A nurse, Lenny Menye, taking a sample at a mobile virus testing site in the Bronx on Thursday.
Credit…James Estrin/The New York Times

Governors and public health officials across the United States are pleading with Americans to change their behavior and prepare for a long winter as the country shatters record after record on coronavirus cases and hospitalizations.

Both records fell yet again Friday, as more than 181,100 new cases were reported nationwide. It was only eight days earlier that the U.S. reported its first 100,000-case day. Now the seven-day average of new daily cases is more than 140,000.

Sixteen states also set single-day case records on Friday, and 30 states added more cases in the last week than in any other seven-day period. On Saturday, officials in West Virginia announced 1,153 new cases, and, in Maryland, the number rose past 2,050, both single-day records.

Gov. Andrew M. Cuomo of New York tweeted: “One in every 378 Americans tested positive for COVID over the past week. Wear a mask.” Mr. Cuomo’s math is on target: In a population of 330 million, 894,819 people, or 1 in 378, tested positive since last Saturday.

In a reversal, Gov. Doug Burgum of North Dakota, which has critically understaffed hospitals and the highest rates of new cases and deaths per person in the nation, announced several measures late Friday, including a mask mandate, a limit on indoor dining of 50 percent capacity or 150 people and a suspension of high school winter sports and extracurricular activities until Dec. 14.

In the spring, North Dakota was one of a handful of states that never entered a lockdown. More recently, Mr. Burgum had for weeks resisted any new orders, emphasizing personal responsibility instead of requirements such as a mask mandate.

But North Dakota’s situation has rapidly deteriorated: Over the past week, it has averaged 1,334 cases per day, an increase of 54 percent from the average two weeks earlier, and deaths are climbing fast. Hospitals are so overwhelmed that on Monday, Mr. Burgum angered the state nurses’ union by announcing that medical workers who test positive could stay on the job to treat Covid-19 patients as long as the workers show no symptoms.

Writing in The Washington Post last week, Renae Moch, the public health director for Bismarck and Burleigh County, N.D., warned: “I can only hope our approach to this disease improves quickly — before our winter of hurt arrives and too many more North Dakotans pay the ultimate price.”

In New Mexico on Friday, Gov. Michelle Lujan Grisham announced the nation’s most sweeping statewide measure of the fall season, issuing a two-week “stay at home” order to begin Monday. She asked people to shelter in place except for essential trips and said nonessential businesses and nonprofits must cease in-person activities.

Gov. Kate Brown of Oregon issued orders Friday to place the state in a partial lockdown for two weeks, shuttering gyms, halting restaurant dining and mandating that social gatherings have no more than six people. Ms. Brown, along with the governors of California and Washington, also urged residents to avoid all nonessential interstate travel in the days ahead.

Nearly half of all states have measures in place for visitors, but the measures themselves vary from mandatory testing to quarantine requirements. On Thursday, California surpassed one million cases, becoming the second state, after Texas, to do so.

The latest wave of cases is washing over nearly every part of the United States, unlike the spring, when it was concentrated in the New York metropolitan area. Case numbers are trending upward in 49 states, and no states are seeing declines. More than 30 states, from Alaska to New Hampshire, have set records in recent days.

More than 1,380 new deaths were also reported on Friday, pushing the 7-day average to more than 1,090 new deaths a day. And hospitalizations for Covid-19 also set a national record on Friday for the fourth-straight day, reaching 68,516, according to the Covid Tracking Project — a figure that has more than doubled in just five weeks.

The outlook is especially dire in the Great Lakes region. Pennsylvania, Indiana and Minnesota all exceeded their previous single-day records on Thursday by more than 1,000 cases. Gov. Mike DeWine of Ohio warned that hospitalizations had soared to record levels. Wisconsin surpassed 300,000 known cases this week, an increase of more than 130,000 in just a month.

And in New York City, an early hot spot now facing a possible second wave, the mayor warned on Friday that public schools could close as early as Monday if the seven-day average positivity rate surpasses 3 percent. Private residential gatherings must be limited to 10 people beginning at 10 p.m.

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, appeared on “CBS This Morning” on Friday to repeat his pleas to Americans to take the virus seriously.

“If we do the things that are simple public health measures, that soaring will level and start to come down,” he said. “You add that to the help of a vaccine, we can turn this around. It is not futile.”

A patient in El Paso, Texas, was transported to Del Sol Medical Center on Friday.
Credit…Joel Angel Juarez for The New York Times

More than 1,000 Americans are dying of the coronavirus every day on average, a 50 percent increase in the last month. Iowa, Minnesota, New Mexico, Tennessee and Wisconsin have recorded more deaths over the last seven days than in any other week of the pandemic. Twice this past week, the country has suffered more than 1,400 deaths reported in a single day.

“It’s getting bad and it’s potentially going to get a lot worse,” said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. “The months ahead are looking quite horrifying.”

More than 244,000 people have died from the coronavirus in the United States, more than any other country, and experts say the pace of new deaths is likely to accelerate in the coming weeks.

In towns and cities in Wisconsin and New Mexico, medical examiners are stocking extra body bags, parking mobile morgue units — the size of trucks — outside their doors and ensuring that refrigerated morgue trucks are cooled and ready to be used if needed. And hospitals are filling with patients, threatening the limits of medical systems in some regions.

Deaths lag several weeks behind infections, so the toll being recorded now reflects transmission that happened several weeks ago, before the country began logging more than 140,000 new cases per day and hospitalizations reached their highest levels of the pandemic. On Friday, public health officials reported more than 181,000 new cases across the country, more than ever before.

The rising case numbers — and the threat of mounting deaths — have led some experts to call for a coordinated national shutdown for four to six weeks, but with no announcements from the White House for new measures to respond to the soaring outbreak, most of the country is open for business, even as a few governors began calling for new restrictions on Friday.

Tents are stationed outside Texas Tech University Health Sciences Center El Paso to help emergency departments handle the city’s surge in virus cases.
Credit…Joel Angel Juarez for The New York Times

Just two small hospitals serve mostly rural Elkhart County in northern Indiana, and earlier this week one of them instructed the local ambulance services not to bring any more patients.

With coronavirus cases hitting daily records, Elkhart General Hospital had run out of room.

The hospital’s capacity is 144 beds and more than 200 patients had been admitted, said Dr. Michelle Bache, the hospital’s vice president for medical affairs. On Tuesday, more than 90 were Covid-19 patients, and there were over 20 people with various medical issues in the emergency room needing beds.

“The patients were building up in the waiting room and causing an unsafe situation,” said Dr. Bache, adding that it was only the second time in her 22 years at the hospital that ambulances had been diverted.

Administrators went hunting for more rooms. They reopened 12 beds in a wing that had been shuttered for five or six years, stopped elective surgeries and moved nurses from other departments to staff the beds.

That, and releasing five coronavirus patients, who no longer needed hospitalization, allowed the hospital to start taking ambulances again. It did not really provide a sense of relief, however. Across Indiana, 2,548 Covid-19 patients are hospitalized and infections are rising, with a 39 percent increase in hospitalizations in the state over the past two weeks.

The need for yet more beds is inevitable. Elkhart County hit another record on Thursday with 411 infections out of a population of roughly 200,000, said Dr. Bache. “There still seems to be some people who think that Covid is not real, and the patients we have are not real, so that is frustrating,” she said. “These patients are sick enough to need oxygen.”

Hospital administrators calculated how many more patients they could admit if they put two in each room. They surveyed the hospital auditorium to assess how many beds would fit. They thought about a tent, but temperatures were already dipping below freezing.

The numbers are sapping the medical system of its elasticity. Typically, Memorial Hospital in South Bend, just 15 miles east, takes patients that Elkhart General cannot handle. But Memorial said it could not take any now. Hospitals in Indianapolis, three hours south, have some capacity, but transferring even a few patients dramatically lowers the availability of ambulances, Dr. Bache said.

Elkhart General is not alone in facing this dilemma.

In Mississippi on Thursday, Dr. Thomas Dobbs, the state health officer, said that the main hospitals in Jackson, the capital, had run out of available critical care beds and very few were available elsewhere.

One hospital could not find a transfer bed in Mississippi, so it looked in cities like Birmingham and Mobile in neighboring Alabama, but they were also full, Dr. Dobbs told a news briefing. The closest critical care bed they could find was in Pensacola, Fla., more than 200 miles away.

In Brooklyn, people waited in line to be tested for the coronavirus on Friday.
Credit…Anna Watts for The New York Times

New Yorkers stood for hours in long lines to be tested for the coronavirus on Friday, a disturbing indicator that shows the basic public health challenges that the country still faces many months after the pandemic first hit.

People waited for tests they needed for work or school. Some feared they might have gotten sick after flouting social distancing while celebrating after the election. Others hoped to safely visit family on Thanksgiving, which suggested that the problem might only worsen over the coming holidays. And some, dissuaded by the prospect of lingering on sidewalks for more than three hours in the rain, walked away untested.

“It’s so frustrating,” said City Councilman Mark Levine of Manhattan, who chairs the council’s Health Committee. “We keep hitting new problems in tests. We solve one and another pops up.”

The lines underscore how a second wave of the virus is threatening New York City, and come as the rest of the country confronts record numbers of new cases — more than 165,000 nationally on Friday. Several governors have warned that they are seriously considering further restrictions in a last-ditch effort to curb the outbreak.

New York City had a record number of tests on Thursday, more than 74,000, officials said. Across the country, nearly 1.5 million people a day are being tested, according to the Covid Tracking Project — nearly double the number in August and far more than during the first wave of the pandemic in the spring, when there was far less capacity.

Now, public health systems around the country are once again straining under the growing demand for testing. Some areas face looming shortages of laboratory capacity. In others, such as New York City, clinics and other testing sites have been swamped by huge numbers of people seeking to be tested.




Trump Touts Vaccine Progress and Promises Rapid Distribution

President Trump lauded progress being made on coronavirus vaccine candidates on Friday, and ignored surging virus rates across the country. At the same event, Vice President Mike Pence acknowledged the increase.

“Pfizer announced on Monday that its China virus vaccine is more than 90 percent effective. This far exceeds any and all expectations. Nobody thought they’d get to that level. Three other vaccines are also in the final stages of trial. They’ll arrive within a few weeks, and they will also be mass-produced, and the delivery will be very rapid. We’re ready to go. The vaccine will be distributed to front-line workers, the elderly and high-risk Americans immediately. It will be very — a matter of weeks. While healthy Americans have gone back to work and to school, we continue to spare no expense to protect the elderly and the vulnerable. According to some estimates, a national lockdown cost $50 billion a day and hundreds of thousands of jobs every single day. Ideally we won’t go to a lockdown. I will not go. This administration will not be going to a lockdown. Hopefully the — whatever happens in the future, who knows which administration will be. I guess time will tell. But I can tell you this administration will not go to a lockdown.” “As we see cases rising around the country, as we see hospitalizations rising around the country, I want to encourage the American people with the news. That as we have done from the very beginning, we’re going to continue to move heaven and earth to make sure that your family has access to the level of health care that we’d want any one of our members of our family to have.”

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President Trump lauded progress being made on coronavirus vaccine candidates on Friday, and ignored surging virus rates across the country. At the same event, Vice President Mike Pence acknowledged the increase.CreditCredit…Anna Moneymaker for The New York Times

President Trump made no mention Friday of the record surge of coronavirus cases and hospitalizations as he spoke in the White House Rose Garden, where he offered a rosy assessment of the development of vaccine candidates.

Officials said that two vaccine candidates are under review for emergency use authorizations, from Pfizer and from Moderna, and that 20 million people could be vaccinated in December. The president declared that the vaccine could be available to most Americans by April, a time frame that’s seen as aspirational as opposed to definitive.

The optimistic view of the vaccine development was at odds with a near-complete ignoring of how rapidly the virus is surging. Only Vice President Mike Pence mentioned that cases are increasing. More than 163,000 new cases were announced nationwide on Thursday, yet another record, with more than 30 states reporting seven-day case records. Deaths, too, have been rising, with more than 1,000 a day on average over the last week.

Mr. Trump, by contrast, repeated a falsehood he’s uttered several times, that the reason the case numbers are so much higher in the U.S. than elsewhere is because the nation conducts more tests — a statement that ignores the rise in hospitalizations and deaths.

Dr. Moncef Slaoui, the head of Operation Warp Speed, the administration’s program to develop treatments and vaccines, said, “I think we can say significant progress has been made.”

Warp Speed focused on three types of vaccines, with two in each category, for a portfolio of six vaccine candidates. One type is based on genetic material from the virus, called messenger RNA or mRNA. The two companies using that technology, Pfizer and Moderna, are the front-runners in the race to develop a vaccine.

Mr. Trump touted a new vaccine as something that would dramatically improve the lives of Americans still suffering under restrictions to slow the spread of the virus. Senior citizens who are susceptible to the virus will be able “to reclaim their golden years,” Mr. Trump said.

He also said that under his administration, there will not be lockdowns. He then came close to saying that he hoped the next administration — meaning one led by President-elect Joseph R. Biden Jr. — won’t force nationwide restrictions, before catching himself.

“I will not go — this administration will not be going to a lockdown,” Mr. Trump said. “Hopefully the — the uh — whatever happens in the future, who knows which administration it will be, I guess time will tell.”

Mr. Trump has yet to concede the election, despite every network and The Associated Press declaring Mr. Biden the winner.

Mr. Biden blasted the federal response as inadequate in a statement Friday.

“This crisis demands a robust and immediate federal response, which has been woefully lacking,” Mr. Biden said. “I am the president-elect, but I will not be president until next year. The crisis does not respect dates on the calendar, it is accelerating right now. Urgent action is needed today, now, by the current administration — starting with an acknowledgment of how serious the current situation is.”

Pfizer reported on Monday that its vaccine, developed with the German company BioNTech, was 90 percent effective, based on early data from a large study.

Moderna said on Wednesday that it was also poised to analyze early data. Hopes are high for strong results because the two vaccines are similar.

Referring to Moderna, Dr. Slaoui said, “I would expect that shortly, probably next week, we may hear what I hope to be another very good information regarding an efficacious vaccine.” He said he expected both companies to apply to the Food and Drug Administration within the next few weeks for authorization for emergency use of their vaccines.

Mr. Trump was furious that the Pfizer announcement came after the Nov. 3 election; he had hoped to be able to point to a successful vaccine before the election in order to boost his chances.

As is often the case, Mr. Trump used the event for score-settling.

He criticized officials with Pfizer for saying that they hadn’t been part of Operation Warp Speed. Pfizer did not accept research funding, but is part of an agreement to sell doses to the federal government as part of the program.

Mr. Trump also criticized New York Gov. Andrew M. Cuomo, who said he will have independent experts verify the efficacy of any vaccine the Trump administration authorizes before it’s distributed in his state. Mr. Trump said the vaccine won’t be delivered to his former home state until Mr. Cuomo approves of it.

“It pains me to say that,” Mr. Trump said. He did not mention that leaders of other states have expressed similar concerns about vaccine delivery, such as California, Oregon, Washington State and Nevada.

An adviser to Mr. Cuomo, Rich Azzopardi, said on Twitter that it was Mr. Trump’s own fault.

“.@realDonaldTrump has failed with his pandemic response, lied to Americans about how bad it was when he knew otherwise & was fired by voters for his incompetence,” Mr. Azzopardi wrote. “@NYGovCuomo is fighting to ensure the communities hit hardest by COVID get the vaccine. Feds providing 0 resources.”

Appearing on MSNBC a short time later, Mr. Cuomo said Mr. Trump has a “credibility issue,” adding the president “uses the government as a retaliatory tool.”

The logistics of inoculating and tracking as many as 25 million people by year’s end largely falls to local governments who will struggle for funds and personnel to carry out the task.
Credit…Chandan Khanna/Agence France-Presse — Getty Images

With the prospect that a coronavirus vaccine will become available for emergency use as soon as next month, states and cities are warning that distributing the shots to an anxious public could be hindered by inadequate technology, severe funding shortfalls and a lack of trained personnel.

While the Trump administration has showered billions of dollars on the companies developing the vaccines, it has left the logistics of inoculating and tracking as many as 25 million people by year’s end — and many tens of millions more next year — largely to local governments without providing enough money, officials in several localities and public health experts involved in the preparations said in interviews.

Public health departments, already strained by a pandemic that has overrun hospitals and drained budgets, are racing to expand online systems to track and share information about who has been vaccinated; to recruit and train hundreds of thousands of doctors, nurses and pharmacists to give people the shot and collect data about everyone who gets it; to find safe locations for mass vaccination events; and to convince the public of the importance of getting immunized.

The federal Centers for Disease Control and Prevention have sent $200 million to the states for the effort, with another $140 million promised in December, but state and local officials said that was billions of dollars short of what would be needed to carry out their complex plans.

“We absolutely do not have enough to pull this off successfully,” said Dr. Thomas E. Dobbs III, the state health officer of Mississippi. “This is going to be a phenomenal logistical feat, to vaccinate everybody in the country. We absolutely have zero margin for failure. We really have to get this right.”

Times Insider

Donald G. McNeil Jr. in Karachi, Pakistan, in 2013, reporting on efforts to stop polio. 
Credit…Diego Ibarra Sanchez for The New York Times

Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.

Last Sunday, the United States reported its 10 millionth case of the coronavirus, with the last million added in the preceding 10 days. Covid-19 hospitalizations hit a new high this week, and new daily cases passed 165,000 for the first time on Friday. Throughout the pandemic, the science and health reporter Donald G. McNeil Jr. has been at the forefront of The New York Times’s coverage and was recently awarded the 2020 John Chancellor Award for Excellence in Journalism by the Columbia Journalism School. In this edited interview, he talked about the new wave of infections.

There’s a lot of optimism around Pfizer’s announcement on Monday, which suggested its mRNA-based vaccine could be more than 90 percent effective. What should we make of this? Is it too soon to rejoice?

No, I’d say a little rejoicing is in order. The F.D.A. has said it would accept a vaccine that was only 50 percent effective, which is worse than some year’s flu shots, so everyone’s expectations were lowered. This is pretty great. Plus, we were already pretty sure that mRNA vaccines would be harmless. With this type of vaccine, you’re injecting just a short stretch of the virus’s genome packed into a tiny ball of fat with a mild electric charge. In contrast, some vaccines use a whole virus that is killed or weakened and is more likely to cause bad reactions.

Pfizer actually said its vaccine is at least 90 percent effective. We need to be cautious: That was its news release, rather than the actual data, which scientists will want to examine. But I’ve read previous news releases from Big Pharma companies and compared them to the data issued later, and they’ve been honest.

Some scientists are worried that the virus in animals, like the mink, could mutate and be more dangerous to humans. Does this have any effect on the outlook for a vaccine?

Probably no effect, at least for now. Pfizer said its vaccine works against all the strains circulating in humans. The worrying mutation in one mink strain is mostly in the minks. There’s no immediate worry that it will become a dominant strain in humans.

Lockdowns have renewed around much of the world and have faced some fierce backlash in places like Italy. What’s your view on the efficiency of lockdowns, and what’s the appropriate balance to strike for economic sustainability, mental and emotional well being, and health in terms of the virus?

We need to stop thinking of lockdowns as if they are an end in themselves. A really harsh lockdown — in which people are literally ordered to stay home — pauses transmission long enough for you to launch real tools: rapid accurate testing, rapid contact tracing, isolation of infected people away from their families, and so on. China did that. New Zealand did that. But we never had any of that here. Our “national lockdown” in the spring was a joke.

China refused to reopen cities until they had zero cases for 14 days. We never dropped below an average of 20,000 cases a day. We can’t do contact tracing because a) many Americans won’t cooperate and b) outside of lockdown, every case has about 50 contacts — 20,000 times 50 is one million new contacts to trace every day. Who can do that? It’s impossible. So we’re basically stuck with masks and not eating or meeting indoors until the vaccines arrive. If people don’t do that, their hospitals get overwhelmed. When that happens, a virus that kills less than 1 percent of its victims suddenly kills 2 or 3 or 4 or 5 percent because people can’t get ventilators, can’t get ambulances, can’t even get oxygen. “Flattening the curve” is all about slowing things down so your hospitals don’t collapse.

Some companies have offered perks, like free lunch, to get workers to return to the office. Other companies, including The New York Times, have extended home working until summer 2021. When would you personally feel comfortable returning to the office?

When I’m vaccinated and everyone around me is.

The holiday season is just around the corner. What advice do you have for families eager to celebrate with their loved ones?

Do it by Zoom. Don’t let Junior come home and kill Grandma. Think of this like World War II — our soldiers didn’t get to fly home to eat turkey. My father was at Normandy. My mother was with the Red Cross in occupied Austria. They missed the holidays. Life went on. There were happier years later.

Those We’ve Lost

Lynn Kellogg, here in a television appearance in 1970, had a leading role as an uptight debutante-turned-hippie in the original Broadway production of “Hair.”
Credit…Ivan Peixoto

Lynn Kellogg Simpers, a singer and actress who, as Lynn Kellogg, played Sheila, the uptight debutante who turns into a free-spirited hippie in the original 1968 Broadway production of “Hair,” died on Thursday in St. Louis. She was 77.

The cause was Covid-19, according to Timothy Philen, her publicist.

Her husband, John Simpers, said she had been infected at a recent gathering in a large theater in Branson, Mo. Most of the people there were not wearing masks, he said. Ms. Kellogg Simpers had a non-life-threatening form of leukemia that compromised her vascular system, he added. She died in a hospital.

“Hair,” the original counterculture musical created by James Rado and Gerome Ragni, ran for more than four years at the Biltmore Theater. It has always been an ensemble show, but Sheila is the closest thing it has to a female lead. Her big Act I ballad, “Easy to Be Hard” — “How can people be so heartless? … Especially people who care about strangers/Who care about evil and social injustice?” — comes in response to the casual rudeness of the character Berger (played by Mr. Ragni). Sheila is also one of the lead singers on the show’s finale, “Let the Sun Shine In.”

John Chapman, reviewing the show in The Daily News, did not care for the “tribal love-rock” music, but he liked the cast’s youthful energy. And he appreciated Sheila. “I did see at least one pretty girl, Lynn Kellogg,” he wrote, “and she sang a pretty song called ‘I Believe in Love.’”

The 1969 Tony Awards seemed to be biased in favor of mainstream Broadway productions, and therefore against “Hair,” but the cast’s performance of a medley of “Hair” numbers on the awards telecast impressed a lot of people, including the next celebrity to appear onstage, Zero Mostel.

An intensive care unit in Thessaloniki, Greece, on Wednesday. The country has added a daily average of 2,489 new cases over the past seven days.
Credit…Alexandros Avramidis/Reuters

The authorities in Greece announced on Saturday the closure of all schools as the country faces a spike in coronavirus infections and deaths.

Although Greece was relatively successful in containing the first phase of the pandemic, in the spring, the second wave has been more taxing. Greek health authorities announced 3,038 new infections on Friday, a large number of them in the north, where hospitals are under particular pressure, with deaths and intubations increasing sharply in recent days.

Greece has added a daily average of 2,489 new cases over the past seven days, pushing its total caseload since the start of the pandemic to 69,675. Deaths are rising rapidly, with an average of more than 40 a day over the last week.

High schools had already closed as part of the country’s second lockdown, which was introduced earlier this month, and they will continue to operate by remote learning. The new restrictions mean that kindergartens and primary schools will also close, until at least the end of the month.

Announcing the new measures, Greece’s education minister, Niki Kerameus, said that the authorities understood the “upheaval” being created for parents but that health experts had said the move was necessary. Last month, Ms. Kerameus announced via a tweet that she and her husband had tested positive for the virus and would enter isolation.

A nationwide public curfew is now also in effect from 9 p.m. until 5 a.m., with exceptions made for people who need to go out for work, to visit a doctor or to walk a pet.

The curfew was announced a few days after Greece’s second nationwide lockdown began, which closed most shops and reinstated a system enforced during the spring lockdown that required people to send a text message to the government citing their reason for leaving their house.

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