Covid-19 Live Updates: Federal Program to Supply Tests to Nursing Homes Led to Unexpected Costs, Challenges and ‘Testing Hell’


Credit…Julia Rendleman for The New York Times

After months of enduring a dearth of protective medical gear and staggering death tolls from the coronavirus pandemic, nursing home operators and employees across the United States experienced something close to elation as rapid-result test machines paid for by the federal government began arriving last month at 14,000 residential facilities that serve the elderly.

The hand-held testing devices, which spit out results in as little as 15 minutes, were intended to quickly diagnose and isolate patients, and alter the deadly calculus of a contagion that has taken the lives of 77,000 nursing home residents and workers, more than 40 percent of the nation’s fatalities from Covid-19.

But the initial sense of relief has been overtaken by frustration as nursing homes have discovered that they must pay for test kits on their own, and that the machines are markedly less accurate than lab-based diagnostics.

Because the devices come with a modest starter-set of test supplies that only last a few weeks, facilities, many of them buffeted by financial losses from the pandemic, must pay roughly $32 for each additional test. In communities with high rates of infection, a typical nursing home can churn through hundreds of tests a week.

Many nursing home operators also say they have been overwhelmed by new federal reporting rules, fines and financial incentives that are associated with the program. Facilities can be fined up to $10,000 for failing to meet daily reporting rules that sometimes conflict with those from state or local health agencies, raising questions about the free machines, which cost about $300.

“My initial happiness over the machines has quickly turned to disillusionment,” said Ben Unkle, the chief executive of Westminster-Canterbury on Chesapeake Bay, which operates a skilled nursing center in coastal Virginia. “At the moment we’re in testing hell.”

Shortages in testing supplies have forced Mr. Unkle to rely on an outside lab that charges $100 a test, an expense that he estimates will add $875,000 to the $1 million in pandemic-related losses that the nonprofit provider expects this year. Rather than the 15-minute turnaround, the lab results take up to four days to arrive, complicating efforts at infection control.

“As far as I’m concerned, this is an unfunded mandate that is not giving us the data we need fast enough to improve either care or protection,” Mr. Unkle said.

Credit…Juan Arredondo for The New York Times

New York City officials announced on Tuesday a significant uptick in the citywide daily rate of positive coronavirus tests, which was in part attributable to a rise in cases in nine ZIP codes in Brooklyn and Queens — some in predominantly Orthodox Jewish communities that have largely ignored public health guidance, like wearing masks.

In a news conference, Mr. de Blasio announced a daily rate of 3.25 percent, the highest it had been since June. It was a relatively low number compared with other parts of the country, but “cause for real concern,” the mayor said. On Monday, he reported that the daily rate was 1.93 percent; for weeks it had generally held between 1 and 2 percent on most days.

The uptick in the city comes at a particularly crucial moment, as the city tries to fully reopen public schools this week for in-person learning to hundreds of thousands of students and to resume indoor dining.

The mayor has said that he will automatically shut down classrooms — which are all slated to be open by Thursday — if the test positivity rate exceeds 3 percent over a seven-day rolling average. On Tuesday, Mr. de Blasio said the seven-day average was 1.38 percent and that he would not seek to change those guidelines to target specific areas that had seen an uptick. The city had not seen an increase in cases in schools in the nine ZIP codes in question.

According to the city’s health officials, if schools are forced to close, it could take weeks for them to reopen. The president of the city’s teachers’ union said that if the rates do not drop this week, the city should move to close as many as 80 public schools in ZIP codes where the virus is surging. Random student testing is set to begin Thursday, which could also drive down the rate.

“The goal is to be under 3 percent in a way that is consistent,” Mr. de Blasio said, cautioning that the city was not yet near that point. Public health experts have said cases in schools are inevitable and not necessarily cause for alarm if they are detected quickly.

Over the past two weeks, the cases in the nine ZIP codes account for 25.6 percent of the city’s cases, despite the fact that the population in those areas make up only 7.4 percent of the city’s population, according to information provided by the city’s Health Department.

As part of new enforcement measures in those areas, the city will move to fine anybody who refuses to wear a mask, said Mr. de Blasio, a Democrat. Members of the city’s test and trace program, the Sheriff’s Office and the New York Police Department, among others, will help with enforcement, he said.

If city officials didn’t see improvement in numbers by the end of the day, the city was weighing possible additional options, Mr. de Blasio said, including business closures in certain areas, and a wide-scale closure of institutions like yeshivas and child care, and limits on gatherings.

Community leaders have faulted the city for a lack of engagement with the Orthodox, and particularly Hasidic, communities, which have a longstanding distrust of secular authorities and a particular dislike for Mr. de Blasio. City officials said on Tuesday that they had made extensive outreach efforts recently in the affected communities, which included distributing masks to synagogues, speaking to area leaders and passing out literature about the dangers of the virus.

Indoor dining would begin on Wednesday, the mayor said, but added that officials would watch and see if the move resulted in a further increase in cases.

“If anything looks problematic, we’ll talk to the state and decide together if any adjustments need to be made,” he said.

Shortly afterward, Gov. Andrew M. Cuomo, a Democrat, said that city officials would have to get approval from the state in order to enact any major restrictions. He also said that clusters identified by the state in Brooklyn, as well as Rockland and Orange counties in the Hudson Valley region, required movement to “stamp out the embers right away.”

“A cluster problem is caused by a lack of compliance,” Mr. Cuomo said on Tuesday. “Why was there a lack of compliance? Because the local government failed to do its compliance job.”

He called on local governments to take stronger action to enforce social-distancing rules. But in response to a question about the status of indoor dining, he said “I don’t believe we’re at the point of rolling back anything.”

The governor did warn that without local officials and communities taking more steps, the clusters could quickly turn into a wider outbreak. “A cluster today can be community spread tomorrow,” he said.

Mr. Cuomo has previously said that reaching a 2 percent positivity rate would make him “nervous,” and that surpassing a 3 percent rate would cause “the alarm bells to go off.”

All the clusters, he said on Tuesday, had “an overlap with large Orthodox Jewish communities” and that he would meet with religious leaders to discuss better compliance to mask-wearing and public health guidelines.

Mr. Cuomo also said Tuesday that travelers from Colorado are now required to quarantine for 14 days upon arrival, joining a long list of other states and territories. Arizona and Virginia were removed in the weekly update.

Travelers to Connecticut and New Jersey are also now subject to a 14-day quarantine if they are coming from those same places, though compliance is voluntary in New Jersey and there is a testing alternative in Connecticut.

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The day after Florida surpassed 700,000 coronavirus cases, Dr. Anthony S. Fauci, the nation’s top infectious disease expert, called the recent move by the governor to lift state restrictions on bars and restaurants “very concerning.”

“Now’s the time, actually, to double down at bit,” Dr. Fauci said Monday on ABC’s “Good Morning America.” “And I don’t mean close. When I say that, people get concerned that we’re talking about shutting down. We’re not talking about shutting anything down. We’re talking about common-sense type of public health measures.”

He also expressed reservations about the lack of mask usage, saying Florida and other states were “asking for trouble” by allowing people to congregate without masks. Gov. Ron DeSantis of Florida, a Republican and Trump ally, refused on Friday to mandate mask usage in the state, insisting that such a decision should be left up to local governments.

At a news conference on Tuesday, Mayor Carlos Gimenez of Miami-Dade County discussed a weekly call he had earlier in the day with Dr. Fauci and Dr. Deborah L. Birx. Mr. Gimenez said that on the call, Dr. Birx, too, appeared to be “deeply concerned” with the governor’s decision.

He added that Dr. Birx noted that the virus positivity rate in Miami-Dade remains higher than it was in May. As of Tuesday, the average 14-day positivity rate in the county was 4.44 percent.

“She was heartened by the steps that we took, but she was somewhat concerned about the loosening of the rules,” he said.

In the last week, the state has been experiencing a relatively low number of new cases a day, on average — about one-fifth the seven-day average number of new cases a day it reported at its peak on July 17.

As of Monday, Florida was meeting 36 percent of a testing target developed by Harvard Global Health Institute researchers that measures the minimum amount of testing necessary to mitigate the disease. The state had a positivity rate of 11 percent for the total number of tests processed over the two-week period ending Monday, according to data analyzed by The New York Times. Positive rates should be at or below 5 percent for at least 14 days before a state or country can safely reopen, according to the World Health Organization.

On Friday, Mr. DeSantis removed state restrictions for restaurants and many other businesses. He has also pushed the state’s largest school district, in Miami-Dade County, to open classrooms to in-person learning, despite concerns from parents and teachers.

Over the weekend, Tallahassee police broke up a large party near Florida State University’s campus where about 700 cars were parked and blocking travel lanes, and more than 1,000 people gathered outside. The university has been trying to contain the spread of the virus on campus, where 1,448 students and 31 employees have tested positive since Aug. 2, including 51 people last week. Over a seven-day period ending Monday, Leon County, which includes Tallahassee, has reported 501 new cases, according to a Times database.

While other universities have suspended and expelled students for attending parties against campus policies, Mr. DeSantis last week called those measures “dramatically draconian” and called for creating a “bill of rights” for college students. The return of students to campus — and the parties that come with them — have been blamed for some of the recent outbreaks across the country.

On “Good Morning America,” Dr. Fauci was asked whether he agreed with W.H.O. projections that global deaths, which surpassed one million this week, might double before vaccines could bring the virus under control.

“I’ve got to be careful,” he replied, noting that such predictions, imprecise by nature, might inappropriately ring alarms. “But you’ve got to take it very seriously,” he said of a possible doubling in worldwide deaths. “The numbers globally are very serious.”


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  • After an auspicious beginning to the N.F.L. regular season played during a pandemic, the league got news of its first coronavirus outbreak after Week 3’s games. The Tennessee Titans suspended all in-person activities Tuesday after three players and five members of the team’s personnel tested positive, the first such outbreak to hit a team since training camps began in late July. The Minnesota Vikings, who hosted the Titans on Sunday, also shut down in-person activities. “Both clubs are working closely with the N.F.L. and the N.F.L.P.A., including our infectious disease experts, to evaluate close contacts, perform additional testing and monitor developments,” the league said in a joint statement with the players’ union. “All decisions will be made with health and safety as our primary consideration. We will continue to share updates as more information becomes available.”

  • After weeks of indecision and discussion, FIFA is planning to order soccer clubs to release players who have been called up for World Cup qualification games next week, a move that is very likely to lead to a furious backlash from teams, leagues and player unions fearful of the risks of international travel during the pandemic. The FIFA demand will come after weeks of unsuccessful talks to find a compromise that addresses concerns about committing players to intercontinental travel amid a global rise in cases, and will apply most notably to South American national teams eager to recall their overseas-based players for the first round of qualifying matches for the 2022 World Cup.

A new scientific report confirms that cats and dogs can be infected by the novel coronavirus, and that neither animal is likely to get sick. Cats, however, do develop a strong, protective immune response.

There is still no evidence to suggest that pets have passed the virus to humans, although cats do shed the virus and infect other cats.

Infected dogs in the study didn’t produce the virus in their upper respiratory tracts and didn’t shed it at all, although some other studies have found different results. Neither the cats nor the dogs in the study showed any illness.

Scientists say that while millions of humans have been infected with the virus worldwide and 1 million have died, there are only a handful of reports of pets that have become infected naturally.

So why haven’t cats infected humans if they shed the virus? It might be because the number of humans who have contracted the virus is so large, and they are the ones giving it to cats, said Angela M. Bosco-Lauth, one of the authors of the study. Another possible reason is that infection in everyday life is very different from infection in the lab, where scientists inserted pipettes in the nasal cavities of cats and dogs to give them the virus.

Or, Dr. Bosco-Lauth said, cat infection with the virus could be relatively common without humans noticing, because of a lack of symptoms.

Researchers advise keeping cats indoors, particularly if a human in a household has become infected, because they could spread it to other cats.

Credit…Sharon Chischilly for The New York Times

Long before the coronavirus, the Indian Health Service, the U.S. government program that provides health care to the 2.2 million members of tribal communities, was plagued by shortages of funding and supplies.

Now the pandemic has exposed those weaknesses as never before, contributing to the disproportionally high infection and death rates among Native Americans and fueling new anger about what critics say has been decades of neglect from Congress and successive administrations in Washington.

Hospitals waited months for protective equipment, some of which ended up being expired, and had far too few beds and ventilators to handle the flood of Covid-19 patients. The agency failed to tailor health guidance to the reality of life on poverty-wracked reservations.

The virus has killed more than 500 people in the Navajo Nation in the southwestern United States, giving it a death rate higher than New York, Florida and Texas. It has infected more than 10 percent of the small Choctaw tribe of Mississippi.

A New York Times analysis found that the coronavirus positivity rate for Indian Health Service patients in Navajo Nation and the Phoenix area was nearly 20 percent from the start of the pandemic through July, compared with 7 percent nationally during the same period. It is now down to about 14 percent in both areas, nearly three times higher than the current nationwide rate.

Credit…Elisabeth Ubbe for The New York Times

Almost alone in the Western world, Sweden refused to impose a coronavirus lockdown last spring, as the country’s leading health officials argued that limited restrictions were sufficient and would better protect against economic collapse.

It was an approach that transformed the country into an unlikely ideological lightning rod. Many scientists blamed it for a spike in deaths, even as many libertarians critical of lockdowns portrayed Sweden as a model.

For their part, the Swedes admit to making some mistakes, particularly in nursing homes, where the death toll was staggering. Now, though, the question is whether the country’s current low caseload — compared with sharp increases elsewhere — shows that it has found a sustainable balance, or whether the recent numbers are just a temporary aberration.

With a population of 10.1 million, Sweden averaged just over 200 new cases a day for several weeks, though in recent days that number has jumped to about 380, and critics say the country should test more. The per capita rate is far lower than nearby Denmark or the Netherlands (if higher than the negligible rates in Norway and Finland). Sweden is also doing far better, for the moment, than Spain, with 10,000 cases a day, and France, with 12,000.

In response to the recent outbreaks, many European countries are imposing new restrictions, but avoiding total lockdowns. In essence, some experts say, they are quietly adopting the Swedish approach.

“Today, all of the European countries are more or less following the Swedish model, combined with the testing, tracing and quarantine procedures the Germans have introduced, but none will admit it,” said Antoine Flahault, director of the Institute of Global Health, in Geneva. “Instead, they made a caricature out of the Swedish strategy. Almost everyone has called it inhumane and a failure.”

Credit…Robert Franklin/South Bend Tribune, via Associated Press

The president of the University of Notre Dame, the Rev. John I. Jenkins, has issued a public apology after coming under criticism for not wearing a mask or adhering to social distancing guidelines during the Supreme Court nomination ceremony over the weekend at the White House for Judge Amy Coney Barrett.

“I failed to lead by example,” Father Jenkins, who is also a philosopher trained in theology and a member of Notre Dame’s philosophy department, said in a letter on Monday to the Notre Dame community. “I especially regret my mistake in light of the sacrifices made on a daily basis by many, particularly our students, in adjusting their lives to observe our health protocols.”

The move by Father Jenkins points to the challenges some public figures face as they promote virus-mitigation efforts. He has repeatedly urged students and staff to hew to social-distancing guidelines but was seen in videos and photographs shaking hands with others and not wearing a mask at the Rose Garden event on Saturday for Judge Barrett, who is a professor at Notre Dame.

In his written apology, Father Jenkins said he was given a rapid coronavirus test upon arriving at the White House. He said he and others were told after receiving negative results that it would be safe to remove their masks. Still, he said following that guidance was a mistake.

In August, Notre Dame became one of the first major universities to resume in-person classes, but had to shift to virtual learning for two weeks this month in response to a spike in coronavirus cases. While Notre Dame has switched again to in-person classes, Father Jenkins said he had decided to quarantine “in an abundance of caution” after returning to the campus from the White House.

In other news around the United States:

  • In the six months since Covid-19 brought the United States to a standstill, the opioid epidemic has taken a sharp turn for the worse. Last year, after aggressive efforts to expand access to treatment, Vermont saw its first decrease in opioid-related deaths since 2014; that year, the governor devoted his entire State of the State Message to what he called “a full-blown heroin crisis” gripping Vermont. But the state saw 82 opioid overdoses through July of this year, up from 60 during the same period last year.

  • In New York City, a principal prepared for the first day of school at Brooklyn’s Public School 9, where Sandra Santos-Vizcaino — the first New York City public-school teacher to die of the coronavirus — was once a beloved third-grade teacher. Nearly half of families across the city have opted their children out of in-person classes altogether through at least the end of November, a statistic that reflects both the pervasive fear felt by many city parents and skepticism of the city’s reopening plan.

  • After months of keeping tens of thousands of theme park workers on furlough with full health-care benefits in hopes that a light at the end of the pandemic tunnel would appear, Disney announced it would eliminate 28,000 theme park jobs in the United States, or about 25 percent of its domestic resort work force. The job cuts will come from Disney’s theme parks in California and Florida.

Katina Brenn, the school superintendent in Colby, Kan., knows what is supposed to be done when students are exposed to the virus: Quarantine them at home for 14 days.

But what if it’s a quarter of the school?

Colby is a small town in western Kansas, with fewer than 300 students in its close-knit high school. When a girl on the volleyball team tested positive recently, the whole team was sent home to quarantine. Then a football player was exposed, raising concerns about the rest of the squad. Soon, the school was facing having to quarantine as many as 75 students.

The town pushed back. “The parents were upset,” Ms. Brenn said. “They want their kids to get an education.”

She said she heard from parents who were worried that the way things were going, their children would have to be quarantined again and again when someone they knew was potentially exposed — and in Colby, everybody knows everybody.

The pandemic, once mainly an urban problem, has surged across the Great Plains and Upper Midwest in recent weeks, reaching previously unscathed small towns and rural areas. North Dakota, South Dakota and Wisconsin now lead the nation in new cases per capita, and the figures for states like Kansas are as bad as they have ever been.

No one has yet died of Covid-19 in Thomas County, which includes Colby, but there have been 163 coronavirus cases so far among the population of 7,700, and one-third of those cases are new and considered currently active. And the hub of the community is Colby High.

Ms. Brenn said having the schools open for in-person learning was vital, so parents could go to work and keep the town running.

At a recent county meeting, officials agreed to roll back restrictions and allow students who were not directly exposed to a known case and who had no symptoms to return to school.

“Parents really want their children to be at school,” Ms. Brenn said, adding that the school system had taken precautions like hula hoops laid out on gym floors to enforce spacing between students during physical education classes. “We’re really trying to keep our kids safe,” she said. “We think that their schools are their safe place.”

Credit…Federico Parra/Agence France-Presse — Getty Images

An independent association of health workers in Venezuela reported this week that at least 200 doctors, nurses and health care technicians across the country have died after contracting the coronavirus.

The count by Médicos Unidos Venezuela involves a rare effort to provide greater visibility into how the virus is evolving in Venezuela. Officially, Venezuela’s government says the virus has killed only 12 health workers.

In what critics contend is also a gross undercount, Venezuela officially had 73,528 cases and only 614 deaths as of Monday, far lower than any other large country in Latin America either on a per capita or absolute basis. Neighboring Colombia has reported 818,203 cases and 25,641 deaths.

Public health experts say the Venezuelan government’s repressive measures in response to the pandemic are hampering efforts to accurately assess its impact. Security forces have detained at least 12 doctors and nurses in Venezuela for speaking publicly about the virus, according to medical unions.

Venezuela’s health ministry did not immediately respond to a request for comment.

Dr. Jaime Lorenzo, the director of Médicos Unidos, said the exodus of thousands of health workers from Venezuela in recent years had also constrained efforts to mitigate the spread of the virus in the country.

“The personnel we have left are getting sick as they deal with fatigue and a lack of protective equipment,” Dr. Lorenzo said.

Health care workers have been hit hard by the virus around the world. In a survey of countries in the Western Hemisphere, including the United States, the Pan American Health Organization found that the virus had killed more than 2,500 health workers, the group said this month.

Global roundup

Credit…Sebastian Scheiner/Associated Press

Israel’s second national lockdown is likely to last at least a month and perhaps much longer, Prime Minister Benjamin Netanyahu said on Tuesday, as the country’s soaring infection rate of around 8,000 confirmed new cases a day remained among the highest in the world.

“In my opinion, it won’t be less than a month, and it could take much more time,” Mr. Netanyahu said during a Facebook Live video session.

The lockdown came into effect in mid-September, on the eve of the Jewish New Year holiday, and was tightened on Friday after Mr. Netanyahu warned that without immediate measures, Israel would “reach the edge of the abyss.” Israelis must remain within 1,000 meters of their homes unless they are going to authorized places of work or seeking essential supplies or services, and outdoor gatherings are limited to 20 people.

But synagogues were allowed to hold indoor prayers for limited numbers of worshipers during Yom Kippur, the holiest day in the Jewish calendar, which fell on Sunday night and Monday, and large gatherings of ultra-Orthodox worshipers were captured on video in several locations.

The number of seriously ill virus patients has surpassed 800, a number that government and health officials had long cited as the maximum that Israel’s hospitals could cope with in their current capacity.

Israel reported 234 virus deaths over the last week, which works out to 2.6 per 100,000 people, exceeding the per capita death rate for that period in the United States.

In other developments around the world:

  • The authorities in Germany announced a number of new rules to try to halt rising cases while keeping the economy, schools and day care centers open. Group gatherings will be capped at 50 in bars and rented spaces, with a recommendation that private parties be capped at 25. Bars, restaurants, hairdressers and others will be fined a minimum of about $58 if patrons don’t leave required contact data.

  • Ontario, the most populous province in Canada, on Monday reported 700 new infections, its highest one-day total. Premier Doug Ford said the province was beginning a second wave that would be worse than the first, but he resisted calls by experts for more stringent health measures. In the neighboring province of Quebec, which has also experienced a surge in infections, Premier François Legault said on Monday that Montreal, Quebec City and the administrative region of Chaudière-Appalaches would be designated as “red zones” for four weeks starting on Thursday. Home visits will be mostly banned and movie theaters, libraries, museums, bars and casinos will be closed. Restaurants will be limited to takeout service, but schools will remain open.

  • Kenya on Monday extended its nationwide curfew for two months, though it will start two hours later, at 11 p.m. In an address to the nation, President Uhuru Kenyatta also said bars and nightclubs could reopen starting Tuesday. There will be no change to schools, which have been closed since March.

  • The drug company Regeneron announced on Tuesday that a Covid-19 treatment in an ongoing study hastened recovery time and reduced the amount of virus in the nasal cavities of a small number of volunteers. Its drug is a combination of two monoclonal antibodies, powerful proteins that can attach to and destroy the virus. The new results are from 275 volunteers who were treated after being diagnosed with Covid-19, half of whom received one infusion of the drug while the rest got a placebo. Volunteers who were not making their own antibodies at the start of the trial benefited the most, Regeneron reported; their symptoms resolved in an average of 6 to 8 days, compared with 13 days in those who received a placebo. Dr. George Yancopoulos, the company’s president and chief scientific officer, said in a news release that Regeneron had “begun discussing our findings with regulatory authorities.”

  • Twelve crew members on a cruise ship intercepted by the authorities in Greece tested negative for the virus on Tuesday, after initially testing positive. The ship, carrying more than 1,500 people and bound for the Greek island of Corfu, was docked in Piraeus, Greece’s main port.

Credit…Anna Moneymaker for The New York Times

Negotiators resumed talks on Monday over a coronavirus relief package in a final bid to revive stalled negotiations as House Democrats unveiled a $2.2 trillion coronavirus relief bill that would provide aid to American families, businesses, schools, restaurants and airline workers.

The release of the legislation came minutes before Speaker Nancy Pelosi of California and Steven Mnuchin, the Treasury secretary, spoke on the phone Monday evening, as the pair seeks to end the impasse over another round of aid. Ms. Pelosi and Mr. Mnuchin spoke for about 50 minutes Tuesday morning, said Drew Hammill, a spokesman for Ms. Pelosi, and discussed the new legislation House Democrats had introduced. The pair agreed to speak again on Wednesday.

The moves appeared to be the most concrete action toward another stimulus bill since negotiations stalled nearly two months ago. But the sides remain far apart on an overall price tag, and with just over a month before Election Day, lawmakers and aides in both chambers warned that the time frame for striking a deal was slim.

Absent an agreement with the administration, the House could vote this week to approve the legislation, responding to growing pressure for Congress to provide additional relief and quelling the concerns of moderate lawmakers unwilling to leave Washington for a final stretch of campaigning without voting on another round of aid. But at roughly $1 trillion more than what Mr. Mnuchin has signaled the White House is willing to consider, the package is likely just a starting point, all but guaranteed to be rejected by the Republican majority in the Senate should the House pass it in its current form.

Democrats maintained a provision that would revive a lapsed $600 enhanced federal unemployment benefit and another one that would send a second round of $1,200 stimulus checks to Americans. And some measures were either added or expanded: $225 billion for schools and $57 billion for child care, an extension of an expiring program intended to prevent the layoffs of airline workers through March 31 and the creation of a $120 billion program to bolster ailing restaurants.

Credit…Jonah Markowitz for The New York Times

In the past two weeks, leading epidemiologists from many respected institutions have, through different methods, reached the same conclusion: About 85 to 90 percent of the American population is still susceptible to SARS-CoV-2, the virus causing the current pandemic.

The number is important because it means that “herd immunity” — the point at which a disease stops spreading because nearly everyone in a population has contracted it — is still very far off.

The evidence — both from antibody testing and from epidemiological modeling — runs strongly counter to a theory being promoted in influential circles that the United States has either already achieved herd immunity or is close to doing so, and that the pandemic is all but over. That conclusion would imply that businesses, schools and restaurants could safely reopen, and that masks and other distancing measures could be abandoned.

“The idea that herd immunity will happen at 10 or 20 percent is just nonsense,” said Dr. Christopher J.L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, which produced the epidemic model frequently cited during White House news briefings as the epidemic hit hard in the spring.

That belief began circulating months ago on conservative news programs like those of Rush Limbaugh and Laura Ingraham. It has been cited several times by Dr. Scott W. Atlas, President Trump’s new pandemic adviser. It appears to be behind Mr. Trump’s recent remarks that the pandemic is “rounding the corner” and “would go away even without the vaccine.”

But it is also gaining credence on Wall Street and among some business executives, said prominent public health experts, who consider the idea scientifically unfounded as well as dangerous; its most vocal adherents are calling for mask-wearing and social distancing to end just as cold weather is shifting social activity indoors, where the risk of transmission is higher.

Even in places where the pandemic hit especially hard — a French aircraft carrier, the Brazilian city of Manaus, the slums of Mumbai and a neighborhood in Queens, N.Y. — infections did not noticeably slow down until almost 60 percent of the inhabitants were infected. And even those levels may not suffice, given that cases are increasing again in Brazil and in Brooklyn, areas that had seen cases spike and then drop off.

A leading humanitarian relief organization issued a sharply critical report Tuesday on what it described as fundamental shortcomings in the global response to the pandemic, punctuated by “absence of global leadership, insufficient funding, and lack of coordination between countries.”

The report by the International Rescue Committee, a group formed during World War II that responds to the most urgent humanitarian crises, said it had calculated that an unprecedented $8 trillion had been committed by governments to domestic economic stimulus packages to counter the pandemic’s effects — but only $48 billion for areas of the world least capable of combating the scourge. The group said the lack of a coordinated approach to the pandemic had led to “dire consequences for millions of the most vulnerable people around the world.”

Within the first few months of lockdown measures this year, the group said, 15 million more known cases of gender-based violence were reported. An additional 70 to 100 million people could be pushed into extreme poverty, it said, and 10 of the world’s most fragile countries could face famine this year or in the first quarter of 2021.

“The international community has both a moral obligation and strategic imperative to support the most vulnerable,” said David Miliband, the president and chief executive of the International Rescue Committee.

Its report, coming as global virus deaths surpassed 1 million, was issued on the final day of the United Nations General Assembly session, held virtually this year because of the pandemic. The 193-member organization’s inability to manage the crisis, which Secretary General António Guterres has called the biggest challenge in U.N. history, has been a recurring theme.

Mr. Guterres’s frustration was evident in his opening remarks on Tuesday to one of the last online sessions of the General Assembly.

“Unless we take action now, we face a global recession that could wipe out decades of development,” Mr. Guterres said.

As obesity continues to climb in the United States, its role in Covid-19 is a thorny scientific question. Recent studies have shown that people with extra weight are more susceptible than others to severe bouts of disease. And experiments in animals and human cells have demonstrated how excess fat can disrupt the immune system.

But the relationship between obesity and Covid-19 is complex, and many mysteries remain. Excess weight tends to go hand in hand with other medical conditions, like high blood pressure and diabetes, which may by themselves make it harder to fight Covid-19.

Obesity also disproportionately affects people who identify as Black or Latino — groups at much higher risk than others of contracting and dying from Covid-19, in large part because of exposure at their workplaces, limited access to medical care and other inequities tied to systemic racism. And people with extra weight must grapple with persistent stigma about their appearance and health, even from doctors, further imperiling their prognoses.

“A new pandemic is now laying itself on top of an ongoing epidemic,” said Dr. Christy Richardson, an endocrinologist at SSM Health in Missouri. Regarding obesity’s effects on infectious disease, she said, “We are still learning, but it’s not difficult to understand how the body can become overwhelmed.”

Like many other conditions that can exacerbate Covid-19, excess weight does not have a quick fix, especially in areas where access to healthy food and opportunities for exercise are vastly uneven among communities.

“If we don’t address these social underpinnings, I think we’ll continue to see a recurrence of what is happening now,” said Dr. Jennifer Woo Baidal, a pediatric weight management specialist at Columbia University.

Credit…Pete Kiehart for The New York Times

While families across the United States this summer were on edge about the coming school year, top White House officials were pressuring the Centers for Disease Control and Prevention to play down the risk of sending children back to school, according to documents and interviews with current and former government officials.

The effort included an attempt to find alternate data showing that the coronavirus pandemic was weakening and posed little danger to children — a strikingly political intervention in one of the most sensitive public health debates of the pandemic.

A member of Vice President Mike Pence’s staff said she was repeatedly asked by Marc Short, the vice president’s chief of staff, to get the C.D.C. to produce more reports and charts showing a decline in coronavirus cases among young people.

Mr. Short dispatched junior members of the vice president’s staff to circumvent the C.D.C. in search of data he thought may better support the White House’s position, said Olivia Troye, the aide, who has since resigned.

In another instance, Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, pushed the C.D.C. to incorporate a document from a mental health agency inside the Department of Health and Human Services that warned school closures would have a long-term effect on the mental health of children and that asymptomatic children were unlikely to spread the virus.

Scientists at the C.D.C. pointed out numerous errors in the document and raised concerns that it appeared to minimize the risk of the coronavirus to school-age children, according to an edited version of the document obtained by The New York Times.

The gist of the mental health agency’s position — stressing the potential risks of children not attending school — became the introductory text of the final C.D.C. policy, leaving some officials there dismayed.

Credit…Adrees Latif/Reuters

A wariness of spam calls and phishing scams has stymied coronavirus contact-tracing efforts around the country to the extent that elected leaders are pleading with their constituents to pick up their phones.

“Hello? Yes, it’s you we’re looking for,” Mayor Muriel Bowser of Washington, D.C., told residents. “Contact tracing is a critical tool in getting our city back on its feet. Answer the call.”

Gov. Mike DeWine of Ohio urged those in his state to “answer the call!”

Both of their pleas, sent in tweets, told residents that contact tracers would not ask them about information like Social Security numbers or bank accounts. But most people don’t wait long enough to hear the voice on the other end.

They have good reason to be wary: Americans received 58.5 billion automated calls, often referred to as robocalls, in 2019, according to YouMail, which provides software that blocks such calls.

The nation’s capital received the most robocalls per person last year, according to YouMail: The average person in Washington was barraged with 599 calls in 2019.

Carolyn Cannuscio, an associate professor of family medicine at the University of Pennsylvania, said that while contact tracing could still be effective without a 100 percent response rate, “the process depends upon active engagement of the public.”

Volunteers at the university have been tracing contacts since April, Dr. Cannuscio said, in conjunction with the Philadelphia Health Department. Calls from the team show as “Penn Medicine,” she said, and around 75 percent of people called answer.

“That’s far better than what many municipalities are reporting,” she said.

Credit…Ramon Van Flymen/EPA, via Shutterstock

The Netherlands tightened its coronavirus restrictions on Monday while warning that its most severe wave of cases yet was likely to get worse.

People in the country’s three largest cities — Amsterdam, Rotterdam and The Hague — are now advised to wear masks in stores, a step the government had not yet recommended. Bars and restaurants will be closed at 10 p.m., with no new customers allowed after 9 p.m.

No more than four people will be allowed in a group indoors, with a total capacity of 30 people, and just three visitors can be hosted inside a home. A limit of 40 people was set for outside gatherings, with exceptions for events like funerals and religious gatherings.

The new restrictions are effective as of Tuesday night and will be in place for at least three weeks.

The Netherlands, with a population of 17.4 million, never instituted a full lockdown, instead targeting more high-risk businesses for shutdowns. Its daily cases had topped out at 1,335 on April 10 before falling into double-digits in June and July.

But figures began rising in late July, and September has seen a dramatic, steady increase. Officials recorded nearly 3,000 cases on Sunday and Monday, and warned that the figure was expected to reach 5,000 in the coming weeks.

“We’re doing our best, but the virus is doing better,” Hugo de Jonge, the country’s health minister, said at a news conference on Monday.


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