Mayor Bill de Blasio of New York City said that for the first time in several months, the city reported the daily rate of positive test results for the coronavirus had risen to more than 3 percent, a relatively low number compared with other parts of the country, but a significant uptick in New York, particularly as hundreds of thousands students return to school this week.
The increase was in part attributable to a rise in cases in nine area codes in South Brooklyn and Queens, in predominantly Orthodox Jewish communities.
In a news conference, Mayor Bill de Blasio announced a daily rate of 3.25 percent, the highest it had been since June. On Monday, the daily rate was 1.93 percent.
“That is cause for real concern,” he said.
If city officials didn’t see improvement in numbers by the end of the day, the city was weighing possible additional options, the mayor said, including business closures in certain areas, and a wide-scale closure of institutions like yeshivas and child care, and limits on gatherings.
Mr. de Blasio said that indoor dining would begin tomorrow, but he said officials would watch and see if the move resulted in a further uptick 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 said that clusters of cases identified by the state in Brooklyn, as well as Rockland and Orange counties in the Hudson Valley region, required action to “stamp out the embers right away.” He called on local governments to take stronger action to enforce social-distancing rules.
“You have a job,” he said. “Do it.”
He also warned that if local officials and communities did not take steps to halt the virus’s spread, the clusters could quickly turn into a wider outbreak. “A cluster today can be community spread tomorrow,” he said.
Mr. Cuomo said all the clusters 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.
The uptick in the city comes at a particularly crucial moment, as the city tries to fully reopen schools for in-person learning and introduce indoor dining this week. 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, the mayor said the seven-day average was about 1.38 percent.
As part of new enforcement measures, the city will move to fine anybody not wearing a mask, the mayor said. Also, nonpublic schools and child care centers will be forced to close if they do not adhere to safety measures.
Early last week, city health officials warned residents of several areas — including Gravesend, Borough Park and Midwood in Brooklyn — that strict lockdown measures would be enacted if they did not see a larger effort to follow coronavirus safety measures.
On Friday, the mayor ordered the Police Department and the Sheriff’s Office to enforce public health guidelines in these areas, where residents often do not wear masks. But Mr. de Blasio on Tuesday said that communities could expect enforcement — and in particular, fines — to escalate. “That will be starting on a large scale today,” he said.
Last week, the city health department threatened to ban gatherings of more than 10 people if improvement was not seen quickly. That restriction has not been implemented so far.
On Tuesday, about 300,000 children returned to public school classrooms for the first time since they were shuttered in March. Hundreds of thousands more children, including middle and high school students, are expected to report to schools by the end of this week.
Public health experts have said cases in schools are inevitable and not necessarily cause for alarm if they are detected quickly.
Mr. de Blasio has twice delayed the start of in-person classes over safety concerns and a staffing shortage. Just two confirmed cases in a single school could halt classes for up to two weeks so public health officials can identify the source of the outbreak.
On Sunday, the union representing the city’s principals said it had lost faith in Mr. de Blasio’s ability to reopen schools, and called on the state to take over the effort. Though the mayor has faced considerable political opposition to reopening, he has still succeeded in bringing more children back into classrooms so far than any other large district in the country.
Most of New York’s 1.1 million students began the school year remotely last week, while about 90,000 pre-K students and children with advanced disabilities reported to classrooms.
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.
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.
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.
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.”
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.
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.
In the 10 months since a mysterious pneumonia began striking residents of Wuhan, China, Covid-19 has killed more than one million people worldwide as of Monday — an agonizing toll compiled from official counts, yet one that far understates how many have really died.
The coronavirus may already have overtaken tuberculosis and hepatitis as the world’s deadliest infectious disease. And unlike all the other contenders, it is still growing fast.
Like nothing seen in more than a century, the virus has infiltrated every populated patch of the globe, sowing terror and poverty, infecting millions of people in some nations and paralyzing entire economies.
But as attention focuses on the devastation caused by halting a large part of the world’s commercial, educational and social life, it is all too easy to lose sight of the most direct human cost.
More than a million people — parents, children, siblings, friends, neighbors, colleagues, teachers, classmates — all gone, suddenly, prematurely. More than 200,000 in the United States, which has the largest total number of coronavirus deaths in the world, followed by Brazil, with over 140,000.
Dr. Michael Ryan, the head of the World Health Organization’s emergencies program, said on Monday that the actual numbers were probably higher.
“When you count anything, you never count it perfectly,” he said at a news conference in Geneva. “But I can assure you that the current numbers are likely an underestimate of the true toll of Covid.”
Those who survive Covid-19, the disease caused by the virus, are laid low for weeks or even months before recovering, and many have lingering ill effects of varying severity and duration.
Yet much of the suffering could have been avoided.
“This is a very serious global event, and a lot of people were going to get sick and many of them were going to die, but it did not need to be nearly this bad,” said Tom Inglesby, the director of the Johns Hopkins Center for Health Security.
At the height of the first wave, places like China, Germany, South Korea and New Zealand showed that it was possible to slow the pandemic enough to limit infections and deaths while still reopening businesses and schools.
But that requires a combination of elements that may be beyond the reach of poorer countries — and that even ones like the United States have not been able to muster: wide-scale testing, contact tracing, quarantining, social distancing, mask wearing, providing protective gear, developing a clear and consistent strategy, and being willing to shut things down in a hurry when trouble arises.
Time and again, experts say, governments reacted too slowly, waiting until their own countries or regions were under siege, either dismissing the threat or seeing it as China’s problem, or Italy’s, or New York’s.
Thomas R. Frieden, a former head of the U.S. Centers for Disease Control and Prevention, said that a major failing had been in governments’ communication with the public, nowhere more so than in the United States.
“You have standard principles of risk communication: Be first, be right, be credible, be empathetic,” he said. “If you tried to violate those principles more than the Trump administration has, I don’t think you could.”
The world now knows how to bend the curve of the pandemic — not to eliminate risk, but to keep it to a manageable level — and there have been surprises along the way.
Masks turned out to be more helpful than Western experts initially predicted. Social distancing on an unheard-of scale has been more feasible and effective than anticipated. The difference in danger between an outdoor gathering and an indoor one is greater than expected.
And, crucially, people are most contagious when they first show symptoms or even earlier, not days or weeks later, when they are sickest — a reversal of the usual pattern with infectious diseases. That makes preventive measures like wearing masks and swift responses like isolating and testing people for possible exposure much more important. If you wait until the problem is evident, you’ve waited too long.
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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. It means 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.
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The World Health Organization said Monday that 120 million rapid antigen tests for the coronavirus would be made available to low- and middle-income countries over the next six months. The diagnostic tests, produced by the American company Abbott Laboratories and SD Biosensor of South Korea, are priced at no more than $5 per unit and can provide results in 15 to 30 minutes, said Tedros Adhanom Ghebreyesus, the director general of the agency. The first orders for rapid antigen tests under the program, which is not yet fully funded, are expected to be placed this week.
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The pandemic will keep this year’s economic growth rate in East Asia and the Pacific region to 0.9 percent, the lowest since 1967, the World Bank said in an economic update on Monday. The bank forecast that China — where the virus is contained and spending is recovering, especially among the wealthy — would lead regional growth with a 2 percent expansion, but output in the rest of the region would shrink about 3.5 percent.
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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.
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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.
— Jennifer Jett and
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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