask covering his face.

The mayor announced that city employees would soon be furloughed, but he declined to say how many. The Houston Zoo, he said, could expect to see funding deferred under what he called “the worst budget that the city will deal with in its history.”

Cities across the country are struggling under the economic shadow of the coronavirus. But few have to deal with a collapse in their fundamental industry at the same time.

“We’ve probably seen within weeks the same amount of economic shock that used to occur in years,” said State Senator Paul Bettencourt, a Houston Republican whose district includes a stretch of Interstate 10 that is home to Shell, ConocoPhillips and other oil and gas giants. “We’ve gone through this before. The problem is we didn’t do it in the middle of a pandemic.”

The Houston area by some estimates may lose 200,000 to 300,000 jobs — a blow worse than the Great Recession of 2008 and 2009.

Houston has been through oil booms and oil busts before. The oil downturn of the 1980s was the worst ever, costing the region one in seven jobs. But now even the Petroleum Club of Houston is closed, along with bars, malls and churches.

Around the world, one group has demonstrated a remarkable resistance to the virus: women. Whether in China, Italy or the U.S., women have been less likely to become acutely ill — and far more likely to survive.

That fact has made doctors wonder: Could hormones produced in greater quantities by women be at work?

Two groups of scientists have rushed to test the hypothesis. Two clinical trials will each dose men with the sex hormones for limited durations.

Last week, doctors on Long Island in New York started treating Covid-19 patients with estrogen in an effort to boost their immune systems, and next week, physicians in Los Angeles will start treating male patients with another hormone that is predominantly found in women, progesterone, which has anti-inflammatory properties and can prevent harmful overreactions of the immune system.

“There’s a striking difference between the number of men and women in the intensive care unit, and men are clearly doing worse,” said Dr. Sara Ghandehari, a pulmonologist and intensive care physician at Cedars-Sinai in Los Angeles who is the principal investigator for the progesterone study. She said that 75 percent of the hospital’s intensive care patients and those on ventilators were men.

The genesis of the estrogen trial at the Renaissance School of Medicine at Stony Brook University on Long Island stemmed from a similar observation, said Dr. Sharon Nachman, the trial’s principal investigator, who credited a Stony Brook surgeon, Dr. Anthony Gasparis, with the idea.

The trial enrolled its first patient this past week, and preliminary results could be available in a few months, she said.

“Coronavirus” is one fist nestled against and behind the other, then opened, fingers spread like a sunburst or a peacock tail.

Rorri Burton demonstrates via FaceTime, her sturdy hands and bare nails even cleaner than she usually scrubs them. The gesture is almost pretty compared to, say, “serological testing,” which, as she translates it, goes: “Pricked finger, test, analyze, see. Person before had coronavirus inside body? Doesn’t matter. Feels sick? Not feels sick? Doesn’t matter.”

Ms. Burton, who regularly appears with Los Angeles County officials, has recently joined an increasingly visible pantheon of essential workers: the people gesticulating on television and in internet live streams beside the governors and public health officers communicating the mighty struggle to stop the spread of the coronavirus.

As the pandemic has ground on, interpreters, hired to help satisfy a legal requirement to provide “functionally equivalent” communication for deaf and hearing-impaired consumers, have found themselves in the restless sights of a cooped-up American public, even as they are forced to ad-lib a whole new vocabulary of crisis.

Interpreters also have spurred disability rights groups who keep asking, in vain, why the White House’s televised briefings aren’t being interpreted live for deaf viewers.

A different type of coronavirus test is required to screen the U.S. population on the necessary scale, Dr. Deborah L. Birx, the White House coronavirus response coordinator, said on Sunday, adding that it would take “a huge technology breakthrough” to get there.

What’s needed, she said on NBC’s “Meet the Press,” is a screening test that detects antigens, like the screening tests used for flu, strep and other diseases. Antigens stimulate the body to produce antibodies, and are essentially evidence of an immune response.

“We have to be able to detect the antigen, rather than constantly trying to detect the actual live virus or the viral particles itself, and to really move into antigen testing,” she said. The current RNA tests, which are more precise but more laborious, would then be used to confirm diagnoses.

Dr. Birx also spoke about another category of tests, those for antibodies, which indicate past exposure rather than detect a current infection. She said she thought the World Health Organization was being “very cautious” in its recent report that found no evidence that people who had recovered from the virus and had antibodies were protected from a second infection.

Reliable antibody tests will be vital as states begin reopening their economies and allowing people to return to work and public spaces. A recent analysis of 14 antibody tests by a team of scientists found that only three delivered consistently reliable results, and even those had some flaws.

On CNN’s “State of the Union,” Dr. Birx did not disagree with the W.H.O.’s statement, but she said that the C.D.C. and the F.D.A. were gathering data that would help improve and refine antibody tests. “With all of that data together, I think, it’s going to create a very clear picture about antibodies,” she said.

Dr. Birx acknowledged that the nation was not using existing testing capacities to the fullest. She said the administration was working with states to identify all their testing sites and supply the needed swabs and chemical reagents.

How to care for your pets in quarantine.

They may not know what is going on, but they do notice that you’re home more often. So, here are some tips to keep them safe, healthy and beautiful — whether they are your old family members or new foster pets.

Here’s what’s happening around the world.

In New Zealand, retailers, restaurants, construction sites and schools will start to reopen on Tuesday. Follow updates on the pandemic from our team of international correspondents.

Reporting was contributed by Alan Blinder, Eileen Sullivan, Jessica Silver-Greenberg, David Enrich, Jesse Drucker, Stacy Cowley, Marc Santora, Roni Caryn Rabin, Pam Belluck, Shawn Hubler, Manny Fernandez, David Montgomery, David Gelles, Kate Kelly, Katie Rogers, Neil Vigdor and David Yaffe-Bellany.



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